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GI Flashcards

1
Q

What is GERD

A

Reflux of stomach contents into esophagus

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2
Q

What leads to the sx of GERD

A

Breakdown of reflux barrier and poor clearance of aci

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3
Q

What causes GERD

A

Incompetent Barrier (LES relaxation, hiatial hernia, scleroderma)
Aggressive reflux
Reduced acid clearance in esophagus
Increased abdominal pressure

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4
Q

What are 4 common associated conditions of GERD

A

Sliding Hiatal Hernia
Tobacco and Alcohol
Scleroderma
Decreased Gastrin Production

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5
Q

Sx of GERD

A 
Pyrosis
Regurgitation
Water Brash
Dysphagia
Hoarseness
Globus Sensation
Chronic Cough
Asthma
Chest Pain
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6
Q

What are common complications of GERD

A

Barrett’s Esophagus
Ulcers or Adenocarcinoma
Dental Caries

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7
Q

Dx of GERD

A

Trial of H2 blockers first
Endoscopy
pH Monitoring

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8
Q

Tx of GERD

A

Lifestyle Modification
H2 blockers, PPI, Antacids
Fundoplication if no relief

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9
Q

What are indications for surgical treatment of GERD

A

Failure of medical management
Esophageal Stricture
Pulmonary Insufficiency (nocturnal aspiration)
Barrett’s Esophagus (squamous epithelium transition to columnar due to reflux)

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10
Q

What is an Esophageal Stricture

A

Narrowing or tightness of esophagus causing problems in swallowing

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11
Q

What causes Esophageal Stricture

A

Ingesting Lye or caustic substances

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12
Q

Dx of Esophageal Stricture

A

EGD within 24 hours of ingestion to assess level of ulceration + contrast to rule out performation

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13
Q

Tx of Esophageal Stricture

A 
Immediate: NPO + IV fluids + H2 blocker
Don't induce emesis
Medical: Shallow - Corticosteroids
Moderate to deep - Abx (Penicillin or Gentamicin)
Endoscopy every 2 years
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14
Q

What is surgical tx for Esophageal Stricture

A

Dilation: With Maloney Dilator/Balloon Catheter
Esophagectomy: With Colon interposition or gastric pull up

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15
Q

What is a Hiatal Hernia

A

Protrusion of GE junction through hiatus of diaphragm

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16
Q

What are 6 causes of Hiatal Hernia

A 
Widened Hiatus
Esophageal shortening
Increased intra-abdominal pressure
Autosomal Dominant
Congenital
Acquired (traumatic)
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17
Q

What are the 4 types of Hiatal Hernias

A

Type 1: Sliding Hernia
Type 2: Defect in phrenoesophageal membrane, leads to gastric fundus herniation
Type 3: Both GE junction and fundus herniate through hiatus
Type 4: Omentum/Colon/Small bowel present in hernia sack

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18
Q

Sx of Hiatal Hernia

A

Asymptomatic

Reflux symptoms

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19
Q

Dx of Hiatal Hernia

A

Upper Endoscopy

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20
Q

Tx of Hiatal Hernia

A

Tx for GERD sx

Surgical if severe

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21
Q

What is Zenker’s Diverticulum

A

False Pharyngoesophageal Diverticulum

Involves mucosa and submucosa at UES

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22
Q

Sx of Zenker’s Diverticulum

A

Dysphagia + Neck Mass + Hilitosis + Food regurgitation + Heartburn

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23
Q

Dx of Zenker’s Diverticulum

A

Barium Swallow

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24
Q

Tx of Zenker’s Diverticulum

A 
Diverticulectomy
Cricopharyngeal Myotomy (UES relaxation)
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25
Q

What is Leiomyoma

A

Benign smooth muscle tumor

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26
Q

Sx of Leiomyoma in Esophagus

A

Dysphagia

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27
Q

Dx of Leiomyoma in Esophagus

A

Barium Swallow: Will show filling defect
Esophagoscopy: CONFIRMS Dx
Ultrasound to confirm mass is intramural

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28
Q

Tx of Leiomyoma in Esophagus

A

Surgical Removal
Enucleation: Removal of mass without harm to surrounding tissues
Resection if low grade tumor

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29
Q

What are 3 forms of Intraluminal Masses

A

Mucosal Polyps, Lipomas, Myxofibromas

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30
Q

Sx of Intraluminar Masses

A

Dysphagia + Regurgitation + Weight Loss

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31
Q

Dx of Intraluminar Masses

A

Radiographs and Esophagoscopy

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32
Q

Tx of Intraluminar Masses

A

Esophagotomy and Repair

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33
Q

Sx of Esophageal Carcinoma

A

Dysphagia, first with solids then eventually with liquids
Weight Loss
Hoarseness if laryngeal nerve is damaged

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34
Q

Dx of Esophageal Carcinoma

A

Contrast XRAY

Upper Endoscopy with Biopsy

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35
Q

Tx for Esophageal Carcinoma

A

Radio Frequency Ablation and Endoscopic Mucosal Resection for low grade
Esophagectomy + Gastric pull-up or colon resection for invasive

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36
Q

What population is more likely to get Squamous Cell Carcinoma of Esoaphgus

A

African Americans and Chinese
Smokers, Alcoholics
Hot foods or bad oral hygiene

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37
Q

What population is more likely to get Adenocarcinoma of Esophagus

A

White men with GERD, usually final stages that eventually lead to Barrett’s Esophagus

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38
Q

What is Achalasia

A

Loss of peristalsis in lower esophagus + lower esophageal sphincter remains closed during swallowing

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39
Q

What causes Achalasia

A

Neurologic: Loss of Auerbach’s plexus, Vagus Nerve
Infectious: Chagas, but rare

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40
Q

Sx of Achalasia

A

Dysphagia

Regurgitation

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41
Q

Dx of Achalasia

A

Distal narrowing and proximal dilation of esophagus
Manometry: Motility study shows increased LES pressure thatdoes not relax
Xray with contrast: BIRDS BEAK

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42
Q

Tx of Achalasia

A

Surgical Myotomy

Bolloon Dilation

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43
Q

What is Diffuse Esophageal Spasm

A

Strong non-peristaltic contractions of esophagus + Normal Sphincters

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44
Q

Sx of Diffuse Esophageal Spasms

A

Chest pain with radiation to back, ears, neck, and jaw

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45
Q

Dx of Diffuse Esophageal Spasms

A

Manometry: Repetitive high-amplitude contractions
Xray with Contrast: Segmented Spasms/CORKSCREW Esophagus
Endoscopy

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46
Q

Tx of Diffuse Esophageal Spasms

A

Medical: Antireflux/CCB/Nitrates
Surgical: Long Esophagomytomy

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47
Q

What is Nutcracker Peristalsis

A

Hypertensive Peristalsis

Presents like Diffuse Esophageal Spasms but are very strong Peristaltic waves

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48
Q

Dx and Tx for Nutcracker Peristalsis

A

Manometry, Xray with Contrast, Antireflux Meds, Long Esophagomytomy

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49
Q

What is Peptic Ulcer Disease

A

Damage to gastric mucosal barrier causing erosion through submucosa or muscularis propria

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50
Q

Causes of PUD

A

H.Pylori
NSAIDS
Bile Reflux
Gastrinoma (Zollinger-Ellison Syndrome): Neuroendocrine tumor that secretes gastrin, leads to ulcers and diarrhea

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51
Q

Sx of PUD

A

Burning mid-epigastric stomach paid reduced by food or antacids
N/V, Hematemesis, Melena
Usually asymptomatic until severe

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52
Q

Dx of PUD

A

Upper GI Xray: Barim pooling at ulcer
Endoscopy if alarm sx present (weight loss, melena, mass)
H.Pylori Breath Test

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53
Q

Tx of PUD

A

H.Pylori Positive do Triple Therapy: Clarithromycin + PPI + Amoxicillin/Metronidazole if allergic
Triple Therapy usually done for 10-13 days
H.Pylori Negative do PPI or H2 blocker for 4-8 weeks
Sucralfate: binds in ulcer and protects for 6 hours

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54
Q

What are 5 surgical indications for PUD

A 
Intractability
Uncontrolled Bleeding
Perforation
Gastric Outlet Obstruction
Malignancy
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55
Q

What is the most common type of Gastric Cancer

A

Gastric Adenocarcinoma: poor survival 90-95% are malignant

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56
Q

What are the 2 types of Gastric Adenocarcinoma

A

Intestinal Type: Glandular and well-differentiated found in Distal stomach
Diffuse Type: Poorly differentiated small cell infiltrating tumor of proximal stomach

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57
Q

What are risk factors for gastric adenocarcinoma

A 
Older males
High Salt Intake
Smoked Meats
Low Protein
Vit. A and C
Smoking
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58
Q

Sx of Gastric Adenocarcinoma

A

Epigastric Pain + Anorexi + Fatigue + Vomiting and Weight Loss
Palpable Lymph Nodes: Supraclavicular or Periumbilical

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59
Q

Dx of Gastric Adenocarcinoma

A

Upper GI Xray

Upper Endoscopy + Biopsy

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60
Q

Tx of Gastric Adenocarcinoma

A

Subtotal or Total Gastrectomy
Resection or Bypass + Radiotherapy
Adjuvant Chemotherapy: 5-FU/Leukovorin + Radiation

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61
Q

What is a Gastric Lymphoma

A

Uncommon with good prognosis

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62
Q

Sx of Gastric Lymphoma

A

Abdominal Pain + Early Satiety + Fatigue + Constitutional B Sx (Fevers, night sweats, weight loss)

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63
Q

Dx of Gastric Lymphoma

A

Endoscopy and Biopsy with Endoscopic US for staging

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64
Q

Tx for Gastric Lymphoma

A

Medical: Chemo + Radiation (CHOP: Cyclophosphamide + Hydroxyduanomycin + Oncovin + Prednisone)
Surgical: Gastrectomy

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65
Q

What is a Gastric Sarcoma

A

Uncommon Cancer that arises from mesenchymal cells

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66
Q

Sx of Gastric Sarcoma

A

Usually incidental until large and obstruction

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67
Q

Dx of Gastric Sarcoma

A

Immunohistochemical stain hows CD1117

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68
Q

Tx of Gastric Sarcoma

A

Surgical removal

Imatinim (Gleevac)

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69
Q

What is Gastric Dumping Syndrome

A

When ingested food passes through the stomach rapidly and enters small intestine largely undigested

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70
Q

What causes Gastric Dumping Syndrome

A

Gastric Bypass, Roux-en-Y Surgery

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71
Q

Sx of Early Dumping Syndrome

A

15-30 minutes after a meal

N/V, bloating, cramping, diarrhea, dizziness, and fatigue

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72
Q

Sx of Late Dumping Syndrome

A

1-3 hours after meal

Weakness, sweating, dizziness

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73
Q

Dx of Dumping Syndrome

A

Clinical

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74
Q

Tx of Dumping Syndrome

A

Avoid foods that cause it

Eat several small meals a day low in carbs, avoid simple sugars

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75
Q

What is Pyloric Stenosis

A

Hypertrophy of muscular layer of pylorus that obstructs the gastric outlet

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76
Q

What age group does Pyloric Stenosis usually present in

A

2 weeks to 2 months old

Usually males, caucasians

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77
Q

Sx of Pyloric Stenosis

A

Projectile vomiting in infants

May lead to dehydration, Hypochloremia + Hypocalcemia + Metabolic Alkalosis + Jaundice

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78
Q

Dx of Pyloric Stenosis

A

Olive Shaped mass at midepigastric region
Ultrasound: Thick Pylorus, muscular wall width
Upper GI Xray: Gastric retention, elongation/narrowing antrum, string sign

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79
Q

Tx of Pyloric Stenosis

A

Pyloromyotomy: Incision of the longitudinal and circular muscles of the antrum

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80
Q

What are 4 causes of Small Bowel Obstruction

A

Adhesions
Hernias
Malignancy
Gallstones/Crohn’s/Intussusception/Volvulus

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81
Q

Sx of Small Bowel Obstruction

A

Crampy Abdominal pain + N/V + Bloating

Inability to pass stool or flatus

82
Q

Dx of Small Bowel Obstruction

A

Abdominal Xray: Dilated small bowel loops + Air-fluid levels

CT: Localizes obstruction

83
Q

Tx of Small Bowel Obstruction

A

Conservative: IV Resuscitation + NG tube decompression
Surgical: If alarm sx (peritoneal signs + Leukocytosis + Fever + No Resolution)

84
Q

What is Crohn’s Disease

A

Ulcerative changes from transmural inflammation especially in Ileum.
Rectum is usually spared

85
Q

What causes Crohn’s Disease

A

Idiopathic

Increased colon cancer risk after 8-10 years

86
Q

Sx of Crohn’s Disease

A

Abdominal cramping + Chronic diarrhea with or without blood/mucus
Constitutional sx
Fulminant: Bowel obstruction or ileus/acute abdomen/sepsis

87
Q

Dx of Crohn’s Disease

A

CT or Barium Enema: Skip lesions + Cobblestoning of mucosa + Fistulas
Endoscopy with small bowel follow through (see short thickened mesentry + grayish pink discoloration + fat wrapping)

88
Q

Tx of Crohn’s Disease

A

Diet Modification: Low Fiber
Low Risk: Corticosteroids + Azathiopurine
High Risk: Anti-TNF (Infliximab)
Bowel Resection

89
Q

What is Meckel’s Diverticulum

A

Remnant omphalomesenteric duct, pouthc near ileocecal valve

90
Q

Sx of Meckel’s Diverticulum

A

PainLESS Rectal Bleeding without fever, nausea, vomiting or diarrhea

91
Q

Dx of Meckel’s Diverticulum

A

Radionuclide Scan: IV infusion of technitium-99m pertechnetate taken up by ectopic gastric mucosa

92
Q

What are risk factors for Colorectal Cancer

A 
Family Hx
IBD and Polyps
Age>50
Diet (high fat or low fiber, fruits, veggies, calcium)
Lifestyle (Inactive, Obesity, Alcohol)
93
Q

What is Familial Adenomatous Polyposis

A

More than 100 polyps in colon at a young age

Has 100% risk of Colon Cancer

94
Q

What is HNPCC

A

No polyposis preceding cancer

One site of mutation leading to colon and extracolonic malignancy

95
Q

What is the most common form of colorectal cancer

A

Adenocarcinoma

96
Q

Sx of Colorectal Cancer

A

Blood in stools
Change in bowel pattern
Abdominal Pain

97
Q

Sx of Right sided Colorectal Cancer

A

Bleeding: Melana, Iron Deficiency Anemia, Right sided mass

98
Q

Sx of Left sided Colorectal Cancer

A

Obstruction: Change in bowel habits, blood in stools, cramping abdominal pain

99
Q

Dx of Colorectal Cancer

A

Colonoscopy with bopisy
CEA to later evaluate for recurrence
CT for extent and mets

100
Q

Tx of Colorectal Cancer

A

Curative: Surgery +/- chemo
Chemo: 5-FU for patients with positive LN or mets
Radiation: Pre-operative to shrink tumor
Palliative: Chemo, Diverting Ostomy, Pain Management

101
Q

Discuss Colorectal Cancer Screening

A

Average Risk: 50 yrs
1st degree relative with CRC: 40yrs or 10yrs younger than dx
Ulcerative Colitis: 8 years after dx
Primary Sclerosing Cholangitis + UC: Time of dx
FAP: Age 10 + Prophylactic Colectomy
HNPCC: Age 20 or 10 yrs younger than dx relative

102
Q

What risk does someone with FAP have of developing cancer vs. someone with HNPCC

A

FAP: 100%
HNPCC: 80%

103
Q

What is a Carcinoid Tumor

A

Neuroendocrine Tumors of Appendix, Ileium, Rectum, Stomach, Colon

104
Q

Sx of Carcinoid Tumor

A

Flushing, Heart Palpitations, Abdominal Cramping, Wheezing and SOB

105
Q

Tx of Carcinoid Tumor

106
Q

What is Diverticulosis

A

Not a true diverticula

It only involve 2 layers: Mucosa and Submucosa

107
Q

Where is the most common site for Diverticulosis

A

Sigmoid Colon

108
Q

What causes Diverticulosis

109
Q

Sx of Diverticulosis

A

Asymptomatic

LLQ pain, Bleeding, Point tenderness

110
Q

Dx of Diverticulosis

A

Colonoscopy, but can’t do while there is active bleeding

CT Scan

111
Q

Tx of Diverticulosis

A

High fiber diet

Fiber supplements

112
Q

What is Diverticulitis

A

Inflamed diverticula secondary to obstruction/infection (Fecaliths)

113
Q

Sx of Diverticulitis

A

Fever, LLQ pain, Leukocytosis

114
Q

Dx of Diverticulitis

A

CT

Increased WBC

115
Q

Tx of Diverticulitis

A

Clear liquid diet, Broad Spectrum Abx (Cipro, Bactrim, Metronidazole)

116
Q

What are the categories of IBD

A

Ulcerative Colitis and Crohn’s Disease

117
Q

What is Ulcerative Colitis

A 
Diffuse, CONTINUOUS superficial ulcers restricted to the colon
Starts distal (rectum)
Involves Mucosa and Submucosa only
118
Q

Sx of Ulcerative Colitis

A

LLQ pain, Colicky
Tenesmus, urgency
Bloody Diarrhea, hemeatochezia

119
Q

Dx of Ulcerative Colitis

A

Colonoscopy: See uniform inflammation, sandpaper appearance, pseudopolyps
Barium Study shows Stovepipe sign (loss of haustral markings)
+P-ANCA

120
Q

Tx of Ulcerative Colitis

A

Surgery is curative

121
Q

What is a Sigmoid Volvulus

A

Twist or torsion of organ on pedicle due to long freely moveable sigmoid colon or mesentery

122
Q

What causes a Sigmoid Volvulus

A

Sigmoid twists counterclockwise around mesenteric axis

Torsion causes bowel obstruction and ischemia

123
Q

Sx of Sigmoid Volvulus

A

Abdominal Pain and Distension + Obstipation

124
Q

Dx of Sigmoid Volvulus

A

Barium Enema: Bird beak twist

Abdominal Radiograph: Bent inner tube or Coffee Bean Sign

125
Q

Tx of Sigmoid Volvulus

A

Sigmoidoscopic Decompression if non-strangulated

sigmoidectomy if non-decompressible

126
Q

What are Hemorrhoids

A

Swollen and inflamed subepithelial veins of the rectum and anus

127
Q

What causes Hemorrhoids

A

Prolonged straining during defecation

128
Q

What is an internal Hemorrhoid and its sx

A

Anastomosis of superior rectal artery and rectal veins
NOT painful
Associated with bleeding, discharge, prolapse and pruritis

129
Q

What is an external Hemorrhoid and its sx

A

Anastomosis of inferior hemorrhoidal arteries and veins below the dentate line
May cause acute swelling and pain

130
Q

Tx for Hemorrhoids

A

Conservative: High fiber diet, increase water bulk laxatives all to decrease strain during defectation
Medical: Injection sclerotherapy, rubber band ligation, electrocoagulation
Surgical: Hemorrhoidectomy

131
Q

What is an Anal Fissure

A

Linear shaped ulcer

Due to tear in anoderm

132
Q

What causes Anal Fissures

A

Trauma to the anal canal during defectation

133
Q

Sx of Anal Fissures

A

Painful tearing type pain

Blood on defectation

134
Q

Dx of Anal Fissures

A

Visual Inspection

135
Q

Tx of Anal Fissures

A 
Sitz Baths
Topical Anaesthetics
Nitroglycerin Topical
Botulinium Toxin
CCB: Nifedipine or Diltiazem
136
Q

What is a Pilonidal Cyst

A

Chronic gland infection from hair foreign body leading to infection

137
Q

Tx of Pilonidal Cyst

A

Perianal hygiene and shaving or laser epilation of area to reduce hair getting stuck
Surgical I&D: For acute abscess
Bascom Closure Flap

138
Q

What is an Anorectal Fistula

A

Palpable subcutaneous tract between the external opening and the anus
Often created by drained abscess

139
Q

Tx of Anorectal Fistula

A

Fistulotomy (open a fistular tract)

140
Q

What is Cholelithisis

A

Gallstones

141
Q

What are most gallstones made of

A

Cholesterol

Can be Bilirubin or Calcium Bilirubinate

142
Q

Sx of Gallstones

A

Infrequent episodes of epigastric/RUQ pain that radiates to Right Scapula

143
Q

Dx of Gallstones

A

Ultrasound

144
Q

Tx of Gallstones

A

Elective Cholecystectomy

145
Q

What is Acute Cholecystitis

A

Persistent bile duct obstruction

146
Q

What causes acute cholecystitis

A

Gallstones trapped in the duct passageways

147
Q

Sx of Acute cholecystitis

A

Steady, Severe RUQ/Epigastric pain, radiation to right shoulder Leukocytosis
Postprandial N/V, Diaphoresis, Fever

148
Q

Dx of Acute Cholecystitis

A

+ Murphy’s Sign
Ultrasound shows stones and wall thickening
HIDA scan

149
Q

Tx of Acute Cholecystitis

A

Conservative: NPO, IV Fluids, Abx
Cholecystectomy: Usually within 72 hours of onset

150
Q

What is a Choledochal Cyst

A

Congenital malformation of pancreaticobiliary tree

151
Q

Sx of Choledochal Cyst

A

Intermittent jaundice, pain, abdominal mass

152
Q

Dx of Choledochal Cyst

A

Ultrasound or Radionuclide scan

153
Q

What is Choledocholithiasis

A

Stones in the common bile duct

Most come from gallstones but these can form without a gallbladder

154
Q

Sx of Choledocholithiasis

A

Asymptomatic

RUQ pain, radiates to shoulder, intermittent obstructive jaundice, acholic stools, bilirubinemia

155
Q

Dx of Choledocholithiasis

A

ERCP (Endoscopic Retrograde Cholangiopancreatography)

156
Q

Tx of Choledocholithiasis

A

Small stones will pass spontaneously
Surgical: Common Bile Duct Exploration
Mechanical Extraction: Under Fluoroscopic Guidance

157
Q

What is Cholangitis

A

Stones impacted within bile duct with inflammation behind the obstruction, leads to bacterial infection

158
Q

Sx of Cholangitis

A

Charchot’s Triad: Fever and Chills, Jaundice, Frequent RUQ pain
Reynold’s Pentad: Above + Altered mental status, Hypotension

159
Q

Dx of Cholangitis

A

Patient looks toxic, febrile, jaundice, hypotensive
Leukocytosis
Ultrasound: Bile duct dilation

160
Q

Tx of Cholangitis

A

Empiric Abx + Urgent ERCP + Cholecystectomy + fluid and electrolyte resuscitation

161
Q

What is Primary Sclerosing Cholangitis

A

Inflammation and fibrosis causing stenosis and obstruction of biliary tract that can lead to biliary cirrhosis and liver failure

162
Q

Sx of Primary Sclerosing Cholangitis

A

RUQ pain, Painless Jaundice, Pruritis, Fatigue, N/V, Hepative failure

163
Q

Dx of Primary Sclerosing Cholangitis

A

ERCP or Percutaneous Transhepatic Cholangiogram

Criteria: Thickening/Stenosis of biliary ducts, Rule out other factors, No primary liver disease

164
Q

Tx of Sclerosing Cholangitis

A

Internal Biliary Drainage

External Biliary Drainage

165
Q

What is Cholangiocarcinoma

A

Typically associated with gallstones

Typically Adenomas

166
Q

Dx of Cholangiocarcinoma

A

ERCP or Percutaneous Transhpeatic Cholangiogram

CT: 50% have porcelain gallbladder

167
Q

Tx of Cholangiocarcinoma

A

Surgical Resection

Whipple

168
Q

What is Hepatocellular Carcinoma

A

Primary cancer of liver parenchyma

169
Q

What causes Hepatocellular Carcinoma

A

Cirrhosis

Hepatitis/Alcoholic Liver Disease/Non-Alcoholic Fatty Liver Disease

170
Q

Sx of Hepatocellular Carcinoma

A

Pain, weight loss, cachexia, mass, bruit or friction rub, sudden ascites

171
Q

Dx of Hepatocellular Carcinoma

A 
Ultrasound every 6 months
Serum Alpha-Fetoprotein
CT/MRI with contrast
Leukocytosis/Anemia
Biopsy
172
Q

Tx of Hepatocellular Carcinoma

A

Surgical Resection
Tx chronic viral hepatitis
Liver Transplant

173
Q

What is the most common site for Mets

A

Lymph Nodes followed by Liver

174
Q

What is Pancreatitis

A

Inflammation of the pancreas

175
Q

What causes Pancreatitis

A

Alcohol Abuse
Biliary Tract Disease (gallstone pancreatitis)
Congenital Abnormalities and Latrogenic

176
Q

Sx of Acute Pancreatitis

A

Mild abdominal discomfort, with eventual shock, hypotension, and hypoxemia
Epigastric pain that radiates to back

177
Q

What are the following signs related to Acute Pancreatitis:
Turner’s Sign
Cullen’s Sign

A

Turner’s Sign: Flank Ecchymosis when blood extends into tissues
Cullen’s Sign: Periumbilical Ecchymosis from blood traveling along falciform ligament

178
Q

Dx of Acute Pancreatitis

A

Serum Amylase: 200-500 in Alcoholic Pancreatitis
Amylase:Creatinine Clearance
Serum Lipase: Elevated
Ultrasound and CT is Diagnostic

179
Q

Tx of Acute Pancreatitis

A 
NPO + IV Fluids
ERCP
Fluids, Pain Management, Enteral Feeding
NG tube
Abx
180
Q

What is Chronic Pancreatitis

A

Unrelenting sx of inlammation and fibrosis and ductal calcifications
Leads to both exocrine and endocrine failure

181
Q

What causes Chronic Pancreatitis

A

Alcohol Abuse

Prolonged duration of acute causes

182
Q

Sx of Chronic Pancreatitis

A

May eventually lead to glucose intolerance in diabetics

Common bile duct or duodenal obstruction form calcifications

183
Q

Tx of Chronic Pancreatitis

A

Analgesia/Pain Meds
Endocrine Hormone Replacement
Exocrine (Lipase and Amylase) Replacement
Smaller meals, low fat content, elimination of smoking and alcohol, enzyme replacement, vitamins
Surgery

184
Q

What is a Pancreatic Adenocarcinoma

A

4th most common cause of cancer

Increased risk with smoking, obseity, diet, and hereditary polyposis syndrome

185
Q

Sx of Pancreatic Adenocarcinoma

A

Vague epigastric pain, weight loss, back pain
Thrombophlebitis (inflammation of wall of vein)
HEAD of pancreas is the most common site

186
Q

Dx of Pancreatic Adenocarcinoma

A

Chemo: 5-FU + Gemcitabine
Intraoperative Radiotherapy
Whipple Procedure

187
Q

What is a Direct Hernia

A

Medial to epigastric vessels

Goes directly through Hasselbach’s Triangle through abdominal and inguinal canal

188
Q

What is an Indirect Hernia

A

Lateral to epigastric vessels
Passes through internal inguinal ring
5x more common!

189
Q

Tx for Inguinal Hernia

A

Surgery: Return hernia contents to peritoneal cavity, Ligate the base of hernia sac, Tighten internal ring and repair abdominal wall

190
Q

What is Bariatric Surgery

A

Weight loss surgery for morbid obseity

191
Q

What are indications for Bariatric Surgery

A

BMI>40 or BMI>35 with co-morbidities (obesity hypoventilation syndrome/cardiopulmonary problems/Diabtes)

192
Q

What are contraindications for Bariatric Surgery

A

Superobesity (BMI>50)
Pyschiatric Illness
Lack of motivation or understanding
Age>60

193
Q

What is a Roux-en Y Gastric Bypass

A

Stomach is divided and attached to the small intestine about 50-60cm distally leaving a “roux limb” that drains all bile, pancreatic, and stomach enzymes

194
Q

What are complications that can arise with Roux-en Y Gastric Bypass

A 
Anastomotic Stricture
Marginal Ulcer
Anastomotic Leak
Dumping Syndrome
Gallstone Formation
Vitamin and Mineral Deficiency (Folate/B12/Iron/Calcium)
195
Q

What is a Lap Band

A

Laproscopically placed band around the stomach that can be adjusted post operatively

196
Q

What are complications that can arise with a Lap Band

A

Erosions
Stenosis
Slippage of the band

197
Q

What are results of Bariatric Surgery

A

50-70% of excess weight is lost in the first year

70-80% of excess weight is lost in the next 3 years

198
Q

What results with Vitamin C Deficiency

A

Scurvy

Bleeding, Impaired Wound Healing

199
Q

What results in Vitamin E Deficiency

A

Hemolytic Anemia

200
Q

What results in Vitamin A Deficiency

A

Problems with vision

Night Blindness, Bitot Spots, Corneal Xerosis

201
Q

What results with Niacin Deficiency

A

Pellagra

4 D’s: Dermatitis, Diarrhea, Dementia, Death

202
Q

What results with Vitamin B6 Deficiency (Pyridoxine)

A

Peripheral Neuropathy
Seborrheic Dermatosis
Glossitis
Cheilosis

Surgery (12 decks)

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