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Gastroenterology > General surgery > Flashcards

General surgery Flashcards

1
Q

what % of appy are perforated at presentation?

A

25%

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2
Q

what is the alvarado score for appendicitis?

A 
pre-test probability:
migratory right iliac pain
N/V
anorexia
tenderness on exam in right iliac fossa
rebound tenderness
fever
leucocytosis
left shift
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3
Q

how do you manage perforated appy?

A

IV abx until afebrile

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4
Q

who gets pyloric stenosis

A

2 week to 2 month
male 4;1
first born
Fhx esp in mom

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5
Q

How do we dx pyloric stenosis

A

must rule out other etiology for emesis
AUS - length > 14 mm, thickness > 4 mm
UGIS - string sign

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6
Q

what is the electrolyte abnormality in pyloric stenosis

A

hypochloremic metabolic alkalosis
loss of H and Cl in the emesis
kidneys try to balance by excreting Na and HCO3

then kidneys try to reabsorb Na at the expense of H and K = paradoxical aciduria

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7
Q

what type of intussuception can not be reduced radiologically?

A

jejuno-ileal - too far and can’t get enough pressure

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8
Q

who gets intussuception?

A

3 mo to 3 yrs
males 3:1
recurrence 3-11%

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9
Q

what is the most common type of intussuception?

A

ileocolic - 85%

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10
Q

what are absolute contraindications for pneumatic reduction of intussusception?

A

peritonitis
persistent hypotension
pneumoperitoneum

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11
Q

what are the rules of 2 for Meckel’s diverticulum?

A 
2% of population
2;1 M
2-6% asymptomatic
within 2 feet of ileocecal valve
2 inces long
2 types of mucosa - gastric or pancreatic
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12
Q

what are CF of Meckel’s ?

A

MC - bleeding, painless, episodic

diverticulitis - inflammation, pain, perforation

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13
Q

how do you Dx Meckel’s?

A

99Tc scan

give ranitidine before helps make it more sensitive

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14
Q

T or F. prenatal Dx of CDH is associated with better outcome than post natal Dx

A

True

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15
Q

what chromosomal abnormality of most commonly associated with CDH

A

Trisomy 18

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16
Q

what are important mgnt steps for a CDH?

A
  1. intubate on first breath
  2. NG to decompress
  3. stabilize
  4. RO other abnormalities - ECHO and genetics
  5. wait until stable to operate
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17
Q

if you are suspicious for TEF, what might help Dx? and if found, what other investigations are warranted

A

insert 8-10F NGT - will block at 10 cm if TEF

Need ECHO for ? VACTERL
need to look for anal atresia

18
Q

which upper GI abnormality may show up with no air on abdo Xray

A

esophageal atresia

19
Q

what is the mc typeof esophageal atresia?

A

EO with distal TEF

20
Q

what is the best test for volvulus Dx

A

upper GI series

US is a screen only - mesenteric vessel orientation

21
Q

what is the DDx for billious emesis in a neonate?

A
  1. Mid gut volvulus
  2. malrotation
  3. duodenal atresia
  4. Hirshsprung
  5. ileus - NEC
22
Q

when does malrotation and vulvulus tend to present?

A

first month - 65%

firts year - 13%

23
Q

how do we Dx Hirschsprung?

A

screen- contrast enema looking for transition zone seen in 80-% might not see in early presentation
classic is rectosigmoid
Gold - suction rectal Bx - no ganglion, hypertrophic nerves and incraesed ACh-esterase stain(seen in all constipation
(can do rectal manometry in older)

24
Q

How do Pt with Hirschsprung present

A

abdo distension
bilious emesis
failure to pass mec in 24 hrs
enterocolitis - fever, lethargy, HD un stable

25
Q

how do you manage Hirschsprung?

A

rectal decompression with saline irrigation

Sx early - definitive pull-through

26
Q

which of these has associated malrotation - omphalocele and gastroschisis

A

BOTH!!!

27
Q

what is the MC cardiac malformation associated with omphaloceles?

A

TOF

28
Q

if baby found to have omphalocele, what other investigations are required?

A

ECHO - TOF
genetics for BWS, T13, T18
multiple and isolated congenital anomalies (musculoskeletal, 24%; urogenital, 20%; cardiovascular, 15%; and central nervous system, 9%)

29
Q

where is the defect in gastroschisis?

A

Right of umbilicus

30
Q

what are the issue with gastroschisis?

A

atresia
volvulus
prolonged ileus

31
Q

doe omphaloceles have bowle atresia?

A

not usually
bowel works well
50% have associated abnormalities

32
Q

what age group gets inguinal hernias?

A

most common in < 1 year olds

33
Q

when should an inguinal hernia be repaired?

A

if strangulated - right away
otherwise - within 2 weeks bc risk of incarceration is 30-40% and inc if wait
CL exploration only if ex-prem

34
Q

how do you manage an incarcerated inguinal hernia?

A

attempts manual reduction with sedation

followed by OR 24-48 hours later

35
Q

what are complications of inguinal hernia repair?

A 
scrotal swelling
scrotal hematoma - resolves 10-14 d
iatrogenic undescended testicle
recurrence - esp if incarcerated or prem
testicular atrophy
36
Q

why do we do orchidopexies?

A
  1. fertility
  2. malignancy
  3. risk of torsion/hernia/trauma
37
Q

how can you tell apart an incarcerated hernia from a acute hydrocele?

A

incarcerate - patient looks a bit sicker, emesis, abdo pain, no poops

38
Q

what are CF of UC

A 
tenesmus
urgency
crampy abdo pain
norcturnal BM
Bloody stool/diarrhe
anorexia/wgt loss
39
Q

what defines fulminant colitis

A

fever
> 5 bloody stools X 5 days
severe anemia
hypoalbuminemia

40
Q

what are extra Gi manifestations of Crohn’s

A 
apthous ulcers
arthritis
EN
clubbing
renal stone/gallstones
delayed puberty
41
Q

what are the typical CF of Crohn’s

A

weight loss - can be the only sign
abdo pain
diarrhea
fatigue

42
Q

how do we Dx Crohn’s

A

bc can have small bowel disease
UGI/SBFT
colonoscopy for Dx

Gastroenterology (3 decks)

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