General surgery and pediatric surgery chapters 4-5 Flashcards
(79 cards)
when diagnosis of GERD is uncertain do what
pH monitoring
dysplastic changes of esophagus what treatment
ablatation and nissen fundoplication
motility problems of esophgus studies
barium swallow first
manometry confirm diagnosis
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
achalsia
xray shows megaesophagus
manometry is diagnostic
balloon dilation done by endoscopy to treat
diagnosing cancer of esophagus
barium swallow first in young low risk patients
to prevent perforation
then endoscopy and biopsy
-this first if high risk
diagnosis and treatment of mallory weiss tear and tx
endoscopy and photocoagulation (laser) if persistent bleed
most resolve on own
diagnosing boerhaave syndrome
contrast swallow (gastrografin first then barium if negative)
diagnosing gastric adenocarcinoma
endoscopy and biopsy
managment of mechanical intestinal obstruction
treatment
-complete vs partial
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
diagnosing right sided colon cancer
colonoscopy and biopsy
bloody bowel movement cancer
which occult blood
left side
right side has 4+ for occult blood
treatment of anorectal fissure
first then refractory
stool softener, topical nitroglycerin, botulimum, CCB, topical anesthetics, sitz baths, fluids and fiber
if refractory then dilation or lateral sphincterotomy
fistula in ano develops after what and treatment
after pt had ischiorectal abscess drained
fistulotomy
when young person with GI bleed think what location
upper GI tract
workup for melana
upper GI endoscopy bc blood must be digested
red blood per rectum can come from where so what is workup
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
if upper GI bleed excluded from red blood per rectum then do what first then what (based off blood loss)
-in an active bleed
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
patients with a recent history of blood per rectum but not actively bleeding what is workup for young person and for old person
young do upper GI endoscopy
old do upper and lower
blood per rectum in a child is from what and workup
meckel diverticulum
start workup with technetium scan looking for ectopic gastric mucosa
diagnosing abdominal perforation
upright x ray showing free air under diaphragm
onset of colicky falnk pain radiating to inner thigh and scrotum or labia is what
may also see what in UA
best diagnostic test
ureteral stones
microhematuria
CT
treating acute diverticulitis
NPO, IVF, and Abx
if this does not cool down then probably abscess that can be drained percut
if cannot then surgery
when should surgery be performed in acute diverticulitis
if have 2 episodes then elective removal
volvulus of sigmoid seen in what pop
what is diagnostic and shows what
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
