Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical review 3 > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Atelectasis

A

Partial or complete collapse of the lung, common after surgery.
Most common in elderly and overweight, smokers, symptoms or respiratory disease.
- Most common 48 hours after surgery
S/sx: Ventilation/perfusion mismatch. Decreased O2 sat. Infection (pneumonia). Fever, tachypnea, tachycardia. Elevation of diaphragm, scattered rales, decreased breath sounds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GI tract wake up after abdominal surgery.

A

Small bowel first to wake at around 24 hours, stomach is next at around 48 hours, last is the colon (passing gas) at around 72 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ileus

A

Disruption of the normal propulsive ability of the GI tract; failure of peristalsis
Eti: - Increased sympathetic activity in GI tract because post surgery there are inhibitory neural reflexes on spinal afferent signals.
- Nitric oxide, vasoactive intestinal polypeptide, and maybe substance P thought to act as inhibitory neurotransmitters in the gut.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Post surgical bowel obstruction

A

Eti: illeus, or internal hernia or adhesions.
S/sx: - Moderate, diffuse abdominal discomfort
- Constipation
- Abdominal distention
- N/V, especially after meals
- No BM or farting
- Lots of burping
Manage:
- Pain management, replacement fluid therapy, electrolyte replacement, nutritional support, continue abdominal examinations, gastrografin
- Bowel rest (clear fluids etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DVT

A

Etiology: Virchow’s triad: venous stasis, hyper-coagulability, endothelial injury.
S/sx: leg pain, swelling, homens sign, etc.
Manage: LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pulmonary embolism

A

Eti: often from DVT
S/sx: Dyspnea unexplained by auscultatory findings, ECG changes (S1Q3T3- large S wave in lead 1, Q waves in lead 3, inverted T waves in lead 3 indicates acute right heart strain). Pain in the thorax between clavicles.
Manage: warfarin for long term anticoag, fibrinolysis may be indicated for massive PE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Post surgical bowel obstruction

A

Eti: failure of post-op return of bowel function, adhesions, or internal hernia.
s/sx: abdominal pain, no flautus or bowel movements, vomiting back food.
Tx: Nasogastric suction, laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

IV phlebitis

A

Eti: inflammation in vein after needle placement for extended period.
Timeline: most common reason for post-op fever after day 3.
S/sx: triad: induration, edema, tenderness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the five w’s of post op fever?

A

Wind: atelectasis or pneumonia
Water: UTI
Wound: Superficial, intra-abdominal abscess, peritonitis etc.
Walking: DVT/PE
Wonder drugs: drug fever, pseudomembranous colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Atelectasis POF

A

Presentation time: first 24 hours
S/sx: Isolated fever, tachypnea, dyspnea and or tachycardia
Dx: chest x-ray
Tx: Pulmonary hygiene (suction, chest physiotherapy, nasotracheal suction), admit if patient is ill appearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pneumonia POF

A

Presentation time: 3-7 days Postop
S/sx: dyspnea, chest pain, fever, productive cough, and or tachypnea
Dx: chest x-ray
Tx: Admission and treat with broad-spectrum abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pseudomembranous colitis POF

A

Aka: C. diff, can present any time
S/sx: Fever, abdominal cramps, diarrhea, pus or mucus in stool, nausea, dehydration
Dx: stool testing using immunoassay
Tx: Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 or 4 stages of wound healing

A

3: inflammatory, fibroblastic, maturation
4: hemostasis, inflammatory, proliferation, remodling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pyomyositis

A

Eti: purulent infection of skeletal muscle from hematogenous spread, usually from abscess formation
Timeline: 3 stages
S/sx: fever, pain, cramping localized to single muscle group.
Stage 1: swelling, local muscle pain
Stage 2: 10-21 days: fever, exquistie muscle tenderness, edema, frank abscess may be visible, leukocytosis
Stage 3: systemic toxicity
Eval: X-ray, lab data, T2 weighted MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

necrotizing fasciitis

A

Eti: Type 1: polymicrobial, type2: group A strep.
- Infection of deeper tissues, desctruction of muscle facia over subQ fat.
S/sx: skin color change from red-purple to patches of blue-gray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

gas gangrene

A

Eti: Most often: Clostridium perfringes
S/sx: severe pain, numbness, confusion, flu-like symptoms, skin color change, crepitus of skin
Eval: image that shows gas w/i soft tissue
Tx: surgical debridement and soft tissue reconstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

cellulitis

A

Eti: Mostly GABHS and staph, involves the deeper dermis and subQ fat
S/sx: warm, edema, erythema
Eval: blood culture if concerned about systemic toxicity
Management: Abx PO, Abx IV if systemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Stages of skin ulcers

A

Stages:

1: Skin intact but with non-blanchable redness for greater than 1 hour after relief of pressure
2: Blister or other break in the dermis with partial thickness loss
3: Full thickness tissue loss. SubQ fat may be visible; destruction extends into the muscle
4: Full thickness tissue loss with involvement of bone, tendon, or joint. Includes undermining and tunneling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Achalasia

A

Eti: Loss of peristalsis in distal 2/3rds of esophagus and impaired LES relaxation. Loss of myenteric plexus neurons.
S/sx: dysphagia for both liquids and solids, (gradual and progressive)
- regurgitation of undigested food
- heartburn, not due to GER, but stasis of undigested food in esophagus
- chest pain, usually with a meal
Dx: EGD, barium swallow (birds beak), esophageal manometry (gold standard)
Tx: Pneumatic dilation, surgical (heller myotomy and partial fundoplication)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Esophageal varices

A

Eti: portal hypertension caused by cirrhosis, up to 80% of patients with portal hypertension will eventually develop.
S/sx: Asymptomatic until rupture. Upper GI bleed: hematemesis, melena, may have hypovolemia. Cirrhosis on exam.
Dx: EGD shows enlarged veins.
Tx: initial: IV fluids, transfusion, if coagulopathy: FFP, vit K, empiric abx (usually 3rd gen cephalosporin).
- Vasoconstrictive drugs (octreotide),
- Endoscopic variceal ablation
- Ballon tamponade (when other techniques don’t work)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Zenker’s diverticulum

A

Eti: Progressive herniation of the mucosa and submucosa through the Killian triangle.
Presentation: dysphagia, regurgitation of undigested food, halitosis, GERD, gurgling sounds in neck, may present with aspiration pneumonia
Dx: Barium swallow
Tx: not required if asymptomatic, surgery: CP myotomy w/ diverticulectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Esophageal carcinoma

A

Eti:adenocarcinoma: GERD: most common predisposing factor
- Squamous cell carcinoma: smoking, ETOH, chronic indigestion
Sx: Dysphagia, initially solids, later liquids, weight loss, odynophagia, hoarseness, respiratory symp
Dx: Barium swallow (usually presents as intraluminal mass or stricture, EGD for biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Barrett’s esophagus

A

Eti: GERD + shorter/weaker LES, associated with hiatal hernias
Risks: Long history of GERD, h pylori gastritis, smoking, obesity
Dx: EGD, barium swallow etc.
Tx: PPIs or fundoplication (preferred), but still need surveillance, q12-24 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Caustic injuries to esophagus

A

Eti: ingestion of caustic solution, usually suicide attempt, or accident in kids
Sx: inflammatory edema of lips, mouth or tongue, chest pain, dysphagia, drooling, hematemesis, dysphagia etc.
Dx: CXR, esophagogram
Tx; Depends on severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hiatal hernia

A

Eti: obesity, aging, generally weakening of musculofascial structures.
Sx: dysphagia, epigastric discomfort, anemia, heartburn, regurg, post-prandial bloating, resp sympt
Dx: Barium swallow, EGD
Tx: surgery if symptomatic (nissen fundoplication)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Perforation of esophagus

A

Eti: Iatrogenic, severe vomiting, external trauma
Sx: cervical: neck pain, crepitus, dysphagia, signs of infection
- thoracic: tachycardia, tachypnea, dyspnea, hypotension…
Dx: Xray, esophagogram, CT chest, thoracentesis
Tx: Broad spectrum abx, surgery within 24 hours,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Schatzes ring

A

Eti: associated with GERD and hiatal hernias
Sx: dysphagia to solid food, especially large boluses
- intermittent, not progressive
Dx: barium esophogram is more sensitive than EGD
Tx: endoscopic dilation, or endoscopic electrosurgical incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Bacterial peritonitis (primary)

A

Eti: hematogenous or lymphogenous spread, or from the gut or fallopian tubes…
Presentation: abrupt onset of fever, abdominal pain, distention, rebound tenderness
Dx: fluid from paracentesis: used for gram stain, culture, serum ascities albumin gradient, ect.
Tx: empiric, third gen ceph

29
Q

Bacterial peritonitis (secondary)

A

Eti: GI perforation, ischemic bowel, IBD, appendicitis, trauma, PID, peritoneal dialysis
Sx: abdominal pain and rigidity, N/V, anorexia, fever, rebound tenderness. Changes in bowel function, character of pain, location, etc. depend on cause
Dx: paracentesis eval…
Tx: abx with anaerobic coverage

30
Q

Intra-abdominal abcess

A

Eti: GI perforations, postop complications, penetrating injuries, sequela of peritonitis
Sx: fever, tachycardia, pain, prolonged ileus after surgery or peritonitis
Dx: CT is best
Tx: abx and drainage
Surgical: operative drainage if no improvement after percutaneous

31
Q

Retroperitoneal abcess

A

Eti: injury or infection of adjacent structures
Pres: fever, abdominal pain, flank pain, anorexia, N/V, weight loss. May have thigh and back pain. + iliopsoas sign if located near psoas muscle
Dx: CT is best
Tx: abx and drainage

32
Q

Ascities

A

Eti: disease of the peritoneum, or CHF, cirrhosis, Budd-chiari, et.
Pres: fluid wave, scrotal edema, umbilica or inguinal hernia, plural effusion, peri-umbilical nodule (sister mary joseph, or supraclavicular nodule (malignancy).
Dx: US or CT, paracentesis

33
Q

Peptic ulcer disease

A

Eti: decrease of the mucosa in gastric ulcers, increase in acid or pepsin in duodenal ulcers.
Major causes: H. pylori, NSAIDs,
Sx: gnawing dull ache, hunger like pain
DU: better after meal, worse on empty stomach
GU: worse after meal
Complications: “coffee ground” emesis, hematemesis, melena
Dx: EGD

34
Q

Zollinger-Ellison syndrome

A

Eti: gastrin-secreting gut neuroendocrine tumors (gastrinomas), which result in hypergastrinemia and acid hypersecretion
Sx: multiple ulcers, “kissing ulcers”
Dx: fasting serum gastrin, Secretin stimulation test

35
Q

Mallory-Weiss tear

A

Eti: cough, vomiting, heavy lifting, seizures
sx: history of non-blooding vomiting followed by hematemesis, melena, epigastric pain radiating to the back
Dx: EGD
Tx: Endoscopic therapy

36
Q

Gastric carcinoma

A

Eti: H pylori; also salted, cured, smoked, or pickled foods containing nitrites
Sx: Indigestion, weight loss, early satiety, abdominal pain/fullness, nausea, post-prandial vomiting, dysphagia, melena, hematemesis, anemia
Dx: EGD, CEA (carcinoembryoic antigen) elevated
TX: preop chemo, surgery

37
Q

pyloric stenosis

A

Eti: hypertrophy & hyperplasia of the muscular layers of the pylorus, causing a functional outlet obstruction
Epi: most often first 3-12 weeks of life
Sx: non-bilious, projectile vomiting
Dx: abdominal US,

38
Q

Hepatic trauma

A

Eti: Blunt or penetrating trauma
S/sx: Hypovolemic shock, hypotension, decreased uriniary output, low central venus pressure, sometimes abdominal pressure
Dx: FAST exam, high res CT with contrast, may have leukocytosis, coagulopathy, acidosis…
Tx: Ensure hemodynamic stability, often requires surgical management.

39
Q

Liver cancer

A

Eti: hepatocellular carcinoma, cancer arising from hepatocytes, or intrahepatic cholangiocarcinoma, cancer arising from biliary epithelial cells.
Risk: Hep B and C
Eval: AST and ALT may be elevated, but are non-specific, may have elevated alk phos. Image.

40
Q

Cholecystitis

A

Eti: 80% of acute from obstruction of the cystic duct by a gallstone.
S/sx: Acute RUQ pain, fever and
Eval: US with sonographyic murphy sign, PMNs and leukocytosis.
Tx: most cases resolve spontaneously

41
Q

Cholagnitis

A

Eti: Bacterial infection of biliary ducts, always as sign of biliary obstruction, often caused by choledocholithiasis, biliary stricture and neoplasm.
S/sx: Charcot’s triad: biliary colic, jaundice, chills and fever
Eval: US, may also need ERCP
Manage: IV abx, often: cefazolin, cefoxitin, surgical if severe or unremitting.

42
Q

Choledocolithiasis

A

Eti: gallstone in common bile duct
S/sx: Biliary type pain.
Dx: Labs (AST/ALT, serum bilirubin, alk phos, GGT), transabdominal US, MRCP, ERCP
Tx: Removal of stone

43
Q

Pancreatitis

A

Eti: non-bacterial inflammatory disease, caused by activation, interstitial liveration, autodigestion of pancrease by its own enzymes. Most is caused by gallstones and ETOHism.
S/sx: acute sudden, super abdominal pain, nausea, vomiting and elevated serum amylase.
Dx: Can have elevated Hct with edematous pancreas, serum amylase 3x normal. (lipase is specfic to pancreas).
Tx: Reduce pancreatic secretory stimuli, correct electrolyte balance.
Surgical: Endoscopic sphincterotomy, surgery C/I in acute pancreatitis

44
Q

pancreatic pseudocyst

A

Defined fibrous wall but lacks epithelial lining.
Eti: encapsulated collection of fluid with high enzyme concentrations arising from pancreas.
S/sx: Epigastric mass and pain, mild fever, persistant serum amylase. Should be considered when acute pancreatits last more than a week.
Tx: Expectant management is reasonable, spontaneous resolution in about 40% of cases.

45
Q

Pancreatic abscess

A

Fatal if not treated surgically.
Eti: Develops in severe cases of pancreatitis w/ hypovolemic shock and pancreatic necrosis. Often seen in post-op pancreatitis.
S/sx: rising fever, lack of improvement of severe acute pancreatitis. Can have some vomiting or jaundice. Often just fever.
Eval: Serum amylase may be elevated, leukocytosis.
Tx: Infected fluid must be drained by percutaneous catheter drainage. Post-op abx to cover for E. coli, staph, klebsiella, proteus, candida albicans.

46
Q

What is Ranson’s criteria?

A 
Estimates mortality of patients with pancreatitis based on 48 hour lab values.
(0-11 points, 7 points = 100% mortality.
On admin: 
- WBC greater than 16k
- Age greater than 55
- Glucose greater than 200
- LDH greater than 250
48 hours into admin:
- HCT drop >20%
- BUN increase >5mg/dL
- Ca<8mg/dL
- Arterial pO2 <60mmgH
47
Q

Acute appendicitis

A

Eti: Obstruction of the appendix by a fecalith, inflammation, foreign body, or neoplasm
S/sx: vague/colicky periumbilical pain, N/V, anorexia, fever, constipation
Dx: leukocytosis w/ neutrophilia, microscopic hematuria and pyruria, CT abdomen/pelvis
Tx: peroperative broad-spectrum abx w/ gram neg and anaerobic coverage

48
Q

blind loop syndrome

A

aka: small intestine bacterial overgrowth
Eti: failure to limit bacterial growth. Structural lesions causing stasis, IBD, scleroderma
S/sx: diarrhea, steatorrhea, distention, abd discomfort, weight loss, dyspepsia
Dx: culture and breath test
Tx; augmentin or flagyl

49
Q

Short bowel syndrome

A

Most common after after large resection due to AMI. Usually occurs in patients with less than 100cm of bowel remaining.
S/sx: diarrhea, steatorrhea, dehydration, weakness, fatigue.

50
Q

Small bowel obstruction

A

Eti: Most often due to adhesions related to prior abd. surgery. Hernia, neoplasm, IBD.
ABCs: adhesions, bulge (hernia), cancer
S/sx: N/V, colicky abd. pain, obstipation, abdominal distension
…

51
Q

Large bowel obstruction

A

Eti: Colon cancer, diverticulitis, volvulus
Pathophys: Obstruction = mucosal edema = impaired venous and arterial blood flow to bowel.
S/sx: Obstipation, vomiting, deep visceral cramping
Dx: abdominal XR, CT w/ rectal contrast, contrast enema
Tx: Hydration, TPN
Surgery: Removal of necrotic bowel, or obstructing lesion

52
Q

Acute mesenteric vascular occlusion

A

Eti: Sudden decrease of mesenteric blood supply, inadequate perfusion, most commonly by embolus
Epi: CVD greatest risk
S/sx: Severe abdominal pain out of proportion of physical findings, poorly localized. N/V/D
Dx: Urgent CTA, mesenteric arteriography
Labs: WBC, metabolic acidosis, elevated lactate

53
Q

Colon cancer

A

Eti: adenomatous polyp into malignancy, 3rd leading cause of cancer death.
Epi: Lynch syndrome
S/sx: Fe def anemia, rectal bleeding, abdominal pain, change in bowel habits, obstruction, majority asymp.
Dx: colonoscopy, barium enema, CT cap, elevated CEA

54
Q

diverticulosis

A

Eti: weakness in bowel wall
Epi: 50-60% of adults by 60. M=W
S/sx: uninflammed diverticula, usually asymp, LLQ tender, palpable left colon, sigmoid most common site.

55
Q

Diverticultitis

A

Eti: micro or macroscopic perforation/ obstruction of a diverticulum = inflam response
Epi: avg age: 62
S/sx: fever, LLQ pain, N/V, constipation or diarrhea, flatulence, bloating
Dx: CT abd pelv., elevated WBC, colonoscopy
Tx: clear liquid diet, broad spectrum abx (cipro + flagyl or augmentin

56
Q

Volvulus

A

Eti: rotation of segment of the LI
S/sx: colicky pain V, obstipation
Dx: XR: coffee bean sign, birds beak sign
Tx: fluid, electrolytes, surgical emergency

57
Q

Perirectal abscess

A

Eti: infection in cryptoglandular epithelium lining the anal canal
S/sx: perirectal pain worse with movement or sitting

58
Q

Anorectal fistula

A

Eti: can develop from perirectal abscess

…

59
Q

Pilonidal cyst and abscess

A

Eti: hair containing cyst located just below the coccyx
S/sx: painful swollen lesion in sacrococcygeal region
Tx: I&D, if abscess = abx

60
Q

Crohn’s vs Ulcerative colitis S/sx?

A

UC: Limited to the colon, rectum always involved. C: any where from mouth to anus, TERMINAL ILEUM mc. Urgency, tenesmus, incontinence, 4 stools per day to 10 severe.
C: healthy areas between inflamed areas.
UC: Continuous inflam of colon.
UC: only effects innermost lining of bowel
C: Can have symptoms for many years before dx.
UC: Usually gradual onset of symptoms over a couple of weeks.
UC: Bloody stool in more common, bloody diarrhea

61
Q

Extraintestinal symptoms of ulcerative colitis

A

MSK:arthritis, large joints, ankylosing spondylitis, osteoporosis,
Eye: uveitits and episcleritis
Skin: erythema nodosum, pyoderma gangrenosum
Hepatobiliary: primary sclerosingcolagnitis, fatty liver,autoimmune liver disease
Hematopoietic/coag: venous and arterial thromboembolism
Pulmonary: rare

62
Q

Extraintestinal symptoms of crohns

A

fatigue, weight loss,
MSK: arthritis,
Eye: uvetitis
Skin: erythema nodosum, pyoderma gangrenosum
Hepatobiliary: primary sclerosising cholagitits
renal stones, VTE, ATE

63
Q

Work up for UC

A

CBC for anemia
Elevated ESR
Low albumin
Electrolyte abnormalities (due to dehyrdation from diarrhea)
Abdominal radiography: “thumbprinting” secondary to edema and colonic dilation
Avoid barium enema for risk of ileus with toxic megacolon

64
Q

UC v C: different signs on colonoscopy etc.

A

Colonoscopy: UC: ulceration in rectum, sandpaper appearance.
C: Skip lesions, cobblestone appearance.
Barium studies:
UC: Stove pipe sign (loss of haustral markings)
C: String sign: narrowed due to transmural stricutres

65
Q

UC v C: Complications

A

UC:
- primary sclerosing cholangitis, colon CA, toxic megacolon. (smoking decreases risk for UC)
C: Perianal dz: fistulas, stricture, aabscess, granulomas

66
Q

What does ERCP stand for

A

Endoscopic
Retrograde
Cholangiopancreatography

67
Q

Types of polyps

A

Pseudopolyps: due to IBD (non-cancerous)
Hyperplastic: low risk, 90% of all polpys
Adenomatous polyps: 10% of polyps, 10-20 years before becoming cancerous
- Tubulous adenoma: nonpedunculated
- Tubulovillous (mixture)
- Villous adenoma: (highest risk) tend to be sessile

68
Q

Umbilical hernia

A

Risk: more common in women, multiple pregnancy, ascites, obesity
Findings: bulge at umbilicus, can have patient sit up, or valsalva to elicit popping out.

69
Q

Staging of breast cancer

A 
TNM: 
T: Primary tumor: size and if in situ or moved
N: lymph nodes: regional involvement
M: metastatsis
Stage 0: T in situ, N0, M0
Stage 1: T1 (<5 cm big), N0, M0
Stage IIA: T0-T2, N1, M0
Stage IV: includes M1

Clinical review 3 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions