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Pestana DF > General surgery and pediatric surgery chapters 4-5 > Flashcards

General surgery and pediatric surgery chapters 4-5 Flashcards

1
Q

when diagnosis of GERD is uncertain do what

A

pH monitoring

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2
Q

dysplastic changes of esophagus what treatment

A

ablatation and nissen fundoplication

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3
Q

motility problems of esophgus studies

A

barium swallow first

manometry confirm diagnosis

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4
Q

dysphagia that is worse with liquids and pt sitting up straight and waiting allows the weight of the column of liquid to overcome sphincter.

sometimes regurge of unddigested food

see what on x ray and what diagnoses and what is treatmetn

A

achalsia

xray shows megaesophagus

manometry is diagnostic

balloon dilation done by endoscopy to treat

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5
Q

diagnosing cancer of esophagus

A

barium swallow first in young low risk patients
to prevent perforation

then endoscopy and biopsy
-this first if high risk

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6
Q

diagnosis and treatment of mallory weiss tear and tx

A

endoscopy and photocoagulation (laser) if persistent bleed

most resolve on own

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7
Q

diagnosing boerhaave syndrome

A

contrast swallow (gastrografin first then barium if negative)

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8
Q

diagnosing gastric adenocarcinoma

A

endoscopy and biopsy

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9
Q

managment of mechanical intestinal obstruction

treatment
-complete vs partial

A

npo, ng suction, and IV fluids at first then surgery if this does not work

do within 24 hours of complete obstruction or few days with partial obstruction

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10
Q

diagnosing right sided colon cancer

A

colonoscopy and biopsy

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11
Q

bloody bowel movement cancer

which occult blood

A

left side

right side has 4+ for occult blood

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12
Q

treatment of anorectal fissure

first then refractory

A

stool softener, topical nitroglycerin, botulimum, CCB, topical anesthetics, sitz baths, fluids and fiber

if refractory then dilation or lateral sphincterotomy

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13
Q

fistula in ano develops after what and treatment

A

after pt had ischiorectal abscess drained

fistulotomy

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14
Q

when young person with GI bleed think what location

A

upper GI tract

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15
Q

workup for melana

A

upper GI endoscopy bc blood must be digested

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16
Q

red blood per rectum can come from where so what is workup

A

anywhere in the GI tract

pass NG tube and aspirate gasttic contents

  • if blood then upper source, so do endoscopy
  • no blood and fluid is white the territory from tip of nose to pylorus excluded but duodenum still possible, still do upper GI endoscopy

if upper GI bleed excluded then other notecard

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17
Q

if upper GI bleed excluded from red blood per rectum then do what first then what (based off blood loss)

-in an active bleed

A

check bleeding hemorrhoids first with anoscopy
-if excluded then

-rate of bleed: if over 2mL/min then angiogram and embolization

if less than 0.5 mL/min, wait till bleed stops then do colonscopy

cases in between can do a tagged red cell study

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18
Q

patients with a recent history of blood per rectum but not actively bleeding what is workup for young person and for old person

A

young do upper GI endoscopy

old do upper and lower

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19
Q

blood per rectum in a child is from what and workup

A

meckel diverticulum

start workup with technetium scan looking for ectopic gastric mucosa

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20
Q

diagnosing abdominal perforation

A

upright x ray showing free air under diaphragm

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21
Q

onset of colicky falnk pain radiating to inner thigh and scrotum or labia is what

may also see what in UA

best diagnostic test

A

ureteral stones

microhematuria

CT

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22
Q

treating acute diverticulitis

A

NPO, IVF, and Abx

if this does not cool down then probably abscess that can be drained percut

if cannot then surgery

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23
Q

when should surgery be performed in acute diverticulitis

A

if have 2 episodes then elective removal

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24
Q

volvulus of sigmoid seen in what pop

what is diagnostic and shows what

A

old people

x rays, air fluid levels in small bowel, distended colon, and huge air filled loop in RUQ that tapers down toward LLQ with shape of parrots beak

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25
Q

treating volvulus of the sigmoid

A

proctosigmoidoscopic exam with old rigid instruments resolves and rectal tube left in

recurrent cases need elective sigmoid resection

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26
Q

what might save the day in mesenteric ischemia if caught early

A

arteriogram and embolectomy

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27
Q

primary hepatoma aka hepatocellular carcinoma in what pts and what blood marker and what image

A

cirrhosis, hep B or C

AFP

CT scan

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28
Q

hepatic adenoma diagnosis and treatment

A

CT scan and emergency surgery bc can rupture and bleed

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29
Q

treating amebic abscess of liver

what country connection

A

mexico, give MTZ

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30
Q

hemolytic jaundice is usually what level of biulirubin

A

6 to 8

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31
Q

hepatocellular jaundice labs

A

direct and indirect bili up
really high transaminases
modest or mild alkaline phosphatase raised

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32
Q

obstructive jaundice labs

A

mainly alk phos elevated

33
Q

workup of obstructive jaundice

A

US or CT

34
Q

obstructive jaundice caused by stones diagnoses and treatment

A

US
ERCP
cholecystectomy

35
Q

what obstructive jaundice tumor is lots of wieght loss and constant back pain

A

pancreatic tumor

36
Q

obstructive jaundice caused by tumor and CT scan negative and FOBT + and colonscopy is negative, what is next step then next step bc what path

A

ampullary cancer

1) **MRCP can show smaller tumors blocking flow of bile
2) ERCP or EUS with biopsy next

37
Q

malignant obstructive jaundice with anemia and positive blood in stool

A

ampullary cancer

38
Q

obstructive jaundice and cancer symptoms what is the management steps

A

1) RUQ US would show thin walled, dilated GB with no inflammation
2) CT scan

3) do MRCP or ERCP if the imaging is not diagnostic
- biopsy

39
Q

biopsy for 3 obstructive jaundice tumors

A

ERCP or endoscopic US with biopsy (tiny tumor in head of pancreas)

40
Q

treatment of pancreatic cancer

A

whipple procdure

pancreatoduodenectomy

41
Q

managment of acute cholecystitis

A

NG suction, NPO, IVF and antibiotics cool it down then can have elective cholecystectomy

cholecystostomy in non surgical candidates

42
Q

acute ascending cholangitis treatment

A

1) NPO, IVF, and IV abx while getting ERCP ready
2) ERCP
3) urgent cholecstectomy has to follow

43
Q

pericholecsytic fluid on U/S

A

cholecystitis

44
Q

if suspected choledocho and RUQ is negative what is next step

A

MRCP

45
Q

what can confirm cholecystitis

A

HIDA

46
Q

biliary pancreatitis produces what sx

dx

tx

A

pancreatitis sx with ALT above 150

1) US shows gallstones
NPO, ng suction, IVF

2) cholecystectomy later
3) if this does not work then ERCP

47
Q

pancreatitis and ALT above 150 =

A

gallstone pancreatitis

48
Q

acute pancreatitis with lower hematocrit

next day, hematocrit lower, serum calcium remains low even with calcium administaration and BUN goes up and metabolic acidosis eventually occurs

A

acute hemorrhagic pancreatitis

49
Q

5-10 days after acute pancreatitis get fevers, septic, leukocytosis

A

CT scan showing abscess

I and D and zbx

50
Q

2 weeks after pancreatitis get early satiety, weight loss and abdominal pain then what

A

CT scan and see pseudocyst

  • if under 6 weeks and 6 cm then W and W
  • if over either above then drain it or surgery
51
Q

if hours to days are SAS or hypotensive after pancreatitis then what and is what

A

CT scan showing necrotizing pancreas

  • if FNA biopsy is positive then carbopenum or meropenum
  • ICU and daily CT scan, once the fluid has finally finished collecting and solidified (usually 4 weeks) then necrosectomy
52
Q

managing cystosarcoma phyllodes

A

seen in late 20s

core or inscisional biopsy needed and removal is mandatory

53
Q

next step if you have bilateral tenderness related to menstrual cycle and multiple lumps that seem to come and go with no dominant or persistent mass

what if one does persist or is a dominant mass

clear, persists, bloody

A

mammogram only

aspiration

  • if clear and goes away then done
  • if mass persists or recurs after aspiration: biopsy
  • if bloody fluid aspirated then send to cytology
54
Q

diagnostic and guides surgical resection in intraductal papillma

A

galactogram

55
Q

treatment for breast abscess

A

I and D

biopsy should be done too

56
Q

treatment of resectable breast cancer

small lesion far from nipple and arola of large breast

A

lumpectomy and radioation

57
Q

treatment of breast cancer that resectable

large tumors by nipple or areola and occupy most of a small breast

A

simple total mastectomy and no radiation following

58
Q

when would you need a sentinel node biopsy in breast cancer?

when resect?

A

if LNs are not palpable in the axilla

if enlarged LNs palpable in axilla they are resected

59
Q

DCIS in breast treatment if lesion conifned to one quarter of breast

what if multicentric lesions

A

multicentric: total simple mastectomy

lumpectomy for confinement then radiation

60
Q

does thyroid cancer affect thyroid function

A

no (usual rule of thumb)

61
Q

follicular cancer diagnosis and treatment

A

hard by FNA

lobectomy may be needed to determine if a follicular neoplasm is benign or malignant

total thyroidectomy

62
Q

medullary cancer from what cells and makes what and treatment

check what else

A

c cells that make calcitonin

radical surgery

check pheo bc MEN type 2*****

63
Q

what helps locate offending gland in hyperparathyroidism

A

sestamibi scan

64
Q

what tumor that produces CNS symptoms when pt fasting

A

insulinoma

65
Q

diagnosing insulinoma and treatment

A

CT and remove

66
Q

what tumor produces severe migratory necrolytic dermatitis

A

glucagonoma

67
Q

what cancer: migratory thrombophlebitis

A

pancreatic

68
Q

hyperplasia vs conns syndrome

which one responds to postural changes (more aldosterone when upright than when lying down)

A

hyperplasia

69
Q

what is diagnostic of coarctation of the aorta

A

spiral CT angiogram

70
Q

renovascular hypertension workup

A

duplex scan and CT angio

71
Q

poly or oligohydramnios can occur in congenital diaphragmatic hernia?

lung sounds and issues and heart issues and sounds

A

poly bc of compression of esophagus

usually left sided so absent lung sounds on left

bowel can moves heart to right which displaces right lung which can lead to right sided heart sounds

72
Q

management of congenital diaphragmatic hernia

A

1) emergency intubation and careful ventilation
2) NG tube placement with suction
3) umbilical artery line for ABGs and BP
4) ubilical vein line for admin of fluids and meds

73
Q

when to repair extrophy of the urinary bladder

A

1-2 days of life

74
Q

double bubble with normal gas pattern beyond is what and how to diagnose

A

malrotation

Upper GI is most accurate then contrast enema is next best test

75
Q

treatment for necrotizing enterocolitis

A

stop feedings
administer broad spectrum abx
IVF
IV nutrition

76
Q

bilious vomiting, feeding intolerance,

xray shows multiple dilated loops of small bowel and ground glass appearance in the lower abdomen

what is it and treatment

A

meconium ileus

gastrografin enema dx and tx

77
Q

baby that is 6-8 weeks old and has persistent progressively increasing jaundice

A

biliary atresia

78
Q

undescended testicle that has not reached the scrotum by age ____ needs to be surgically brought down and fixed in place to prevent what

still at greatest risk for what

A

age 1 need orchiopexy

torsion, infertility, and cancer

greatest risk after surgery is infertility

79
Q

abdominal mass that moves up and down with repsiration in child is most likely what, and what elevated

what if deeper and non mobile

A

malignant liver tumor (hepatoblastoma or carcinoma)

AFP elevated

if deeper and non mobile then wilms tumor or neuroblastoma

Pestana DF (5 decks)

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