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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
Q

Tx of diverticular disease

A

Ciprofloxacin or Augmentin/ + Metronidazole (Flagyl)

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26
Q

MC location of diverticular disease

A

Sigmoid colon

27
Q

Progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis

A

Esophageal cancer

28
Q

complication of Barrett’s esophagus (screen Barrett’s patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus

A

Adenocarcinoma

29
Q

Solid food dysphagia in a patient with a history of GERD

A

Esophageal stricture

30
Q

primary esophageal motility disorder characterized by the absence of lower esophageal peristalsis.

A

Esophageal achlelasia

31
Q

Dx of esophageal achalasia

A

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
Q

Tx of esophageal achalasia

A
  • Esophageal manometry is the best test to diagnosis shows the absence of esophageal peristalsis
33
Q

esophageal webs + dysphagia + iron deficiency anemia

A

Plummer vinson

34
Q

Risk factors of adenocarcinoma gastric cancer

A
  • Risk factors for gastric cancer:
    • a family history of gastric cancer
    • gastric ulcers
    • Helicobacter pylori
      • pernicious anemia
35
Q

Dx and tx of gastric cancer

A
  • 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
Q

3 causes of gastritis (heartburn/dyspepsia)

A

Autoimmune or hypersensitivity reaction

Infection (h. pylori)

Inflammation (NSAID or alcohol)

37
Q

How do NSAIDs cause gastric inflammation?

A

cause gastric injury by diminishing local prostaglandin production in the stomach and duodenum.

38
Q

Leading cause of gastritis

A

Alcohol

39
Q

How does pernicious anemia affect gastritis

A
  • Pernicious anemia: + schilling test + ↓ intrinsic factor and parietal cell antibodies
40
Q

What type of ulcer improves with food & which type worsens with foods?

A
  • Duodenal ulcer- pain improves with food*
  • Gastric ulcer- pain worsens with food
41
Q

Tx of hemorrhoids

A

Stool softeners Corticosteroid Sitz baths. Internal hemorrhoids=rubber band ligation

42
Q

Indirect hernia (MC type) is medial or lateral to inferior epigastric arteries

A

Medial = Direct

Lateral = Indirect

MDs Dont Lie

43
Q

Involves protrusion of the stomach through the diaphragm via the esophageal hiatus.

A

Hiatal hernia

44
Q
  • “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”
A

Crohns dz

45
Q

Complications of crohn’s disease

A
  • Obstruction, fistulas, abscesses, and perforation. Malabsorption of B12, megaloblastic anemia. ??Arthritis and uveitis??
46
Q

Tx of Crohn’s

A

TX: Maintenance meds: sulfasalazine (Azulfidine®)

  • Mesalamine (Pentasa®, Asacol ®) DMAR/NSAIDs
  • Prednisone during flare-up
    • Restrict fiber in the diet
47
Q
  • Mucosal surface shows superficial ulcerations area is greatly thickened and rigid “lead pipe”
A

UC

48
Q

Sx and complications of Ulcerative colitis

A
  • N/V, abdominal pain, spastic rectum, and anus
  • anemia (Fe++ deficiency)
  • coagulation defects due to Vit K deficiency,
  • erythema nodosum, uveitis, Toxic Megacolon
49
Q

Tx of UC

A

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
Q

At what bili level is jaundice?

A

bilirubin > 2.5 mg/dl

51
Q

Causes of melena vs hematochezia

A

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
Q

What is Courvoisier’s sign & what is the MCC?

A

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
Q

MC type of pancreatic carcinoma

A
  • Most commonly ductal adenocarcinoma located at the pancreatic head
54
Q

What type of carcinoma is virchows node seen in?

A

Pancreatic carcinoma

55
Q

Sx of pancreatic cancer

A
  • weight loss/epigastric abdominal pain, clay-colored stools
  • Jaundice + palpable non-tender gallbladder (Courvoisier’s 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
Q

Dx of pancreatic cancer

A
  • 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
Q

Pancreatitis and a palpable epigastric mass

A

Pancreatic pseudocyst

58
Q

Study of choice for palpable epigastric mass presenting 2-3 wks after acute pancreatitis

A

CT scan is the study of choice → Pancreatic psuedocyst

59
Q

Pain worsens with which type of ulcer? Pain improves with which type of ulcer?

A

Duodenal ulcer (food classically decreases pain think Duodenum = Decreased pain with food)

Gastric ulcer (food classically causes pain)

60
Q

MCC of duodenal ulcer

A
  • Duodenal ulcers are most commonly caused by H. pylori (95%)
61
Q

Sx of gastric ulcer

A
  • Pain is described as gnawing or burning and usually radiates to the back
62
Q

The most common presenting symptom of a small bowel tumor is

A

abdominal pain- typically intermittent and crampy in nature

63
Q

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.

A

Toxic megacolon

64
Q

Tx of toxic megacolon

A

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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