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EOR - Gen Surg > GI - 50% > Flashcards

GI - 50% Flashcards

1
Q

45-year-old woman with RUQ pain for 12 hours, fever, and leukocytosis

A

Acute cholecystistis

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2
Q

What is murphys sign?

A

RUQ pain with GB palpation on inspiration

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3
Q

What is first line diagnostics for cholecystitis and what is definitive dx?

A

Ultrasound = 1st line = Shows Gallbladder wall >3 mm, pericholecystic fluid, gallstones

HIDA is the best test (Gold Standard) (porcelain gallbladder = chronic cholecystitis)

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4
Q

Most common etiology for acute pancreatitis?

A

Cholelithiasis or alcohol abuse

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5
Q

What is Ransons criteria?

A

Prognosis for pancreatitis

Admit if: Age >55, Leukocyte >16,000, Glucose >200, LDH >350, AST >250

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6
Q

Tx of acute pancreatitis

A

Treatment: IV fluids (best), analgesics, bowel rest

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7
Q

Classic triad of chronic pancreatitis

A

the classic triad of pancreatic calcification (plain abdominal x-ray), steatorrhea (high fecal fat), and diabetes mellitus

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8
Q

Most common types of anal fissures

A

Vertical = MC

Horizontal = Chrons dz, HIV,

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9
Q

Gastric cancer

A

“WEAPON”: Weight loss, Emesis, Anorexia, Pain/epigastric discomfort, Obstruction, Nausea

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10
Q

Bariatric surgery guidelines

A
  • BMI > 40 (basically, 100 pounds above ideal body weight) or
  • BMI > 35 with a medical problem related to morbid obesity
  • Individuals must have failed other non-surgical weight loss programs.
  • They must be psychologically stable and able to follow post-op instructions.
  • Obesity is not caused by a medical disease such as endocrine disorders.
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11
Q

4 cardinal signs of strangulated bowel

A

The 4 cardinal signs of strangulated bowel: fever, tachycardia, leukocytosis, and localized abdominal tenderness.

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12
Q

Colicky abdominal pain, nausea, bilious vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early) or hypoactive bowel sounds (late), prior abdominal surgery

A

Small bowel obstruction

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13
Q

Cholangitis sx

A
  • Charcot’s triad: RUQ tenderness, jaundice, fever
  • Reynold’s pentad: Charcot’s triad + altered mental status and hypotension
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14
Q

complication of gallstones with symptoms secondary to an infected obstruction of the common bile duct (E.coli is the #1 cause)

A

Cholangitis

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15
Q

Dx and tx of cholangitis

A

ERCP is the optimal procedure both for diagnosis and for treatment

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16
Q

Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age

A

Colorectal carcinoma

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17
Q

Apple core lesion on barium enema, adenoma most common type

A

Colorectal carcinoma

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18
Q

Tumor marker for colorectal carcinoma

A
  • Tumor Marker: CEA
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19
Q

severe form of constipation, where a person cannot pass stool or gas

A

Obstipation

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20
Q

What is an ileus

A

Hypomotility of the gastrointestinal tract in the absence of mechanical bowel obstruction AKA lack of muscle contractions in intestines

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21
Q

Ileus that persists for more than 3 days

A

persists for more than 3 d following surgery is termed postoperative adynamic ileus or paralytic ileus

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22
Q

stomach muscles and prevents proper stomach emptying

A

Gastroparesis

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23
Q

Tx of c diff

A
  • IV metronidazole OR PO vancomycin (this is the only use for oral vancomycin)
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24
Q

Difference in diverticulosis and diverticulitis

A

The presence of the pouches themselves is called diverticulosis. When they become inflamed, the condition is known as diverticulitis.

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25
Tx of diverticular disease
**Ciprofloxacin** or **Augmentin/ + Metronidazole (Flagyl)**
26
MC location of diverticular disease
Sigmoid colon
27
**Progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis**
Esophageal cancer
28
**complication of Barrett's esophagus** (screen Barrett's patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus
Adenocarcinoma
29
**Solid food dysphagia in a patient with a history of GERD**
Esophageal stricture
30
primary esophageal motility disorder characterized by the **absence of lower esophageal peristalsis.**
Esophageal achlelasia
31
Dx of esophageal achalasia
**Barium swallow** shows there is acute tapering at the lower esophageal sphincter and narrowing at the gastroesophageal junction, producing a **"Bird’s beak" or "rat's tail" appearance - distal 2/3 most common**
32
Tx of esophageal achalasia
* **Esophageal manometry** is the best test to diagnosis **shows the absence of esophageal peristalsis**
33
esophageal webs + dysphagia + iron deficiency anemia
Plummer vinson
34
Risk factors of adenocarcinoma gastric cancer
* **Risk factors for gastric cancer:** * a family history of gastric cancer * **gastric ulcers** * *Helicobacter pylori* * pernicious anemia
35
Dx and tx of gastric cancer
* **DX: EGD (esophagogastroduodenoscopy)** and **biopsy** showing gastric cancer * a CBC showing **microcytic/hypochromic anemia** * positive guaiac * **Treatment = Radiation** therapy and **chemotherapy** can be beneficial but the prognosis is poor
36
3 causes of gastritis (heartburn/dyspepsia)
Autoimmune or hypersensitivity reaction Infection (h. pylori) Inflammation (NSAID or alcohol)
37
How do NSAIDs cause gastric inflammation?
**cause gastric injury by diminishing local prostaglandin production in the stomach and duodenum.**
38
Leading cause of gastritis
Alcohol
39
How does pernicious anemia affect gastritis
* **Pernicious anemia: + schilling test** + **↓ intrinsic factor** and parietal cell antibodies
40
What type of ulcer improves with food & which type worsens with foods?
* Duodenal ulcer- **pain improves with food\*** * Gastric ulcer- pain worsens with food
41
Tx of hemorrhoids
**Stool softeners Corticosteroid Sitz baths. Internal hemorrhoids=rubber band ligation**
42
Indirect hernia (MC type) is medial or lateral to inferior epigastric arteries
Medial = Direct Lateral = Indirect MDs Dont Lie
43
Involves **protrusion of the stomach** through the **diaphragm** via the esophageal hiatus.
Hiatal hernia
44
* **“skip areas”** with **transmural (full-thickness)** * **young adults (20-40)** 2 to 3 times more common in Jews * **Pathology:** antibodies against **intestinal epithelial cells**. * Appearance leading to the typical **“cobblestone”**
Crohns dz
45
Complications of crohn's disease
* **Obstruction, fistulas, abscesses, and perforation. Malabsorption of B12, megaloblastic anemia. ??Arthritis and uveitis??**
46
Tx of Crohn's
**TX: Maintenance meds: sulfasalazine (Azulfidine®)** * **Mesalamine** (Pentasa®, Asacol ®) DMAR/NSAIDs * **Prednisone** during flare-up * **Restrict fiber** in the diet
47
* **Mucosal surface shows superficial ulcerations** area is greatly thickened and rigid **“lead pipe”**
UC
48
Sx and complications of Ulcerative colitis
* N/V, abdominal pain, **spastic rectum, and anus** * **anemia (Fe++ deficiency)** * **coagulation defects due to Vit K deficiency**, * erythema nodosum, **uveitis**, **Toxic Megacolon**
49
Tx of UC
**Maintenance meds: sulfasalazine (Azulfidine®)** * **Mesalamine** (Pentasa ® Asacol ®,) NSAIDs * **Prednisone** during flare-up * **Antispasmodics** only used for patients with frequent and troublesome diarrhea may precipitate Toxic Megacolon
50
At what bili level is jaundice?
**bilirubin \> 2.5 mg/dl**
51
Causes of melena vs hematochezia
**Melena:** black tarry stool - **upper GI bleed →**Gastric cancer, duodenal ulcers, right-sided colon cancer, portal hypertension with esophageal varices, severe erosive esophagitis, Mallory-Weiss syndrome. **Hematochezia:** bright red blood per rectum (BRBPR) - **lower GI bleed →** Hemorrhoids, anal fissures, polyps, proctitis, rectal ulcers, and colorectal cancer. Diverticulosis is generally an incidental finding, since diverticular bleeding is usually of greater volume.
52
What is [**Courvoisier's sign**](https://smartypance.com/courvoisiers-sign/) **& what is the MCC?**
describes an enlarged, palpable gallbladder in patients with obstructive jaundice caused by tumors of the biliary tree or by pancreatic head tumors. This kind of biliary obstruction evolves slowly. **MCC = Pancreatic carcinoma**
53
MC type of pancreatic carcinoma
* Most commonly **ductal adenocarcinoma** located at **the pancreatic head**
54
What type of carcinoma is virchows node seen in?
Pancreatic carcinoma
55
Sx of pancreatic cancer
* **weight loss**/epigastric abdominal pain, clay-colored stools * **Jaundice + palpable non-tender gallbladder (**[**Courvoisier’s sign**](https://smartypance.com/courvoisiers-sign/)**)** * **Virchow's node** (or signal node) is a lymph node in the **left supraclavicular fossa** (the area above the left clavicle) that is associated with pancreatic cancer
56
Dx of pancreatic cancer
* ERCP * **abdominal CT scan:** 75% show tumor at the **head** of the pancreas, 25% at the tail * pancreatic Bx * abdominal MRI * elevated serum bilirubin * abnormal liver function tests * **CA 19-9** is present in about **80%** of patients who have pancreatic cancer
57
**Pancreatitis and a palpable epigastric mass**
Pancreatic pseudocyst
58
Study of choice for palpable epigastric mass presenting 2-3 wks after acute pancreatitis
**CT scan** is the study of choice → Pancreatic psuedocyst
59
Pain worsens with which type of ulcer? Pain improves with which type of ulcer?
**Duodenal ulcer** (**food** **classically** **decreases pain** **think** **D**uodenum = **D**ecreased pain **with food**) **Gastric ulcer** (**food** classically **causes pain**)
60
MCC of duodenal ulcer
* **Duodenal ulcers** are most commonly caused by **H. pylori (95%)**
61
Sx of gastric ulcer
* Pain is described as **gnawing or burning** and usually **radiates to the back**
62
The most common presenting symptom of a small bowel tumor is
**abdominal pain**- typically **intermittent** and **crampy in nature**
63
24-year-old man with **ulcerative colitis** receives Lomotil for excessive diarrhea and develops **fever, abdominal pain** and **tenderness**, and a **massively dilated colon** on [**abdominal x-ray**](https://smartypance.com/wp-content/uploads/2015/12/GW535H522.jpg)**.**
Toxic megacolon
64
Tx of toxic megacolon
**Decompression of the colon** is required * In some cases, colostomy or even **complete colonic resection may be required**

EOR - Gen Surg (6 decks)

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