General Surgery Boards Flashcards
Types of Rectus sheath hematomas? (3 Types)
Type 1: Doesn’t cross midline and contained to muscle. Observe
Type 2: Crosses to other side and along transversalis fascia. Reverse AC
Type 3: Free rupture. Angio and embolizaiton
Primary Sclerosing Cholangitis. Which cancers do you need to keep an eye for and how to do surveillance:
Billiary/Liver: MRCP and US q6-12 months
CA 19-9: q 12 months
C-Scope: q 1-2 years
While histologic layer do you need to remember for GB cancer?
T1a: invasion into lamina propria.
T1b: invasion into muscularis propria
T2: beyond Muscularis propria
T3: Beyond serosa
T4: into vasculature or more than one extrahepatic structure
How many lymph nodes do you need when doing lymphadenectomy for GB cancer? And which nodes?
6
Porta-hepatis.
Retro-duodenal
Gastro-hepatic
Do you send frozen sections in GB cancer resection?
Which margins do you need to check if you take out cancer incidentally?
Liver margin and cystic duct margin to determine if you need to do a reconstruction
Always check the margins. Best to bget R0 resection.
Bismuth-Corlette Criteria
Type 1: Common hepatic duct
Type 2: Involves hepatic bifurcation
Type 3: Extending into a single (L or R) hepatic duct.
Divided into Type 3a or type 3b (depending on the side)
Type 4: Involves bilateral (L + R) hepatic ducts
Type 5: Involves secondary hepatic ducts on both sides
Types of Choledochal Cysts
Type 1:
Fusiform dilation of the CBD. I.e, dilation of the extrahepatic biliary tract. Treatment is chole, resection of cysts and H-J after getting negative margins and cholecystectomy
Type 2: Diverticulum of the bile duct. Diverticulectomy
Type 3: Dilation within the duodenal wall. Don’t have malignant potential risk. if small, sphincterotmoy. if large, transduodenal excision
Type 4: Extra and intra hepatic. or simply extrahepatic. Always resect w/ HJ. Can do lobectomy if lobe invovled.
Type 5: purely intrahepatic. If focal, resect. If multiple, liver transplant.
When is best time to fix CBD injury?
If in OR, then fix then. < 50% fix over T-Tube. > 50%, HJ
< 72 h - Fix
> 72 h: Get CTA to r/o vascular injury. get control w/ ERCP, PTC, drain.
Which stage anal squamous cell carcinoma can be excised?
T1, which is < 2cm. Need 1 cm margin as long as no sphincter involvement.
How do you stage anal squamous cell CA?
HIV CT C/A/P MRI of pelvis can help u determine if there any adjacent structure involvement Colposcopy Colonoscopy
Nigro protocol?
Mitomycin + RT + 5FU
T1 Colon Cancer
T1 = Invasion into submucosa
T2 colon cancer
T2 = muscularis propria
T3 colon cancer
T3 = subserosa
T4 colon cancer
t4 = invasion into serosa or adjacent organ
T1 colon cancer
n1 1-3
N2 colon cancer
> 4 modes
N3 colon cancer
distant nodes
if patient has N0 disease with colon ca, what stage can they be maximum?
Stage 1 or 2
if pt has N1 - N2 disease, what stage are they with colon cancer?
Stage 3
Stage 1 and stage 2 colon cancer treatment
Stage 1 = Resection
Stage 2 = Resection and chemotherapy if high risk features (less than 12 nodes, lymphovascular invasion, MSH instability
What are the margins needed for rectal cancer?
High rectal: 5 cm
Middle or low: 2cm ideal. However 1cm if close to the anal sphincter.
If doing trans-anal excision: 3mm
How do you manage T1 lesions if High or low rectum?
High rectum: LAR
Low rectum, can do transanal excision (3mm margin) if mobile, less than 3cm, less than 30% of circumfrential wall, and
how do you manage a T2 rectal cancer lesion?
High T2 = LAR
Low T2 (i.e., within 5cm of the anal verge) - these patients can get neoadjuvant chemoRT to try and downstage for either transanal excision or LAPR/APR
