GenSurg Flashcards
? is the name of the duodenal/jejunal feeding tube
How are positions verified
What are the E+ abnormalities seen w/ refeeding syndrome
Dobhoff tube
KUB films
Hypo K, Mg, Phos
What surveillance order is needed on Pts receiving TPN
Feeding tubes can be placed/started ? soon after surgery
Define Visceral vs Parietal pain
Weekly liver enzymes
Day 2 post-op
V: afferent fibers, pain MC midline d/t bilateral innervation
P: sharp/precise pain d/t peritoneal irritation
Sequence of x-ray assessment
What is a 3-way abdomen image and what is it used for
Abdominal x-rays normally show air in ? three areas
Adequacy Bones Calcifications Deformity/Density Extra air Foreign body/Fx
Flat, Upright, CXR for hemo/pneumo-peritononeum
Stomach Small bowel, Rectosigmoid
How are mechanical obstructions distinguished from ileus’
Ileus are more common after ? d/t ?
Sub-diaphragmatic air on x-ray suggests ? issue
Mechanical- more localized, severe pain
Ileus- diffuse and milder
Post-op d/t inc sympathetic nerve activity
Perforated viscous
Where does the appendix arise from
What land mark is used to locate it during removal
What causes this to become obstructed in adults/peds
Postero-medial cecum, 2cm inferior of IC valve
Taeniae of colon converging at base
Adult: fecalith Peds: lymphoid hyperplasia
What are the 3 PE tests performed to locate appendicitis
Mnemonic for Alvarado Score
McBurney: iliac fossa
Obturator- pelvis
Psoas- retroperitoneal/cecal
Migration to R iliac fossa- 2pts Anorexia N/V Tenderness in R iliac fossa Rebound pain Elevated temp Leukocytosis- 2pts (>75% neutrophils) Shift to left of WBCs
5-6: compatible 7-8: probable 9-10: very probable
What ABX are used during appendicitis
Appendix are routinely removed even if not inflamed during ? GI surgery
What PE test is used for rectus sheath hematoma
Cipro+Metronidazole: Perf’d
Cefoxitin: non-perf’d
Meckels Diverticulum
Neg Fothergill sign
Where are Boerhaave perfs most likely to occur
What images are done
What lab result would be elevated from thoracentesis after Boerhave perfs
Left posterolateral wall- causes Hamman crunch
Cervical x-ray
Esophagogram w/ contrast
Chest CT to localize
Amylase
? is the most sensitive imaging study for suspected esophageal cancers
How are Pts managed
? is the most important prognostic factor
Endoscopic US w/ FNA of lymph nodes
Neoadjuvant chemo and rad
Stage of Dz
What are the 2 MC complications to occur within 30days after bariatric surgery
What is the most concerning early complication
? is the MC performed bariatric surgery
Dehydration, E+ imbalance
Anastomotic leak
LSG
? is the most accurate method to Dx gastric ulcers
When is a Dx of Zollinger Ellison Syndrome considered
What lab test is used for Dx
Endoscopy
Ulcer refractory to PPI
Ulcer in distal duodenum/jejunum
Recurrent ulcers despite Tx
Fasting gastrin, d/c PPI one week prior
? pre-op image is used to localize Zollinger Ellison tumors and all are Tx w/ ?
? triple therapy is used for Tx
Why is maintenance therapy done w/ Omeprazole
Somatostain receptor scintigraphy; Resection
Amox Clarith w/ PPI
Inhibits parietal cell ATP tor educe ulcer recurrence
Test of choice for post-gastric ulcer Tx eradication
What procedures done to Tx high risk Pts w/ gastric ulcers
How are perforated duodenal ulcers Tx
Urea breath test
Billroth I- gastroduodenal anastomosis
Bilroth 2- gastrojejunal anastomosis
Roux en-Y gastrojejunostomy
Omental/Graham patch
Complications after antrectomy
Complications after Truncal Vagotomy
? type of diet do Pts adopt to Tx Dumping Syndrome
Leakage from duodenal stump
Delayed emptying, Dumping syndrome, Diarrhea
Low carb, High fat/protein
What is the most sensitive and specific test for suspected Pyloric Stenosis and how is this Tx
? type of ulcer is not associated w/ Ca risk
These ulcers can be Tx by ? methods
US; Laparoscopic pyloromyotomy
Duodenal
EGD <24hrs if hermorrhaging, Selective vagotomy
? is the MC form of volvulus
How are these Dx
Pts w/ ? signs need immediate surgery or ? if no signs are present
Sigmoid then Cecal
Colonic- X-ray; Small bowel- CT
Toxic, Bloody d/c, Fever, Leukocytosis, Peritonitis- surgery
None- sigmoidoscopy
Define Rigler Triad
How is this Dx
How is this Tx
Abdominal radiograph findings for gallstone ileus: Pneumobilia Obstruction Gallstone
CT
Enterolithotomy- incision made proximal to obstruction for relief and removal
Meckel’s Diverticulum is d/t a remnant of ?
What is the Rule of 2s
Omphalomesenteric duct
2% of peds population
2 tissue types: gastric, pancreatic
2 feet from ileocecal valve
? are the MC benign tumors of the small bowel
? are the MC malignant tumors of the small bowel
? are the MC endocrine tumors of the small bowel
Leimyoma, Adenoma
Adenocarcinoma
Carcinoid tumor: hot flash, bronchospasm, arrhythmias
Define Bezoar
How are these conditions Dx by images
How are they Tx
Compacted, retained foreign material in GI tract: Phyto- fiber Lacto- milk Pharma- meds Tricho- hair
AP films
Endoscopy then surgery
? is the most sensitive and specific study to Dx acute cholecystitis
MCC of cholelithiasis
What are the RFs to develop this MCC
Cholescintigraphy: Hida scan
Cholesterol stones
Age Female Obesity Parity
What causes pigmented stones in the gallbladder
When are pigmented stones seen
What are the non-surgical Tx options for cholecystitis in Pts inelligible for surgery
Inc unconjugated bilirubin, turns into Ca bilirubinate
Sickle Thalassemia Spherocytosis
Ursodeoxycholic acid: stones <15mm
ESWL- breaks stones <2mm for passing
Optimum time for cholecystectomy or ? is performed
What is the MC complication that arises from acalculous cholecystitis
Choledocholithiasis leads to ? Dx
<72hrs from Sx onset; Percutaneous cholecystostomy
Gangrene > Perf, Empyema
Cholangitis
Common Bile Duct dilation more than ? suggest choledocolithiasis
What are the high risk features for suspected choledocholithiasis
How are mild or mod/sev cases of cholangitis Tx w/ ABX
> 10mm/1cm
Age >55y/o Bili >30mmol CBD >6mm Dx US w/ stone
Mild/Mod: Cefazolin/Cefoxitin
Sev/Deterioration: Aminoglycoside + Clinda or Metro