General Surgery Flashcards
What is the best way to determine GERD if uncertain?
pH monitoring is best.
Heart burn is usually seen in an overweight individual who wears tight clothing or lying flat in the bed with pain relieved by ___ or over the counter __ blockers.
Heart burn is usually seen in an overweight individual who wears tight clothing or lying flat in the bed with pain relieved by antacids or over the counter H2 blockers.
If there is long standing h/o of GERD, concern is that there could be damage that might have been done to the lower esophagus (peptic esophagitis) and the possible development of ___ esophagus. In this setting, endoscopy and biopdies are the needed tests, and Baretts is a precursor to malignancy.
If there is long standing h/o of GERD, concern is that there could be damage that might have been done to the lower esophagus (peptic esophagitis) and the possible development of Barrett’s esophagus. In this setting, endoscopy and biopdies are the needed tests, and Baretts is a precursor to malignancy.
When would you do surgery on GERD?
- Appropriate long standing symptomatic disease that cannot be controlled by medical means (using lap Nissen)
- Necessary when complications has occured like ulcerations or stenosis.
Imperative if there are severe dysplastic changes
Esohageal motility problems have recognizable symptoms such as cruhing pain with _____ in uncoordinated massive contraction, or the suggestive pattern of dysphagia seen in achalasia, where solids are swallowed with less difficulty than liquids. ____ studies are used for the definitive diagnosis. ___ ___ is typically done first to evaluate for an obstucting lesions.
Motility problems have recognizable symptoms such as crushing pain with swallowing in uncoordinated massive contraction, or the suggestive pattern of dysphagia seen in achalasia, where solids are swallowed with less difficulty than liquids. Manometry studies are used for the definitive diagnosis. Carium swallow is typically done first to evaluate for an obstucting lesions.
Achalasia is seen more commonly in____. There is dysphagia that is worse for ____; the patient eventually learns that sitting up straight and waiting allows the weight of the column of liquid to overcome the sphincter. There is occasional regurgitation of undigested food.
Xray will show ____. ____ is diagnostic. The appealing current treamtn is what?
Achalasia is seen more commonly in women. There is dysphagia that is worse for liquids; the patient eventually learns that sitting up straight and waiting allows the weight of the column of liquid to overcome the sphincter. There is occasional regurgitation of undigested food.
Xray will show megaesophagus. Manometry is diagnostic. The current appealing treatment is balloon dilation done by endoscopy.
Esophageal cancer shows the classic progression of ____ starting with meat, then other solids, then soft foods, eventually liquids and finally (in several months) saliva.
Significant weight loss always is seen.
___ ____ carcinoma is seen in men with a history of smoking and drinking.
______ is seen in people with long-standing gastroesophageal reflux. Diagnosis is established by ___ and ___.
Endoscopic US and CT/PET scan are used to assess local and LN involvement and therefore operability, but most cases present late and therefore are inoperable.
Esophageal cancer shows the classic progression of dysphagia starting with meat, then other solids, then soft foods, eventually liquids and finally (in several months) saliva.
Significant weight loss always is seen.
Squamous cell carcinoma is seen in men with a history of smoking and drinking.
Adenocarcinoma is seen in people with long-standing gastroesophageal reflux. Diagnosis is established by endoscopy and biopsy
Endoscopic US and CT/PET scan are used to assess local and LN involvement and therefore operability, but most cases present late and therefore are inoperable.
What is the most common reason for esophageal performation?
Instrumental performation. Shortly after completion of endoscopy, symptoms as described above will develop. There may be emphysema in the lower neck (virtually diagnostic in this setting). Contrast studies and prompt repair are imperative.
What are symptoms of gastric adenocarcinoma?
- Anorexia
- Weight loss
- Vague epigastric distress or early satiety
- Occasionally hematesis
How do you diagnose gastric adenocarcinoma?
Endoscopy and biopsies are diagnostic.
CT scan helps assess operability. Surgery is the best therapy.
Gastric lymphoma is almost as common as gastric ____. Presentation and diagnosis are similar, but treatment is _____.
Surgery is only indicated if perforation is feared as the tumor melts away. Low grade lymphomatoid transformation (MALTOMA) can be reversed by eradication of ___
Gastric lymphoma is almost as common as gastric adenocarcinoma. Presentation and diagnosis are similar, but treatment is chemotherapy.
Surgery is only indicated if perforation is feared as the tumor melts away. Low grade lymphomatoid transformation (MALTOMA) can be reversed by eradication of H. Pylori
Mechanical intestinal obstruction is typically caused by ____ in those have had had prior laparotomy.
There is colicky abdominal pain and protracted vomiting, progressive abdominal distention (if it is a low obstruction) and no passage of gas or feces. arly on, high pitched bowel sounds coincide with the colicky pain (after a few days there is silence).
Xrays show ___ ___ of small bowel, with __-___ levels.
Mechanical intestinal obstruction is typically caused by adhesions in those have had had prior laparotomy.
There is colicky abdominal pain and protracted vomiting, progressive abdominal distention (if it is a low obstruction) and no passage of gas or feces. arly on, high pitched bowel sounds coincide with the colicky pain (after a few days there is silence).
Xrays show distended loops of small bowel, with air-fluid levels.
How do you manage mechanical intestinal obstruction?
- NPO
- NG suction
- IV fluids
___ obstruction occurs due to compromised blood supply, leading to bowel ischemia. It starts as described above, but eventually the patient develops fever, leukocytosis, constant pain, signs of peritoneal irritation, and ultimately full-blown peritonitis and sepsis. Emergency surgery is required.
Strangulated obstruction occurs due to compromised blood supply, leading to bowel ischemia. It starts as described above, but eventually the patient develops fever, leukocytosis, constant pain, signs of peritoneal irritation, and ultimately full-blown peritonitis and sepsis. Emergency surgery is required.
Mechanical intestinal obstruction caused by an ___ hernia has the same clinical picture and potential for strangulation as described above, but the PE shows the ___ hernia that used to be reducible. Because we can effectively eliminate the hernia, all of these undergo surgical repair, but the timing varies: emergently after proper rehydration in those who appear to be strangulated and electively in those who can be reduced manually and have a viable bowel
Mechanical intestinal obstruction caused by an incarcerated hernia has the same clinical picture and potential for strangulation as described above, but the PE shows the irreducible hernia that used to be reducible. Because we can effectively eliminate the hernia, all of these undergo surgical repair, but the timing varies:: emergently after proper rehydration in those who appear to be strangulated and electively in those who can be reduced manually and have a viable bowel
