GENERAL SURGERY Flashcards
Esophageal cancer
Progressive dysphagia and weight loss
Squamous cell carcinoma - men with long history of smoking and drinking
Adenocarcinoma - long standing GERD
Do barium swallow before endoscopy
Carcinoid syndrome
Small bowel carcinoid tumor with liver mets
Diarrhea, flushing, wheezing, right sided heart valvular damage (prominent JVP)
24 hour HIAA
Right vs left sided colon cancer
RIGHT
Iron deficiency anemia in an old person
4+ occult blood in stool
LEFT
Bloody bowel movements
Which colonic polyps are premalignant? Which are not?
PREMALIGNANT
Villous adenoma
Adenomatous polyps
NOT Juvenile Peutz Jeghers Isolated inflammatory Hyperplastic
Pseudomembranous enterocolitis
Overgrowth of c diff in patients who have been on clindamycin or cephalosporins
Watery diarrhea, crampy abdominal pain, fever, leukocytosis
Tx with metronidazole or oral vancomycin
If resistant to treatment you need a colectomy or a fecal enema
Anal fissure
Young women
Pain with pooping
Avoid bowel movements and get constipated
Might have a tight sphincter problem
Tx with topical diltiazem ointment and that should work
Should you do surgery in crohn of the anus
No
Treat with remicade
What qualifies as the upper GI tract
Tip of nose to ligament of Treitz (connects duodeno jejunal flexure to esophagus)
Abdominal perforation
Sudden onset abdominal pain that is constant, generalized and severe
Peritoneal irritation - tenderness, guarding, rebound, silent bowel sounds
Most common is peforated peptic ulcer
Inflammatory process acute abdomen
Buildup of several hours
Constant and ill defined pain at first
Then location to where problem actually is
Acute pancreatitis
Rapid onset inflammatory process acute abdomen in an alcoholic
Constant epigastric pain that radiates to the back
Nausea and vomiting
Diagnose with serum or urinary amylase or lipase
Hepatic adenoma
Complication of birth control pills
Can rupture and bleed and that would be bad
Dx with CT scan
Amebic abscess of liver
Men with a Mexico connection
Do serology but treat empirically with metronidazole
Hemolytic jaundice
Elevated indirect bilirubin
No bile in urine
Hepatocellular jaundice
Both bilirubins are elevated
Very high LFTs
Modest increase in alkaline phosphatase
Look for hepatitis
Obstructive jaundice
Both bilirubins are elevated
Modest LFTs
Very high alkaline phosphatase
ERCP to look for stone
Fat, female, fertile, forty
US to look for tumor (gallbladder will be thin walled and dilated)
Acute ascending cholangitis
Stone has reached the common bile duct
Temperature spikes up to 105 and very high alkaline phosphatase
IV abx and ERCP with eventual cholecystectomy
Edematous vs hemorrhagic pancreatitis
Edematous - elevated hematocrit
Hemorrhagic - low hematocrit
What do you use to image the breast
Young woman - US
Over 30-40 - mammography
Intraductal papilloma
Young women (20-40) Bloody nipple discharge
Galactogram for diagnosis
Breast abscess
Only in lactating women
Incision and drainage
Keep breastfeeding
Radiology of breast cancer
Irregular speculated mass
Asymmetric density
Architectural distortion
Fine microcalcifications
Which breast cancer has the highest incidence of laterality
Lobular (infiltrating ductal carcinoma)
What makes a breast cancer inoperable?
Local extent - not mets!
Breast cancer mets spots
Bone and brain
Persistent headache and backache are bad signs
Does thyroid cancer usually affect thyroid function?
No
Thyroid cancers
Papillary - slow growing, resection depends on mets
Follicular - total thyroidectomy
Medullary - c cells that release calcitonin, aggressive so do radical surgery and do pheochromocytoma workup (MEN 2)
Anaplastic - old people that’s really bad
Hyperparathyroidism
High serum calcium in blood tests (maybe stones, bones, groans, etc…)
Look for low phosphorous and rule out bone cancer
Probably an adenoma that will be cured with removal
Zollinger Ellison syndrome
Gastrinoma
Virulent peptic ulcer disease resistant to usual therapies
Watery diarrhea
Measure gastrin and do secretin test
Look for pancreatic tumor
Nesidioblastosis
Hypersecretion of insulin in newborn
Remove pancreas
Glucagonoma
Severe migratory necrolytic dermatitis
Mild diabetes
Anemia, glossitis, stomatitis
Primary hyperaldosteronism
Adenoma or hyperplasia
HYPOKALEMIA in hypertensive female patient
Low renin levels
Hyponatremia and metabolic alkalosis
Adrenal CT
Renovascular hypertension
Young women with fibromuscular dyaplasia
Old men with arteriosclerotic occlusive disease
Bruit over the flank
