general surgery GI Flashcards by Lux Smith

what surgery thing would you need to rule out in a GERD presentation

hiatal hernia

globus sensation

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GERD like sxs that would indicate malignancy

New onset age 60 or over
Evidence of GI Bleed
Iron deficiency anemia 
Anorexia
Unexplained weight loss
Dysphagia
Odynophagia
Persistent vomiting
GI cancer in 1st degree relative

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GERD + dysphagia think

Barret’s

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RF for barret’s

Age over 50
Male Sex
White race
Chronic GERD ( more than 5 years or more than 2x per week
Hiatal Hernia
Elevated BMI
Intra-abdominal distribution of body fat
Tobacco use

Chronic GERD plus 2 or more, get upper endoscopy looking for abnormal columnar epithelieum >1cm, + biopsy

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classic pain with duadenal ulcer

2-5 hours after when the stomach has emptied and the

when i eat something i feel better

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peptic ulcers

worsen with eating
feel full earlier and can’t tolerate fatty foods

N amd occasional vomiting

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treatment for perf duodenal ulcer is

laparoscopic surgery

might need to do open if here is a lot of spillage

Coverage with a Graham Omental patch and irrigation of the gastic contents from the abdomen.

Replacement of electrolytes, IV hydration

Broad spectrum antibiotics for spillage of GI flora into sterile space

NG tube, may be placed if vomiting or in the operating roo

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anbx that you would use for duodenal ulcer perf

pipericillin/tazobactum

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zollinger ellison syndrome

gastrin secreting neuorendocrine tumor causing gastric acid and hypersecretion of acids

can get in any endocrine organs

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CM of zollinger ellison

multiple refractory ulcers
kissing ulcers
abdominal pain
diarrhea

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dx for zollinger ellison syndrome

fasting gastrin level best

secreting test, basal acit output is increased

chromogranin a
somastostatin receptor scintography

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zollinger ellison syndrome

surgical resection of tumor

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gastric carcinoma occurs in what population

males >40 yo

andenocarcinoma is the most common

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RF for gastric carcinoma

H pylori-changes the environment of the stomach
pernicious anemia 
achlorrhydria
smoking
ETOH
blood type A

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pernicious anemia

vitamin B deficiency cause by autoantibodies that interfere with B12

body is targeting intrinsic factor

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gastric carcinoma

Indigestion
Weight loss
Early Satiety
Abdominal pain/fullness
Nausea
Post-prandial vomiting
Dysphagia
Melena
Hematemesis
May have FE Anemia
Signs of Metastasis

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vrichow’s node

Supraclavicular Lymph Node (Virchow’s Node)

associated with gastric carcinoma METS

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sister Mary Joseph’s Node)

Umbilical Lymph Node – (Sister Mary Joseph’s Node)

associated with gastric carcinoma METS

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dx of gastric carcinoma

Upper endoscopy with biopsy

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treatment of gastric carcinoma

Gastrectomy

XRT(radiation) and Chemo

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Functional cause of Gastric Outlet obstruction

pyloric stenosis

pyloric stenosis presentation in adults

Can be found in adults secondary to peptic ulcer disease and malignancy

Caused by a fibrotic stricture that persists after an ulcer heals, preventing the pylorus from functioning properly

workup of pyloric stenosis

Ultrasound – done for infants, shows length of the pylorus and the muscle thickness
Barium swallow studies
Endoscopy – can allow for biopsies
CT scan

will see electrolyte abnormalities and need to replace volume

tx of pyloric stenosis

– Laparoscopic or open pyloromyotomy (longitudinal cut in the pylorus to cause the mucosa to bulge outward)
Or endoscopic approach

gallstone pancreatitis labs

AST, ALT, Alk phos, Tbili, D Bili, lipase, amylase lipase most sensitive chem 7 will be Likely signs of dehydration due to vomiting (loss of gastric electrolytes)

UA signs of pancreatitis

billirubin in the urine

chronic pancreatitis would be seen with

calcifications and inflammation in the pancrease are indicative of chronic pancreatits

imaging for acute pacreatitis

Ultrasound of GB and biliary tree for stones and ductal dilation u CT scan is often used

what can be seen on CT of pacreatitis

u Can show pancreatic inflammation u Stones u Pancreatic pseudocysts u Calcifications and inflammation in chonic pancreatitis u May show pancreatic head mass causing obstruction

tx of pancreatits and chiolangitis

admit to hospital NPO IV fluids- lactated ringers ANBX if cholangitis ERCP if cholangitis

acute pancreatitis findings

GALLSTONES ( 5 F’s – Fat, Fertile, Forty, Female, Flatulent) alcohol elevated triglyceride pancreatic tumor

findings with acute pancreatis

N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion or following fatty meals. Exam Cullen and Grey Turner’s Sign – peri-umbilical or flank ecchymosis (indicating retroperitoneal bleeding)

chronic pancreatitis involves

Syndrome involving progressive inflammatory changes which can lead to impaired exocrine and endocrine function. Recurrent Episodes of acute pancreatitis lead to chronic over time.

RF for pancreatic carcinoma

Smoking >60 years old, chronic pancreatitis, ETOH, DM, obesity Most have already metastasized by time of diagnosis – met to regional nodes and liver

CM of pancreatic cancer

Painless jaundice Abdominal pain Pruritis Physical Exam – Courvoisier’s sign – palpable, non-tender distended GB

workup of pancreatic cancer

CT scan – pancreatic protocol with and without contrast (2mm cuts) Labs – Elevated CEA, CA 19-9, may have other elevations if CBD obstruction or PD obstruction

Courvoisier’s sign

palpable, | non-tender distended GB

complications of whipple

if you remove the pylorus you get dumping syndrome terrible diarrhea

presentation of meckle's diverticulm

Asymptomatic Painless rectal bleeding or ulceration Pain periumbilical that moves into the right groin

rule of 2's with meckle's

``` 2 % of population 2 feet from ileosecal valve 2 inches in length, 2 types of ectopic tissue (gastric, pancreas) 2x more common in boys ```

what is meckle's diverticulem?

Persistent portion of embryonic vitteline duct (yolk stalk)

dx tx of meckle's

often a CT scan has already been ordered in the ER -->meckel’s Scan surgical excision

causes of SBO

Post surgical adhesions 60% | Hernias, Crohons disease, Malignancy

Sxs of SBO early and late

Crampy abdominal pain, vomiting, diarrhea (early), Obstipation (late) Pain usually escalates from mild and intermittent --> severe and constant

imaging for SBO

Abdominal xray (often referred to KUB) Shows Air fluid levels in a “step ladder pattern” Shows dilated loops of bowel

mangement for SBO

Admit to hospital NPO (bowel rest) Bowel decompression with NG tube to suction IV fluids If strangulated – surgery is indicated Initial first approach can be laparoscopic or open

why would a fibb put you at higher risk for mesenteric ischemia

higher irsk of throwing a clot hyper coagulable state

work up of mesenteric ischemia

Angiogram gives definitive diagnosis, increased WBC count and lactic acidosis as a result of mesenteric ischemia

mngmt of mesenteric ischemia is

revascularization surgical resection of the unsalvageable bowel surgery is emergent to preserve the bowel

what post op workup would you need for mesenteric ischemia

Workup for hypercoagulable state – may require additional measures to prevent further clots and causes

chronic dz that can cause constipation

cancer DM hypothyroidism