General Surgery Flashcards
0
Q
When is surgery done for pts with reflux?
A
- Maybe indicated in pts w/ long-standing disease not responding to medical mgmt
- Necessary in anyone who has developed complications: ulceration, stenosis ( laparoscopic Nissen fundoplication)
- Imperative in if there are severe dysplastic changes (resection)
1
Q
Indicated tests in pt with chronic Gastric reflux/Barret’s esophagus:
A
Endoscopy + biopsies
2
Q
Diagnosis of esophageal motility problems?
A
- Barium swallow–> no structural problem? –> Manometry
3
Q
Treatment for achalasia?
A
Balloon dilation, surgical myotomy, botox
4
Q
which esophageal cancer is more common in blacks, smokers, and drinkers?
A
Squamous cell carcinoma
5
Q
Which esophagel caner is seen in people with long Hx of reflux?
A
Adenocarcinoma
6
Q
Workup for dysphagia?
A
Barium swallow, manometry, endoscopy with biopsies, and CT (only to assess operability)
7
Q
Treatment of mallory weiss tears
A
Many times resolves on its own….otherwise –> Photocoagulation (laser) via endoscopy
8
Q
What is Boerhaave syndrome and what are its manifestations?
A
Esophageal perforation caused by increased pressures from prolonged, forceful vomiting.
- Severe, continuous sudden onset epigastric/low sternal pain –> fever soon after –> incr WBC –> very sick looking pt.
9
Q
Diagnosis of Boerhaave syndrome?
A
Contrast swallow (gastrogafin 1st --> then barium if negative) -Emergency repair should follow diagnosis
10
Q
What is the most common cause of esophageal perforation?
A
Instrumentation (endoscopy)
-May have emphysema in the lower neck
11
Q
Presentation and treatment for Gastric adenocarcinoma:
A
Presentation:
-elderly, anorexia, weight loss, early satiety, vague epigastric tenderness, occassionally hematemesis. Dx with endoscopy w/ biopsies
Treatment:
- Surgery
12
Q
Therapy for Gastric lymphoma?
A
- Chemo + radiation
surgery only done if perforation is feared as tumor melts away
13
Q
Which GI tumor can be reversed by eradication of H-Pylori?
A
MALTOMA (low-grade lymphomatoid transformation
14
Q
Presentation of Small bowel obstruction
A
- colicky abd pain,
- protracted vomiting,
- progressive abd distention
- no passage of gas or feces
- Early on –> high pitched bowel sounds coinciding with pain…..Later –> absent sounds
15
Q
Small bowel obstruction management
A
Starts with:
-NPO, NG suction, IV fluids –> hope for resolution while watching for early signs of strangulation
Conservative mgmt failed?:
-Surgery within 24 hrs if complete obstruction, few days if partial obstruction
16
Q
Which cases of SBO ALWAYS require surgery?
A
Hernia-related SBO
17
Q
What are signs of strangulation in pt with a SBO?
A
- fever
- incr WBC
- constant pain
- signs of peritoneal irritation
- ultimately –> full-blown peritonitis and sepsis
18
Q
Incarcerated hernia
A
Hernia that can’t be reduced –> can cause strangulation requiring surgery. On exam will be non-reducible hernia that used to be reducible
19
Q
Manifestations of Carcinoid syndrome (episodic)
A
- diarrhea
- Flushing of the face
- Wheezing
- R sided heart valve damage (look for JVD)
- *May have small bowel carcinoid tumor with mets to the liver
20
Q
How do you diagnose Carcinoid syndrome?
A
24 hr urinary 5-HIAA (5hydroxyindole aceti cacid)
-one time level not helpful bc levels fluctuate along with “attacks/episodes”
21
Q
What is the classic picture of acute appendicitis? (progression)
A
Anorexia –> vague periumbilical pain –> several hrs later –> Sharp, severe, constant, localized pain in RLQ with rebound and guarding
-Modest fever and WBCs in 10-15 range
22
Q
Cancer of the right colon presentation:
A
Iron def. anemia in elderly patient for no apparent reason.
-Stools will be +4 for occult blood
23
Q
Treatment for R colon cancer
A
Hemicolectomy
24
Presentation of L colon cancer:
Bloody stools (coats the outside), constipation, change in stool shape (narrow)
25
Dx of L colon cancer?
Flexible proctosigmoidoscopy and biopsies.
26
Large rectal cancers, therapy = ?
Pre-op chemo + radiation
27
Colonic polyps in descending order of malignant potential = ?
- Familial adenomatous polyposis
- Familial multiple inflammatory polyps
- villous adenoma
- adenomatous polyp
28
Non pre-malignant polyps include ________
- Juvenile
- Peutz-jeghers
- isolated inflammatory
- hyperplastic
29
When is surgery indicated in ulcerative colitis?
- disease present for > 20 years (high malignant potential)
- Severe interference with nutrition
- multiple hospitalizations
- need for high dose steroids or immunosuppressants
- Toxic megacolon
30
What organism causes psudomembranous colitis?
C-diff
| - most commonly caused by cephalosporins, but any Antibiotic can potentially cause it.
31
Treatment of C-diff colitis?
- Metronidazole
| - Oral Vancomycin is an alternative
32
When would emergency colectomy be indicated in a pt w/ c-diff ?
- unresponsive to tx
- WBC > 50k
- Lactte > 5
33
Hemorrhoids bleed when they are _______, and hurt when they are ______.
- internal
- external
*internals can cause itching and pain if they become prolapsed.
34
Diagnosis in a woman (more commonly) with severe pain with defacation, blood streaks in stool, who avoids going #2 as much as possible?
Anal fissure
35
Therapy for anal fissure:
- stool softeners
- topical nitroglycerin
- Ca channel blocker ointments TID (80-90% success rate)
- botox injections
- dilation
- failed --> lateral sphincterotomy
36
What sould you suspect in a patient with a fissure, fistula, or small ulceration.....in which surgical interventions WORSEN the problem?
Crohn's disease
-Area typically heals excellently bc of good vascular supply
*fistula should be drained with stetons while medical therapy is underway. Remicade helps healing*
37
What is the presentation and management of an Ischio-rectal abcess?
Presentation:
- febrile, exquisite perirectal pain, can't sit down or have bowel movements due to intense pain, Abcess lateral to anus between anus and ischial tuberosity.
Management:
- Incision and drainage
- rule out cancer
- watch very closely in diabetic bc may turn into necrotizing infection (fournier's gangrene)
38
What is a potential complication of draining a ischiorectal abcess?
Fistula-in-ano
- epithelial migration of anal crypts
- forms opening lateral to the anus
- rule out necrosis or tumor
39
What is the most common cancer of the anus? more common in HIV+ and homosexuals with receptive practices.
Squamous cell carcinoma
40
What is the clinical picture seen with SCC of the anus? How is it diagnosed?
Fungating mass grows out of the anus. Metastatic inguinal lymph nodes might be felt
41
What is the treatment for SCC of the anus?
- starts with Nigro chemoradiation (5FU + mitomycin) protocol
- Surgery only if there is residual tumor (rarely required)
42
3/4 of GI bleeding is from ______
Upper GI tract (tip of nose to ligament of treitz)
43
What are possible bleeding sources in the colon?
- Diverticulosis
- polyps
- angiodysplasia
- cancer
*All are more common in older people, so GI bleeding in a young person is usually upper GI source
44
Vomiting blood and/or melena...what test to do?
endoscopy (but obviously look for sources in mouth and nose first)
45
in a patient with Bright red blood per rectum, where can it be coming from?
Anywhere. lower GI or upper gi that passed too quickly to be digested
46
What is the first step in diagnosis in a patient with active bleeding per rectum?
NG tube
- blood = upper GI source established
- no blood and no bile = nose to pylorus cleared, possibly still duodenal source
- no blood and bile = upper GI cleared --> no need for endoscopy
47
Workup for active GI bleeding after upper GI source has been ruled out is:
- first rule out hemorrhoids with anoscopy
- if bleeding >1 unit every 4 hrs (2 mL/min) --> angiogram with possible embolization
- bleeding less than 0.5 mL/min --> wait till it stops, then colonoscopy
- Cases in between = tagged RBC study
48
What is the workup for a Patient with recent history of bleeding per rectum, without currently active bleeding?
```
young = upper endoscopy
old = both upper and lower endoscopy in same session
```
49
What is the usual cause of BRBPR in a child?
Meckel diverticulum
- ectopic gastric mucosa
- workup with *Technetium scan*
50
What is the best therapeutic option for massive GI bleed from stress ulcer?
Angiographic embolization
51
What is the presentation of acute abdomen caused by perforation?
sudden onset, constant, generalized, severe. Patient is reluctant to move, and very protective of their abdomen (guarding), rebound.
52
What is the most common cause of Acute abdominal pain from perforation?
perforated peptic ulcer
53
What confirms the diagnosis of perforation on imaging?
Free air under diaphragm
54
What is the presentation in acute abd pain caused by obstruction?
Sudden onset colicky pain with radiation. Patient consatntly moves, trying to fnd comfortable position. Few physical findings.
55
Presentation of acute abd pain caused by inflammatory process?
-Gradual onset and slow buildup (hours at least). constant, starts as ill-defined, eventually locates to area of the problem. Often has radiation patterns.
- Physical findings of peritoneal irritation
- Fever and incr WBC (except for in pancreatitis)
56
What is the only process that presents with severe abdominal pain and blood in the lumen of the gut?
Ischemic process
57
What is the difference between primary peritonitis and other causes of acute abdomen (as far as organisms causing it).
- Primary peritonitis will have ascitic cultures with a single organism.
- treat with antibiotics
- Other causes - multiorganism
58
What is the treatment for a generalized acute abdomen?
exploratory laparotomy
| -does not need specific diagnosis for exploration
59
What is the ranson criteria used for? what are it's components?
-Used for assessing severity of pancreatitis, both initially and at 48 hrs after presentation
Components: intial...*GLAAW*
- Glucose > 200
- LDH > 350
- Age > 55
- AST > 250
- WBC > 16k
48 hrs assessment: C HOBBS
- Ca 10%
- O2 4
- Sequestration of fluids >6L
60
What do you suspect in someone with flank pain radiating to scrotum/labia? how would you diagnose it?
Ureteral stones
| -CT
61
What is the diagnostic test for suspected diverticulitis?
CT abdomen
62
Treatment for diverticulitis
- NPO, IV fluids, Antibiotics
| - surgery if does not respond or if multiple recurrences
63
Presentation for volvulus of the sigmoid?
- signs of obstruction
| - severe abdominal distension
64
Radiographic findings in volvulus of sigmoid?
Xrays are diagnostic:
- air-fluid levels in small bowel
- very distended colon
- huge air-filled loop in the RUQ that tapers down toward the LLQ in "parrots's beak" shape
65
Management of volvulus of the sigmoid?
- Proctosigmoidoscopic exam
- rectal tube left in
- Recurrent cases need elective sigmoid resection
66
What do you suspect in an elderly patient who develops an acute abdomen in the setting of A-fib or recent MI?
Mesenteric ischemia
- Clot occludes SMA
- blood in bowel lumen
67
What is the blood marker for hepatocellular carcinoma?
AFP
| -do CT scan for location and extent of tumor
68
Management of liver mets
- If primary tumor is slow growing and mets are confined to one lobe --> resection can be done
- Other means of control include radioablation
69
What do you suspect in a woman on OCPs who develops massive hepatic hemorrhage?
Hepatic adenoma
- Diagnose with CT--> emergency surgery required
- Tendency to rupture and bleed profusely
70
Name a complication of biliary tract disease (particularly acute ascending cholangitis)., in which patients develop fever, leukocytosis, and a tender liver.
Pyogenic liver abcess
71
What is the diagnostic tool for pyogenic liver abcess and what is the treatment?
- Sonogram or CT
| - Percutaneous drainage is required
72
Epidemiology for Amebic liver abcess:
Men, immigrants (especially Central America and mexico)
73
What is the treatment for amebic liver abcess?
Metronidazole
| -seldomly requires drainage
74
How do you diagnose Amebic liver abcess?
Serology (the ameba does not grow in the pus)
| -can take weeks, so empiric traetment is started. If it gets better --> continue, if not --> drainage
75
What are the 3 broad types/causes of jaundice?
- Hemolytic
- Obstructive
- Hepatocellular
76
What do lab values look like in hemolytic jaundice?
- Relatively low Bili (6 or 8ish, not 30's or 40's like other causes)
- High Indirect bili, normal direct
- No bile in the urine
77
What do labs look like in hepatocellular jaundice?
- Elevated direct and indirect bili
- very High transaminases
- modest elevation in AlkPhos
*most common = hepatitis
78
What are lab findings in obstructive jaundice?
- Incr in both direct and indirect bili
- modest incr in transaminases
- Very high AlkPhos**
79
What is the 1st step in workup for Obstructive jaundice?
sonogram
| -next step would be ERCP if obstruction of CBD seen on sonogram
80
What are 3 possible causes of obstructive jaundice caused by a tumor?
- Adenocarcinoma of the head of the Pancreas
- Adenocarcinoma of the ampulla of vater
- Cholangiocarcinoma arising from CBD itself
81
What is the best test to diagnose pancreatic cancer?
CT scan
-Follow it with a percutaneous biopsy
If CT is negative ---> ERCP
82
Best step to diagnose Ampullary cancers:
ERCP
| -Bc theyre in the duct, they can cause obstruction at a very small size, so usually not seen on CT
83
What malignancy might you suspect in pt with obstructive jaundice combined with anemia and +blood in stools?
Ampullary cancer
| -Endoscopy first (the "E" in ERCP)
84
________ occurs when a gallstone temporarily occludes the cystic duct.
Biliary colic
85
symptoms of biliary colic
- Colicky RUQ pain, radiating to the R shoulder and belt-like radiation to back.
- often post-prandial with fatty foods, nausea/vomiting
- Without signs of peritoneal irritation or systemic inflammation
86
Acute Cholecystitis occurs when a gallstone obstructs the _______
cystic duct
87
What is the presentation of acute cholecystitis?
Constant pain (no longer post-prandial), modest fever, incr WBC, peritoneal irritation in RUQ, minimally affected LFTs.
88
How is acute cholecystitis diagnosed?
Ultrasound
| - gallstones, thick gallbladder wall, pericholecystic fluid
89
Management in acute cholecystitis:
NG tube, NPO, IV fluids, antibiotics ----> "cool it down" before following with cholecystectomy
-not responsive or bad surgical candidate --> percutaneous transhepatic cholecystostomy (PTC tube)
90
If a stone partially occludes the CBD, they are at risk for developing ______
Acute ascending cholangitis
91
Describe the presentation of acute ascending cholangitis
Very sick patient*
- temp 104-105
- chills
- very high WBC
- hyperbilirubinemia
- VERY high Alkphos
- potentially shock if delayed treatment
92
How is acute ascending cholangitis treated?
- IV antibiotics
- emergency decompression of CBD via ERCP
- PTC is also an option
- Surgery rarely
- Cholecystectomy must follow**
93
Name 2 late complications of acute pancreatitis:
- Chronic pancreatitis
| - Pancreatic pseudocyst
94
For acute pancreatitis, test for _____ amylase/lipase early on, and ______ amylase/lipase is presenting after a coupleof days.
- Serum
| - Urine
95
In acute edematous pancreatitis, hematocrit may (Increase/Decrease?)
-Increase
| Edema, hemoconcentration of blood
96
What do you suspect in a pt with: Epigastric pain radiating to the back, high lipase/amylase, low hematocrit, high BUN
-Hemorrhagic pancreatitis
| risk of developing multiple pancreatic abcesses
97
What is the management for hemorrhagic pancreatitis?
- daily CT scans, IV imipenem, supportive therapy in ICU
| - *Necrosectomy* after about 4 weeks
98
About 5 weeks after acute pancreatitis, a _______ my develop, showing a large mass and pancreatic juice outside the ducts (most commonly the lesser sac)
Pancreatic pseudocyst
| -Diagnose with CT
99
What is the treatment for a pseudocyst 6 cm or smaller?
Observe
| -also for cysts that have been present for less than 6 weeks
100
Treatment for pancreatic psudocysts >6 cm or >6 weeks old?
-drainage
| percutaneously to outside, surgically into GI tract, endoscopically into stomach
101
What are some clinical findings/presentation in chronic pancreatitis?
steatorrhea, diabetes, constant epigastric pain
* supplement enzymes, insulin, pain control (although not very efective)
- if certain areas are blocked, ERCP might help
102
What is seen on imaging in chronic pancreatitis?
Pancreatic calcifications
103
ALL abdominal hernias should be electively repaired to avoid risk of obstructionstrangulation.........exceptions include ________
- umbilical hernias in pts younger than 2-5
| - esophageal sliding hiatal hernias (not "true" hernias)
104
When do irreducible hernias need emergency surgery vs when can they just be elective surgery?
- Reducible hernia that becomes irreducible --> Emergency surgery
- Irreducible for years --> elective repair
105
At what age should mammography be started?
40
| -earlier if there is family hx
106
what is the most convenient, effective and inexpensive way to obtain breast biopsies?
Ultrasound-guided or mammogram-guided
| *Even when not palpable on exam
107
What breast mass is a firm, rubbery mass that moves easily with palpation?
Fibroadenoma
108
What is the diagnosis and management for fibroadenoma of the breast?
- Fine needle aspiration or ultrasound
| - Removal is optional, or observation
109
__________ are seen in very young adolescents, and have very rapid growth. They are removed in order to avoid deformity and distortion of the breast.
Giant juvenille fibroedenoma
110
This mass is seen in women in their late 20's....they grow over many years and become very large, replacing and distorting the entire breast (yet not invading or becoming fixed)
Cystosarcoma phyllodes
| -most are benign, but have some malignant potential
111
Management for suspected cystosarcoma phyllodes:
Core or incisional biopsy and mandatory removal
112
___________ is seen in middle aged women, with b/l breast tenderness related to menstrual cycle (worse in last 2 weeks), with multiple lumps that come and go
Mammary dysplasia
| -aka "fibrocystic change" or "cystic mastitis"
113
Workup of fibrocystic change/mammary dysplasia
- No dominant mass --> mammogram is sufficient
- Dominant mass --> Aspiration --> clear and mass goes away = that's it.
* if bloody fluid --> sent for cytology
* if mass persists after aspiration, or comes back --> formal biopsy required
114
_______ is seen in women in their 20s - 40s, and presents with bloody nipple discharge.
intraductal papilloma
115
How is intraductal papilloma diagnosed and managed?
diagnosis: galactogram
mgmt: surgical resection
116
Breast abcess is seen only in ________ women. it is managed with ________
- Lactating
| - Incision and drainage with biopsy of abcess wall
117
What are some strong clinical indicators of breast cancer?
-ill-defined fixed mass, orange peel skin, retraction of the nipple, lesions of areola, redness, palpable axillary nodes
118
in breast cancer during pregnancy, treat the same way...except no ______ during the 1st trimester, and no ________ at all.
- Chemo
| - Radiotherapy
119
What is the treatment for resectable breast cancer?
- starts with lumpectomy plus axillary lymph node sampling + post-op radiation
* only when tumor is small, large breast, away from nipple
- OR....Modified radical mastectomy with axillary sampling
120
_______ carcinoma of the breast has higher incidence of bilaterality
Lobular
121
Management of Ductal carcinoma in situ
- Total simple mastectomy for multicentric lesions, with axillary node disection
- Lumpectomy and radiation if the lesion(s) is confined to one quarter of the breast
122
Inoperability of breast cancer is based on ________
local extent (NOT mets*)
123
What should follow surgery for virtually all pts with breast cancer?
Adjuvant systemic therapy
-Chemo in most cases, hormonal therapy if receptor positive
* premenopausal women = tamoxifen
* postmenopausal = anastrazole
124
What si the most common specific location for spinal breast cancer mets?
- vertebral pedicles
125
What are you concerned for in a woman with Hx of breast cancer who has persistent headache or back pain?
Metastasis
| -Diagnose with MRI
126
What is the diagnostic method of choice for someone with thyroid nodule(s) who is euthyroid?
-FNA
127
If FNA from a thyroid nodule is read as benign, manage by _________
Following. do not intervene
128
If FNA from a thyroid nodule is read as malignant or indeterminate, manage with _________
Thyroid lobectomy with frozen section for histologic diagnosis
129
If follicular cancer of the thyroid is diagnosed, management is ______
Total thyroidectomy
| -For future mets --> radioactive iodine
130
True or false.....Thyroid nodules in hyperthyroid patients are almost Never cancer?
TRUE!!
131
most hyperthyroid patients are treated with _____
radioactive iodine
| -pts with "hot adenoma" may get surgical excision of the affected lobe
132
Pnemonic for hypercalcemia?
Stones (nephrolithiasis), bones, abdominal groans
133
What is the workup for incidental finding of hypercalcemia?
- repeat labs
- Phosphorus labs (look for low phosphorus)
- rule out cancer with bone mets
- PTH if findings persist
134
What is the curative treatment for 90% of hyperparathyroidism?
Surgical Removal
| -90% of people have a single adenoma
135
What is the physical appearance of someone with Cushing's?
-round hairy face, buffalo hump, supraclavicular fat pads, obese,abdominal striae, thin weak extremities
136
What are common comorbid diseases in patients with cushing's?
- Osteoporosis
- Diabetes
- HTN
- mental instability---???
137
What is the first step in the workup of cushing's?
-Overnight low dose dexamethasone suppression test
138
In a dexamethasone supression test, suppression at a low dose tells you what?
-Rules out cushings
139
In low dose dexamethasone suppression test, if there is no suppression....what's the next step?
-24 hour urine cortisol --> elevated? --> high dose suppression test
140
Dexamethosone suppression test: if suppressed at high dose, this identifies _______
pituitary microadenoma
| - do imaging --> remove
141
No suppression at low OR high dose with dexamethasone suppression test identifies ________
- Adrenal adenoma or paraneoplastic syndrome
| - do imaging --> remove
142
What is the best imaging study for pituitary adenoma vs adrenal adenoma?
- MRI for pituitary
| - CT for adrenal
143
GI ulcers resistant to all usual therapy (including H.Pylori eradication), multiple ulcers, and/or ulcers beyond duodenum are probably ________
-Zollinger ellison syndrome (gastrinoma)
144
Some patients with a gastrinoma also have this GI symptom....
Watery diarrhea
145
Workup for Zollinger-Ellison syndrome?
- Gastrin level
- Secretin test
- CT scan (w/ contrast) of pancreas and nearby areas to locate tumor
- Removal of tumor
- Omeprazole helps pts with metastatic disease
146
What endocrine tumor produces CNS symptoms? and why?
- Insulinoma
- due to low blood sugar affecting CNS function
*always occurs when fasting
147
How do you differentiate between someone with insulinoma vs someone with self-administration of insulin?
- C-peptide
- in factitious, insulin will be high but C-peptide will be low
- insulinoma = both are high
*exception: if pt uses sulfonylurea to induce endogenous insulin secretion, c-peptide diagnostic value defeated
148
_________ is a devastating hypersecretion of insulin in the newborn, requiring 95% pancreatectomy
Nesidioblastosis
149
What skin manifestation is seen with glucagonama?
-migratory necrolytic dermatitis
150
What are some manifestations of glucagonoma?
- mild diabetes
- mild anemia
- glossitis
- stomatitis
151
How do you diagnose/workup and treat glucagonoma?
- glucagon assay
- CT scan used to locate tumor
- resection is curative
152
What 2 agents can help in pts with metastatic, inoperable glucagonoma?
- Somatostatin
| - Streptozocin
153
Primary hyperaldosteronism can be caused by _____ or ______
- Adenoma
| - Hyperplasia
154
What are the primary findings in a pt with primary hyperaldosteronism?
- Hypokalemia*
- Hypertension*
-others = modest hypernatremia and metabolic alkalosis
155
In primary hyperaldosteronism, Aldo levels are ______, and Renin levels are _______
- High
| - Low
156
In patient w/primary hyperaldosteronism, appropriate response to postural changes (more aldo when upright than when lying down) indicate ___________
hyperplasia
| -no response or inappropriate response = adenoma
157
How is primary hyperaldosteronism treated?
- surgical removal --> (is this both for adenoma or hyperplasia??)
- Localize with CT
158
What disease is frequently seen in thin, hyperactive women who have attacks of pounding headache, sweating, palpitations, and pallor?
- Pheochromocytoma
| * attacks coincide with extremely high blood pressure
159
How do you start workup for pheochromocytoma?
- 24 hr urinary Vanillylmandelic acid (VMA), metanephrines (more specific), or free urinary catecholamines
- CT scan to localize tumor
- radionucleotide studies if looking for extraadrenal sites
160
Surgery for a pheochromocytoma requires careful pharmacologic preparation with ________
Alpha-blockers
161
What are some findings seen in coarctation of the aorta?
- HTN in the arms with normal or low pressure in lower extremities
- CXR: scalloping of the ribs
162
What is the best method of diagnosis for coarctation of the aorta, and how is it treated?
- CT angio
| - surgical correction
163
Renovascular hypertension is seen in which 2 distinct epidemiologic groups?
- Young (usually women) with fibromuscular dysplasia
- Old (usually men) with atherosclerotic disease
*usually resistant to HTN tx regimens
164
What is the workup for renovascular HTN?
Multifactorial:
- Duplex of renal vessels
- CT angio
165
What is the therapy for renovascular HTN?
Young women:
-therapy is imperitive --> balloon dilation and stenting
Older pts:
-controversial....life expectancy from other atherosclerotic disease? good surgical candidate? etc
166
5Ps associated with pheochromocytoma
Paroxysms, pressure (high BP), pain (headaches from HTN), palpitations, perspiration
167
Scan to figure out which lobe of parathyroid is over active in hyperPTH?
Sestamibi scan
168
Treatment for pheochromocytoma
Alpha blockade first followed by beta blockade and then resection of tumor (don't resect first because you can release catecholamines into blood and kill pt...also beta blockade before alpha can leave unopposed alpha and cause vasoconstriction and stroke)
169
Why does rib scalloping occur in coarctation of aorta?
Intercostal Collateral vessels take blood from upper aorta to lower aorta and as a result they distend and erode into the ribs giving you scalloped appearance on imaging
170
What is pentalogy of Cantrell?
D COPS...diaphragmatic hernia, cardiac abnormalities, omaphalocele, pericardium malformation, sternal cleft
171
Managing complicated diverticulitis
-complicated if: abscess formation, perforation, fistula formation
Abscess: < 3 cm: iv antibiotics and watch
> 3 cm: ct guided percutaneous drainage, no improvement in 5 days surgical debridement
-perforation w/ peritonitis or fistula or recurrent attacks: sigmoid resection
172
Post op fever defined as
> 100.4
173
Most common cause of post op fever within first few hours after surgery?
- prior infection
- trauma
- surgical inflammation
- malignant hyperthermia (T>104, muscle rigidity, rhabdo, metabolic acidosis, hemodynamics instability)
- acute febrile non-hemolytic drug rxn- 2/2 to cytokines released in blood products from retained leukocytes
