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Surgery > GI > Flashcards

GI Flashcards

1
Q

What is the most important risk factor for adenocarcinoma and why?

A

GERD; causes barret’s esophagus

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2
Q

What does Barret’s metaplasia due?

A

Changes squamous to Columnar/Intestinal (glandular) epithelium

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3
Q

Squamous cell carcinoma affects which part of the esophagus?

A

Mid portion (upper 2/3)

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4
Q

Adenocarcinoma affects which part of the esophagus?

A

Lower 1/3

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5
Q

Gold standard for the diagnosis of esophageal cancer?

A

Endoscopic tissue biopsy

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6
Q

Best for staging esophageal cancers?

A

1) Endoscopy
2) PET
3) Chest and abdominal CT
4) EUS

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7
Q

Gold standard for diagnosing T stage of esophageal cancer?

A

EUS

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8
Q

Gold standard for diagnosing N stage of esophageal cancer?

A

EUS + CT and PET

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9
Q

Gold standard for diagnosing M stage of esophageal cancer?

A

CT and PET

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10
Q

Stage 1 esophageal cancer treatment?

A

Esophagectomy

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11
Q

Stage 2+3 esophageal cancer treatment?

A

Neoadjuvent therapy followed by esophagectomy

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12
Q

When do you do a gastrectomy?

A

Below GEJ involving the cardia (Siewert III)

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13
Q

Black gallstones are mainly made up of?

A

Calcium Carbonate

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14
Q

Brown gallstones are mainly made up of?

A

Calcium Palmitate

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15
Q

Black gallstones are formed in?

A

The gallbladder

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16
Q

Brown gallstones are formed in?

A

The billiary tree

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17
Q

What does hydroxylase do to free cholesterol ester?

A

Turns them into bile salt

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18
Q

What does ACAT do to free cholesterol ester?

A

Turns them to cholesterol ester

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19
Q

What can cause cholesterol saturation?

A

1) Increased secretion of cholesterol
2) Decreased secretion of bile salts
3) Decreased secretion of lecithin

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20
Q

Why do gallstones form in a defective gallbladder?

A

1) Impaired absorptive capacity = ↑tendency of nucleation.

2) Impaired secretion: lack of bile
acidification→ precipitation of Ca
palmitate+Ca bilirubinate+Ca carbonate→Nidus.

3) Impaired motility:
a) Impaired contraction:→↑fasting
volume→ ↑residual volume→↓rate of emptying▬►stasis (obesity,pregnancy, DM,TPN,post-gastrectomy).
b) Accelerated emptying▬►shrinkage of
bile acid pool→saturated bile.

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21
Q

Gallbladder risk factors?

A

1) Elevated estrogen
2) Obesity
3) Rapid weight loss
4) Spinal cord injury & disease with terminal ileum
5) Age
6) Hyperlipidemia
7) Intestinal hypomotility
a) Viral,drug induced
b) Diabetes
c) Increased production of lithogenic secondary bile acids
(deoxycholate)
9) Long term parenteral nutrition

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22
Q

Which drugs can cause gallbladder stones?

A

1) Ceftriaxone (Rocephin)
2) Octreotide

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23
Q

Pathogenesis of pigmented stones?

A

Increase in Beta-Glucuronidase

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24
Q

Pathogenesis of brown stones specifically?

A

Chronic low-grade infections

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25
Q

Pathogenesis of black stones specifically?

A

Mucosa of gallbladder/billiary tree

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26
Q

What is peritonitis?

A

Inflammation of the serous lining of the peritoneal cavity

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27
Q

What are the causes of peritonitis?

A

1) Microorganisms
2) Chemicals
3) Foreign body

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28
Q

Risk factors of primary peritonitis?

A

1) Liver cirrhosis with ascites
2) Chronic ambulatory peritoneal dialysis
3) Abdominal catheters connecting to exterior body

29
Q

Most common cause of Intra-abdominal abscess?

A

Appendicitis

30
Q

On which side do you usually find colorectal polyps?

A

Left

31
Q

Which type of colorectal polyp is most common?

A

Adenomatous polyps

32
Q

Which type of colorectal polyp is most common?

A

Adenomatous polyps

33
Q

What size are most adenomas?

A

<1cm

34
Q

Adenomas are classified according to?

A

The growth pattern of the glands

35
Q

Tubular adenomas?

A

0 to 25% of the glands are villous (MOST COMMON)

36
Q

Tubulovillous adenomas?

A

25 to 75% of the glands are villous

37
Q

Villous adenomas?

A

75-100% of the glands are villous

38
Q

Which is more dangerous: a colorectal polyp on the right or the left side?

A

The right side

39
Q

FAP is associated with which mutation?

A

APC gene

40
Q

What is the risk of cancer in FAP?

A

100%

41
Q

What is the blood supply of the appendix?

A

The appendiceal artery, is a terminal branch of the ileocolic artery

42
Q

On which side do you usually find colorectal cancer?

A

Left

43
Q

Which 2 inherited syndromes predispose to colorectal cancer?

A

1) FAP
2) Lynch syndrome (HNPCC)

44
Q

Mutation in Lynch (HNPCC)?

A

Mismatched repair genes

45
Q

Investigation for a rectal tumor?

A

Pelvic MRI

46
Q

Which blood test is important before and after colorectal surgery?

A

Serum CEA levels

47
Q

Can we give neoadjuvent therapy for colon cancer?

A

No, it can damage the small bowel. Go straight to surgery

48
Q

Younger age is a risk factor for what in diverticular disease?

A

Recurrence

49
Q

How to diagnose diverticulitis?

A

CT

50
Q

Diverticulitis treatment?

A

Antibiotics

51
Q

The high frequency of liver metastasis is
caused by:

A

1) The liver’s vast blood supply, which originates from portal and systemic systems.

2) The fenestrations of the hepatic sinusoidal endothelium may facilitate penetration of
malignant cells into the hepatic parenchyma.

3) Humoral factors that promote cell growth and cellular factors, such as adhesion
molecules, favor metastatic spread to the liver.

4) The liver’s geographic proximity to other intra-abdominal organs may allow malignant
infiltration by direct extension.

52
Q

Best imaging for liver mets?

A

Ultrasound

53
Q

Which cancer is most likely to metastasize to the liver?

A

Colorectal cancer

54
Q

Best management for liver mets?

A

Hepatectomy (resection)

55
Q

Where do carcinoid tumors originate?

A

Enterochromaffin cells

56
Q

Midgut carcinoids secrete large amounts of what?

A

5-HT (Serotonin)

57
Q

WHAT MAKES CARCINOIDS METASTASIZE?

A

THEIR SIZE!!!

58
Q

What is highly specific for carcinoid syndrome?

A

Elevated urine levels of 5-HIAA

59
Q

Treatment of local carcinoid tumors?

A

Resection with lymph drainage

60
Q

Adenocarcinoma + Crohn’s in ileum = good or bad prognosis?

A

Bad

61
Q

Poor prognostic factor in gastric cancer?

A

The T stage (how much it invaded the wall)

62
Q

What would a FAST exam reveal?

A

Hypoechoic rim on the spleen

63
Q

What are the 2 rules of surgery in acute ulcerative colitis?

A

1) Stool frequency >8 times a day or CRP >45 for 3 days (not getting better)

2) IV steroids for 5 days (not getting better)

64
Q

Best surgery in acute ulcerative colitis?

A

Subtotal colectomy and ileostomy

65
Q

Best surgery in acute ulcerative colitis?

A

Subtotal colectomy and ileostomy

66
Q

Which cancer is the most common pancreatic cancer?

A

Ductal adenocarcinoma

67
Q

The most common presenting
symptoms in pancreatic cancer are:

A

1) Pain
2) Jaundice
3) Weight loss

68
Q

What sign do we look for on ERCP in pancreatic cancer?

A

“Double duct sign” = Dilation of both the pancreatic duct and the common bile duct

69
Q

What is the only potentially curative modality of treatment for pancreatic cancer?

A

Complete surgical resection

Surgery (7 decks)

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