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Pestana's > General Surgery > Flashcards

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)
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1
Q

Indicated tests in pt with chronic Gastric reflux/Barret’s esophagus:

A

Endoscopy + biopsies

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2
Q

Diagnosis of esophageal motility problems?

A
  • Barium swallow–> no structural problem? –> Manometry
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3
Q

Treatment for achalasia?

A

Balloon dilation, surgical myotomy, botox

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4
Q

which esophageal cancer is more common in blacks, smokers, and drinkers?

A

Squamous cell carcinoma

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5
Q

Which esophagel caner is seen in people with long Hx of reflux?

A

Adenocarcinoma

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6
Q

Workup for dysphagia?

A

Barium swallow, manometry, endoscopy with biopsies, and CT (only to assess operability)

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7
Q

Treatment of mallory weiss tears

A

Many times resolves on its own….otherwise –> Photocoagulation (laser) via endoscopy

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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.

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9
Q

Diagnosis of Boerhaave syndrome?

A 
Contrast swallow (gastrogafin 1st --> then barium if negative)
-Emergency repair should follow diagnosis
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10
Q

What is the most common cause of esophageal perforation?

A

Instrumentation (endoscopy)

-May have emphysema in the lower neck

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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

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12
Q

Therapy for Gastric lymphoma?

A
  • Chemo + radiation

surgery only done if perforation is feared as tumor melts away

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13
Q

Which GI tumor can be reversed by eradication of H-Pylori?

A

MALTOMA (low-grade lymphomatoid transformation

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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
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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

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16
Q

Which cases of SBO ALWAYS require surgery?

A

Hernia-related SBO

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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
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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

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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
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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”

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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

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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

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23
Q

Treatment for R colon cancer

A

Hemicolectomy

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24
Q

Presentation of L colon cancer:

A

Bloody stools (coats the outside), constipation, change in stool shape (narrow)

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25
Q

Dx of L colon cancer?

A

Flexible proctosigmoidoscopy and biopsies.

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26
Q

Large rectal cancers, therapy = ?

A

Pre-op chemo + radiation

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27
Q

Colonic polyps in descending order of malignant potential = ?

A
  • Familial adenomatous polyposis
  • Familial multiple inflammatory polyps
  • villous adenoma
  • adenomatous polyp
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28
Q

Non pre-malignant polyps include ________

A
  • Juvenile
  • Peutz-jeghers
  • isolated inflammatory
  • hyperplastic
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29
Q

When is surgery indicated in ulcerative colitis?

A
  • disease present for > 20 years (high malignant potential)
  • Severe interference with nutrition
  • multiple hospitalizations
  • need for high dose steroids or immunosuppressants
  • Toxic megacolon
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30
Q

What organism causes psudomembranous colitis?

A

C-diff

- most commonly caused by cephalosporins, but any Antibiotic can potentially cause it.

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31
Q

Treatment of C-diff colitis?

A
  • Metronidazole

- Oral Vancomycin is an alternative

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32
Q

When would emergency colectomy be indicated in a pt w/ c-diff ?

A
  • unresponsive to tx
  • WBC > 50k
  • Lactte > 5
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33
Q

Hemorrhoids bleed when they are _______, and hurt when they are ______.

A
  • internal
  • external

*internals can cause itching and pain if they become prolapsed.

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34
Q

Diagnosis in a woman (more commonly) with severe pain with defacation, blood streaks in stool, who avoids going #2 as much as possible?

A

Anal fissure

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35
Q

Therapy for anal fissure:

A
  • stool softeners
  • topical nitroglycerin
  • Ca channel blocker ointments TID (80-90% success rate)
  • botox injections
  • dilation
  • failed –> lateral sphincterotomy
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36
Q

What sould you suspect in a patient with a fissure, fistula, or small ulceration…..in which surgical interventions WORSEN the problem?

A

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

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37
Q

What is the presentation and management of an Ischio-rectal abcess?

A

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)
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38
Q

What is a potential complication of draining a ischiorectal abcess?

A

Fistula-in-ano

  • epithelial migration of anal crypts
  • forms opening lateral to the anus
  • rule out necrosis or tumor
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39
Q

What is the most common cancer of the anus? more common in HIV+ and homosexuals with receptive practices.

A

Squamous cell carcinoma

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40
Q

What is the clinical picture seen with SCC of the anus? How is it diagnosed?

A

Fungating mass grows out of the anus. Metastatic inguinal lymph nodes might be felt

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41
Q

What is the treatment for SCC of the anus?

A
  • starts with Nigro chemoradiation (5FU + mitomycin) protocol
  • Surgery only if there is residual tumor (rarely required)
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42
Q

3/4 of GI bleeding is from ______

A

Upper GI tract (tip of nose to ligament of treitz)

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43
Q

What are possible bleeding sources in the colon?

A
  • Diverticulosis
  • polyps
  • angiodysplasia
  • cancer

*All are more common in older people, so GI bleeding in a young person is usually upper GI source

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44
Q

Vomiting blood and/or melena…what test to do?

A

endoscopy (but obviously look for sources in mouth and nose first)

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45
Q

in a patient with Bright red blood per rectum, where can it be coming from?

A

Anywhere. lower GI or upper gi that passed too quickly to be digested

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46
Q

What is the first step in diagnosis in a patient with active bleeding per rectum?

A

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
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47
Q

Workup for active GI bleeding after upper GI source has been ruled out is:

A
  • 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
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48
Q

What is the workup for a Patient with recent history of bleeding per rectum, without currently active bleeding?

A 
young = upper endoscopy
old = both upper and lower endoscopy in same session
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49
Q

What is the usual cause of BRBPR in a child?

A

Meckel diverticulum

  • ectopic gastric mucosa
  • workup with Technetium scan
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50
Q

What is the best therapeutic option for massive GI bleed from stress ulcer?

A

Angiographic embolization

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51
Q

What is the presentation of acute abdomen caused by perforation?

A

sudden onset, constant, generalized, severe. Patient is reluctant to move, and very protective of their abdomen (guarding), rebound.

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52
Q

What is the most common cause of Acute abdominal pain from perforation?

A

perforated peptic ulcer

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53
Q

What confirms the diagnosis of perforation on imaging?

A

Free air under diaphragm

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54
Q

What is the presentation in acute abd pain caused by obstruction?

A

Sudden onset colicky pain with radiation. Patient consatntly moves, trying to fnd comfortable position. Few physical findings.

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55
Q

Presentation of acute abd pain caused by inflammatory process?

A

-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)
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56
Q

What is the only process that presents with severe abdominal pain and blood in the lumen of the gut?

A

Ischemic process

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57
Q

What is the difference between primary peritonitis and other causes of acute abdomen (as far as organisms causing it).

A
  • Primary peritonitis will have ascitic cultures with a single organism.
    - treat with antibiotics
  • Other causes - multiorganism
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58
Q

What is the treatment for a generalized acute abdomen?

A

exploratory laparotomy

-does not need specific diagnosis for exploration

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59
Q

What is the ranson criteria used for? what are it’s components?

A

-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
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60
Q

What do you suspect in someone with flank pain radiating to scrotum/labia? how would you diagnose it?

A

Ureteral stones

-CT

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61
Q

What is the diagnostic test for suspected diverticulitis?

A

CT abdomen

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62
Q

Treatment for diverticulitis

A
  • NPO, IV fluids, Antibiotics

- surgery if does not respond or if multiple recurrences

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63
Q

Presentation for volvulus of the sigmoid?

A
  • signs of obstruction

- severe abdominal distension

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64
Q

Radiographic findings in volvulus of sigmoid?

A

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
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65
Q

Management of volvulus of the sigmoid?

A
  • Proctosigmoidoscopic exam
  • rectal tube left in
  • Recurrent cases need elective sigmoid resection
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66
Q

What do you suspect in an elderly patient who develops an acute abdomen in the setting of A-fib or recent MI?

A

Mesenteric ischemia

  • Clot occludes SMA
  • blood in bowel lumen
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67
Q

What is the blood marker for hepatocellular carcinoma?

A

AFP

-do CT scan for location and extent of tumor

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68
Q

Management of liver mets

A
  • If primary tumor is slow growing and mets are confined to one lobe –> resection can be done
  • Other means of control include radioablation
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69
Q

What do you suspect in a woman on OCPs who develops massive hepatic hemorrhage?

A

Hepatic adenoma

  • Diagnose with CT–> emergency surgery required
  • Tendency to rupture and bleed profusely
70
Q

Name a complication of biliary tract disease (particularly acute ascending cholangitis)., in which patients develop fever, leukocytosis, and a tender liver.

A

Pyogenic liver abcess

71
Q

What is the diagnostic tool for pyogenic liver abcess and what is the treatment?

A
  • Sonogram or CT

- Percutaneous drainage is required

72
Q

Epidemiology for Amebic liver abcess:

A

Men, immigrants (especially Central America and mexico)

73
Q

What is the treatment for amebic liver abcess?

A

Metronidazole

-seldomly requires drainage

74
Q

How do you diagnose Amebic liver abcess?

A

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
Q

What are the 3 broad types/causes of jaundice?

A
  • Hemolytic
  • Obstructive
  • Hepatocellular
76
Q

What do lab values look like in hemolytic jaundice?

A
  • 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
Q

What do labs look like in hepatocellular jaundice?

A
  • Elevated direct and indirect bili
  • very High transaminases
  • modest elevation in AlkPhos

*most common = hepatitis

78
Q

What are lab findings in obstructive jaundice?

A
  • Incr in both direct and indirect bili
  • modest incr in transaminases
  • Very high AlkPhos**
79
Q

What is the 1st step in workup for Obstructive jaundice?

A

sonogram

-next step would be ERCP if obstruction of CBD seen on sonogram

80
Q

What are 3 possible causes of obstructive jaundice caused by a tumor?

A
  • Adenocarcinoma of the head of the Pancreas
  • Adenocarcinoma of the ampulla of vater
  • Cholangiocarcinoma arising from CBD itself
81
Q

What is the best test to diagnose pancreatic cancer?

A

CT scan
-Follow it with a percutaneous biopsy

If CT is negative —> ERCP

82
Q

Best step to diagnose Ampullary cancers:

A

ERCP

-Bc theyre in the duct, they can cause obstruction at a very small size, so usually not seen on CT

83
Q

What malignancy might you suspect in pt with obstructive jaundice combined with anemia and +blood in stools?

A

Ampullary cancer

-Endoscopy first (the “E” in ERCP)

84
Q

________ occurs when a gallstone temporarily occludes the cystic duct.

A

Biliary colic

85
Q

symptoms of biliary colic

A
  • 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
Q

Acute Cholecystitis occurs when a gallstone obstructs the _______

A

cystic duct

87
Q

What is the presentation of acute cholecystitis?

A

Constant pain (no longer post-prandial), modest fever, incr WBC, peritoneal irritation in RUQ, minimally affected LFTs.

88
Q

How is acute cholecystitis diagnosed?

A

Ultrasound

- gallstones, thick gallbladder wall, pericholecystic fluid

89
Q

Management in acute cholecystitis:

A

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
Q

If a stone partially occludes the CBD, they are at risk for developing ______

A

Acute ascending cholangitis

91
Q

Describe the presentation of acute ascending cholangitis

A

Very sick patient*

  • temp 104-105
  • chills
  • very high WBC
  • hyperbilirubinemia
  • VERY high Alkphos
  • potentially shock if delayed treatment
92
Q

How is acute ascending cholangitis treated?

A
  • IV antibiotics
  • emergency decompression of CBD via ERCP
    - PTC is also an option
  • Surgery rarely
  • Cholecystectomy must follow**
93
Q

Name 2 late complications of acute pancreatitis:

A
  • Chronic pancreatitis

- Pancreatic pseudocyst

94
Q

For acute pancreatitis, test for _____ amylase/lipase early on, and ______ amylase/lipase is presenting after a coupleof days.

A
  • Serum

- Urine

95
Q

In acute edematous pancreatitis, hematocrit may (Increase/Decrease?)

A

-Increase

Edema, hemoconcentration of blood

96
Q

What do you suspect in a pt with: Epigastric pain radiating to the back, high lipase/amylase, low hematocrit, high BUN

A

-Hemorrhagic pancreatitis

risk of developing multiple pancreatic abcesses

97
Q

What is the management for hemorrhagic pancreatitis?

A
  • daily CT scans, IV imipenem, supportive therapy in ICU

- Necrosectomy after about 4 weeks

98
Q

About 5 weeks after acute pancreatitis, a _______ my develop, showing a large mass and pancreatic juice outside the ducts (most commonly the lesser sac)

A

Pancreatic pseudocyst

-Diagnose with CT

99
Q

What is the treatment for a pseudocyst 6 cm or smaller?

A

Observe

-also for cysts that have been present for less than 6 weeks

100
Q

Treatment for pancreatic psudocysts >6 cm or >6 weeks old?

A

-drainage

percutaneously to outside, surgically into GI tract, endoscopically into stomach

101
Q

What are some clinical findings/presentation in chronic pancreatitis?

A

steatorrhea, diabetes, constant epigastric pain

  • supplement enzymes, insulin, pain control (although not very efective)
  • if certain areas are blocked, ERCP might help
102
Q

What is seen on imaging in chronic pancreatitis?

A

Pancreatic calcifications

103
Q

ALL abdominal hernias should be electively repaired to avoid risk of obstructionstrangulation………exceptions include ________

A
  • umbilical hernias in pts younger than 2-5

- esophageal sliding hiatal hernias (not “true” hernias)

104
Q

When do irreducible hernias need emergency surgery vs when can they just be elective surgery?

A
  • Reducible hernia that becomes irreducible –> Emergency surgery
  • Irreducible for years –> elective repair
105
Q

At what age should mammography be started?

A

40

-earlier if there is family hx

106
Q

what is the most convenient, effective and inexpensive way to obtain breast biopsies?

A

Ultrasound-guided or mammogram-guided

*Even when not palpable on exam

107
Q

What breast mass is a firm, rubbery mass that moves easily with palpation?

A

Fibroadenoma

108
Q

What is the diagnosis and management for fibroadenoma of the breast?

A
  • Fine needle aspiration or ultrasound

- Removal is optional, or observation

109
Q

__________ are seen in very young adolescents, and have very rapid growth. They are removed in order to avoid deformity and distortion of the breast.

A

Giant juvenille fibroedenoma

110
Q

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)

A

Cystosarcoma phyllodes

-most are benign, but have some malignant potential

111
Q

Management for suspected cystosarcoma phyllodes:

A

Core or incisional biopsy and mandatory removal

112
Q

___________ 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

A

Mammary dysplasia

-aka “fibrocystic change” or “cystic mastitis”

113
Q

Workup of fibrocystic change/mammary dysplasia

A
  • 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
Q

_______ is seen in women in their 20s - 40s, and presents with bloody nipple discharge.

A

intraductal papilloma

115
Q

How is intraductal papilloma diagnosed and managed?

A

diagnosis: galactogram
mgmt: surgical resection

116
Q

Breast abcess is seen only in ________ women. it is managed with ________

A
  • Lactating

- Incision and drainage with biopsy of abcess wall

117
Q

What are some strong clinical indicators of breast cancer?

A

-ill-defined fixed mass, orange peel skin, retraction of the nipple, lesions of areola, redness, palpable axillary nodes

118
Q

in breast cancer during pregnancy, treat the same way…except no ______ during the 1st trimester, and no ________ at all.

A
  • Chemo

- Radiotherapy

119
Q

What is the treatment for resectable breast cancer?

A
  • 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
Q

_______ carcinoma of the breast has higher incidence of bilaterality

A

Lobular

121
Q

Management of Ductal carcinoma in situ

A
  • 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
Q

Inoperability of breast cancer is based on ________

A

local extent (NOT mets*)

123
Q

What should follow surgery for virtually all pts with breast cancer?

A

Adjuvant systemic therapy
-Chemo in most cases, hormonal therapy if receptor positive

  • premenopausal women = tamoxifen
  • postmenopausal = anastrazole
124
Q

What si the most common specific location for spinal breast cancer mets?

A
  • vertebral pedicles
125
Q

What are you concerned for in a woman with Hx of breast cancer who has persistent headache or back pain?

A

Metastasis

-Diagnose with MRI

126
Q

What is the diagnostic method of choice for someone with thyroid nodule(s) who is euthyroid?

A

-FNA

127
Q

If FNA from a thyroid nodule is read as benign, manage by _________

A

Following. do not intervene

128
Q

If FNA from a thyroid nodule is read as malignant or indeterminate, manage with _________

A

Thyroid lobectomy with frozen section for histologic diagnosis

129
Q

If follicular cancer of the thyroid is diagnosed, management is ______

A

Total thyroidectomy

-For future mets –> radioactive iodine

130
Q

True or false…..Thyroid nodules in hyperthyroid patients are almost Never cancer?

A

TRUE!!

131
Q

most hyperthyroid patients are treated with _____

A

radioactive iodine

-pts with “hot adenoma” may get surgical excision of the affected lobe

132
Q

Pnemonic for hypercalcemia?

A

Stones (nephrolithiasis), bones, abdominal groans

133
Q

What is the workup for incidental finding of hypercalcemia?

A
  • repeat labs
  • Phosphorus labs (look for low phosphorus)
  • rule out cancer with bone mets
  • PTH if findings persist
134
Q

What is the curative treatment for 90% of hyperparathyroidism?

A

Surgical Removal

-90% of people have a single adenoma

135
Q

What is the physical appearance of someone with Cushing’s?

A

-round hairy face, buffalo hump, supraclavicular fat pads, obese,abdominal striae, thin weak extremities

136
Q

What are common comorbid diseases in patients with cushing’s?

A
  • Osteoporosis
  • Diabetes
  • HTN
  • mental instability—???
137
Q

What is the first step in the workup of cushing’s?

A

-Overnight low dose dexamethasone suppression test

138
Q

In a dexamethasone supression test, suppression at a low dose tells you what?

A

-Rules out cushings

139
Q

In low dose dexamethasone suppression test, if there is no suppression….what’s the next step?

A

-24 hour urine cortisol –> elevated? –> high dose suppression test

140
Q

Dexamethosone suppression test: if suppressed at high dose, this identifies _______

A

pituitary microadenoma

- do imaging –> remove

141
Q

No suppression at low OR high dose with dexamethasone suppression test identifies ________

A
  • Adrenal adenoma or paraneoplastic syndrome

- do imaging –> remove

142
Q

What is the best imaging study for pituitary adenoma vs adrenal adenoma?

A
  • MRI for pituitary

- CT for adrenal

143
Q

GI ulcers resistant to all usual therapy (including H.Pylori eradication), multiple ulcers, and/or ulcers beyond duodenum are probably ________

A

-Zollinger ellison syndrome (gastrinoma)

144
Q

Some patients with a gastrinoma also have this GI symptom….

A

Watery diarrhea

145
Q

Workup for Zollinger-Ellison syndrome?

A
  • 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
Q

What endocrine tumor produces CNS symptoms? and why?

A
  • Insulinoma
  • due to low blood sugar affecting CNS function

*always occurs when fasting

147
Q

How do you differentiate between someone with insulinoma vs someone with self-administration of insulin?

A
  • 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
Q

_________ is a devastating hypersecretion of insulin in the newborn, requiring 95% pancreatectomy

A

Nesidioblastosis

149
Q

What skin manifestation is seen with glucagonama?

A

-migratory necrolytic dermatitis

150
Q

What are some manifestations of glucagonoma?

A
  • mild diabetes
  • mild anemia
  • glossitis
  • stomatitis
151
Q

How do you diagnose/workup and treat glucagonoma?

A
  • glucagon assay
  • CT scan used to locate tumor
  • resection is curative
152
Q

What 2 agents can help in pts with metastatic, inoperable glucagonoma?

A
  • Somatostatin

- Streptozocin

153
Q

Primary hyperaldosteronism can be caused by _____ or ______

A
  • Adenoma

- Hyperplasia

154
Q

What are the primary findings in a pt with primary hyperaldosteronism?

A
  • Hypokalemia*
  • Hypertension*

-others = modest hypernatremia and metabolic alkalosis

155
Q

In primary hyperaldosteronism, Aldo levels are ______, and Renin levels are _______

A
  • High

- Low

156
Q

In patient w/primary hyperaldosteronism, appropriate response to postural changes (more aldo when upright than when lying down) indicate ___________

A

hyperplasia

-no response or inappropriate response = adenoma

157
Q

How is primary hyperaldosteronism treated?

A
  • surgical removal –> (is this both for adenoma or hyperplasia??)
  • Localize with CT
158
Q

What disease is frequently seen in thin, hyperactive women who have attacks of pounding headache, sweating, palpitations, and pallor?

A
  • Pheochromocytoma

* attacks coincide with extremely high blood pressure

159
Q

How do you start workup for pheochromocytoma?

A
  • 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
Q

Surgery for a pheochromocytoma requires careful pharmacologic preparation with ________

A

Alpha-blockers

161
Q

What are some findings seen in coarctation of the aorta?

A
  • HTN in the arms with normal or low pressure in lower extremities
  • CXR: scalloping of the ribs
162
Q

What is the best method of diagnosis for coarctation of the aorta, and how is it treated?

A
  • CT angio

- surgical correction

163
Q

Renovascular hypertension is seen in which 2 distinct epidemiologic groups?

A
  • Young (usually women) with fibromuscular dysplasia
  • Old (usually men) with atherosclerotic disease

*usually resistant to HTN tx regimens

164
Q

What is the workup for renovascular HTN?

A

Multifactorial:

  • Duplex of renal vessels
  • CT angio
165
Q

What is the therapy for renovascular HTN?

A

Young women:
-therapy is imperitive –> balloon dilation and stenting

Older pts:
-controversial….life expectancy from other atherosclerotic disease? good surgical candidate? etc

166
Q

5Ps associated with pheochromocytoma

A

Paroxysms, pressure (high BP), pain (headaches from HTN), palpitations, perspiration

167
Q

Scan to figure out which lobe of parathyroid is over active in hyperPTH?

A

Sestamibi scan

168
Q

Treatment for pheochromocytoma

A

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
Q

Why does rib scalloping occur in coarctation of aorta?

A

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
Q

What is pentalogy of Cantrell?

A

D COPS…diaphragmatic hernia, cardiac abnormalities, omaphalocele, pericardium malformation, sternal cleft

171
Q

Managing complicated diverticulitis

A

-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
Q

Post op fever defined as

A

> 100.4

173
Q

Most common cause of post op fever within first few hours after surgery?

A
  • 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

Pestana's (13 decks)

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