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Surgery > general surgery GI > Flashcards

general surgery GI Flashcards

1
Q

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

A

hiatal hernia

globus sensation

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2
Q

GERD like sxs that would indicate malignancy

A 
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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3
Q

GERD + dysphagia think

A

Barret’s

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4
Q

RF for barret’s

A 
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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5
Q

classic pain with duadenal ulcer

A

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

when i eat something i feel better

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6
Q

peptic ulcers

A

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

N amd occasional vomiting

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7
Q

treatment for perf duodenal ulcer is

A

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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8
Q

anbx that you would use for duodenal ulcer perf

A

pipericillin/tazobactum

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9
Q

zollinger ellison syndrome

A

gastrin secreting neuorendocrine tumor causing gastric acid and hypersecretion of acids

can get in any endocrine organs

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10
Q

CM of zollinger ellison

A

multiple refractory ulcers
kissing ulcers
abdominal pain
diarrhea

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11
Q

dx for zollinger ellison syndrome

A

fasting gastrin level best

secreting test, basal acit output is increased

chromogranin a
somastostatin receptor scintography

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12
Q

zollinger ellison syndrome

A

surgical resection of tumor

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13
Q

gastric carcinoma occurs in what population

A

males >40 yo

andenocarcinoma is the most common

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14
Q

RF for gastric carcinoma

A 
H pylori-changes the environment of the stomach
pernicious anemia 
achlorrhydria
smoking
ETOH
blood type A
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15
Q

pernicious anemia

A

vitamin B deficiency cause by autoantibodies that interfere with B12

body is targeting intrinsic factor

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16
Q

gastric carcinoma

A 
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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17
Q

vrichow’s node

A

Supraclavicular Lymph Node (Virchow’s Node)

associated with gastric carcinoma METS

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18
Q

sister Mary Joseph’s Node)

A

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

associated with gastric carcinoma METS

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19
Q

dx of gastric carcinoma

A

Upper endoscopy with biopsy

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20
Q

treatment of gastric carcinoma

A

Gastrectomy

XRT(radiation) and Chemo

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21
Q

Functional cause of Gastric Outlet obstruction

A

pyloric stenosis

22
Q

pyloric stenosis presentation in adults

A

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

23
Q

workup of pyloric stenosis

A

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

24
Q

tx of pyloric stenosis

A

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

25
Q

gallstone pancreatitis labs

A

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)

26
Q

UA signs of pancreatitis

A

billirubin in the urine

27
Q

chronic pancreatitis would be seen with

A

calcifications and inflammation in the pancrease are indicative of chronic pancreatits

28
Q

imaging for acute pacreatitis

A

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

29
Q

what can be seen on CT of pacreatitis

A

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

30
Q

tx of pancreatits and chiolangitis

A

admit to hospital NPO
IV fluids- lactated ringers

ANBX if cholangitis
ERCP if cholangitis

31
Q

acute pancreatitis findings

A

GALLSTONES ( 5 F’s – Fat, Fertile, Forty, Female, Flatulent)

alcohol
elevated triglyceride
pancreatic tumor

32
Q

findings with acute pancreatis

A

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)

33
Q

chronic pancreatitis involves

A

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

34
Q

RF for pancreatic carcinoma

A

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

35
Q

CM of pancreatic cancer

A

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

36
Q

workup of pancreatic cancer

A

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

37
Q

Courvoisier’s sign

A

palpable,

non-tender distended GB

38
Q

complications of whipple

A

if you remove the pylorus you get dumping syndrome

terrible diarrhea

39
Q

presentation of meckle’s diverticulm

A

Asymptomatic

Painless rectal bleeding or ulceration

Pain periumbilical that moves into the right groin

40
Q

rule of 2’s with meckle’s

A 
2 % of population
2 feet from ileosecal valve
2 inches in length,
2 types of ectopic tissue (gastric, pancreas)
2x more common in boys
41
Q

what is meckle’s diverticulem?

A

Persistent portion of embryonic vitteline duct (yolk stalk)

42
Q

dx tx of meckle’s

A

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

surgical excision

43
Q

causes of SBO

A

Post surgical adhesions 60%

Hernias, Crohons disease, Malignancy

44
Q

Sxs of SBO

early and late

A

Crampy abdominal pain, vomiting, diarrhea (early),

Obstipation (late)

Pain usually escalates from mild and intermittent –> severe and constant

45
Q

imaging for SBO

A

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

46
Q

mangement for SBO

A

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

47
Q

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

A

higher irsk of throwing a clot

hyper coagulable state

48
Q

work up of mesenteric ischemia

A

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

49
Q

mngmt of mesenteric ischemia is

A

revascularization
surgical resection of the unsalvageable bowel

surgery is emergent to preserve the bowel

50
Q

what post op workup would you need for mesenteric ischemia

A

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

51
Q

chronic dz that can cause constipation

A

cancer
DM
hypothyroidism

Surgery (18 decks)

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