general surgery GI Flashcards
what surgery thing would you need to rule out in a GERD presentation
hiatal hernia
globus sensation
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
GERD + dysphagia think
Barret’s
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
classic pain with duadenal ulcer
2-5 hours after when the stomach has emptied and the
when i eat something i feel better
peptic ulcers
worsen with eating
feel full earlier and can’t tolerate fatty foods
N amd occasional vomiting
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
anbx that you would use for duodenal ulcer perf
pipericillin/tazobactum
zollinger ellison syndrome
gastrin secreting neuorendocrine tumor causing gastric acid and hypersecretion of acids
can get in any endocrine organs
CM of zollinger ellison
multiple refractory ulcers
kissing ulcers
abdominal pain
diarrhea
dx for zollinger ellison syndrome
fasting gastrin level best
secreting test, basal acit output is increased
chromogranin a
somastostatin receptor scintography
zollinger ellison syndrome
surgical resection of tumor
gastric carcinoma occurs in what population
males >40 yo
andenocarcinoma is the most common
RF for gastric carcinoma
H pylori-changes the environment of the stomach pernicious anemia achlorrhydria smoking ETOH blood type A
pernicious anemia
vitamin B deficiency cause by autoantibodies that interfere with B12
body is targeting intrinsic factor
gastric carcinoma
Indigestion Weight loss Early Satiety Abdominal pain/fullness Nausea Post-prandial vomiting Dysphagia Melena Hematemesis May have FE Anemia Signs of Metastasis
vrichow’s node
Supraclavicular Lymph Node (Virchow’s Node)
associated with gastric carcinoma METS
sister Mary Joseph’s Node)
Umbilical Lymph Node – (Sister Mary Joseph’s Node)
associated with gastric carcinoma METS
dx of gastric carcinoma
Upper endoscopy with biopsy
treatment of gastric carcinoma
Gastrectomy
XRT(radiation) and Chemo
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
