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Surgery EOR > GI > Flashcards

GI Flashcards

1
Q

What are peritoneal sxs?

A

guarding, muscle spasm, rebound tender

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2
Q

What are our standard special tests for GI?

A

Obturator, psoas, rovsing’s, mcburney’s

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3
Q

Pt has RLQ pain with N/V and + peritoneal sxs. You’re thinking appendicitis. What would you see on CT for appendicitis?

A

preappendiceal fat stranding

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4
Q

If it’s a non-perforated appendix how do we treat?

A

Cipro + Flagyl abx x24hours after appendectomy

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5
Q

If stones are in the gallbladder what is it called?

A

Cholelithiasis

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6
Q

What are the classic sxs of cholelithiasis?

A

colicky abd pain, worse with fatty foods, radiates to the shoulder, Five F’s

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7
Q

If the stone is in the cystic duct what is it called?

A

Cholecystitis

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8
Q

Ultrasound shows thickened gallbladder wall with no stone – dx?

A

Cholecystitis

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9
Q

What if you are very suspicious of cholecystitis and the U/S is normal what do you do?

A

HIDA scan

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10
Q

If the stone is in the common bile duct – dx?

A

Choledocolithiasis

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11
Q

How do we treat choledocolithiasis?

A

ERCP → Lap chole

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12
Q

If a stone is in the common bile duct and the patient has an infection -dx?

A

Cholangitis

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13
Q

What is the Charcot’s Triad?

A

RUQ pain, jaundice, fever

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14
Q

What is the Reynold’s Pentad?

A

Hypotension + AMS

RUQ< jaundice, fever

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15
Q

How do you treat cholangitis?

A

ERCP

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16
Q

While removing a gallbladder the dissection must be done very carefully as to not cut what?

A

Common bile duct – BIG PROBLEM

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17
Q

If we see free air on an abdominal x-ray what does that mean?

A

Perforated

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18
Q

Where does diverticulitis most commonly occur?

A

sigmoid colon

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19
Q

What are some risk factors for diverticulitis?

A

Low fiber diets & chronic constipation

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20
Q

How would you diagnose diverticulitis?

A

Labs = elevated WBC

CT (NO colonoscopy)

R/O cancer

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21
Q

How do we treat diverticulitis?

A

IV fluids, NPO, Cipro + Flagyl

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22
Q

When do we operate on someone with diverticulitis?

A

Obstruction, fistula, perforation, sepsis, failed/deteriorated conservative treatment

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23
Q

A patient presents with epigastric pain that radiates, almost boring to the back, Dx?

A

Acute pancreatitis

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24
Q

What would a pt often say about their pain with acute pancreatitis?

A

Feels better with sitting up & hunched over

Worse lying flat

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25
Q

How do we diagnose acute pancreatitis?

A

LIPASE (better than amylase) will be 3x normal

CT when enzymes are negative (usually best for complications)

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26
Q

How do we treat acute pancreatitis?

A

NPO, IVF, pain meds

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27
Q

When do you do surgery for pancreatitis?

A

Necrotizing, Abscess (I&D), Pseduocyst

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28
Q

How do we treat chronic pancreatitis?

A

NO SURGERY

Pain meds, enzymes, and control diabetes

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29
Q

Describe the location of a direct hernia?

A

Located within Hesselbach’s triangle

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30
Q

Describe the location of an indirect hernia?

A

Lateral to Hasselbach’s triangle

Through the internal ring & can enter the scrotum

31
Q

Which type of hernia is more common in adults vs babies?

A

Babies = Indirect

Adults = Direct

32
Q

What causes a direct hernia?

A

Weak abdominal muscles

33
Q

What causes an indirect inguinal hernia?

A

Congenital

34
Q

Where is a femoral hernia located? Who gets them?

A

down the femoral canal & medial to the femoral vessels

MC in women & pregnancy

35
Q

When would you see a ventral hernia?

A

Generally post-op patients

36
Q

How do hernias present?

A

Abdominal bulge

37
Q

If a pt is unable to move their bowels after surgery, what is it known as?

A

Ileus

38
Q

A pt has colicky abdominal pain and distention. They are passing flatus, and leaky/thin bowel movements – Dx?

A

Small bowel obstruction

39
Q

What is the cause of SBO?

A

adhesions (prior surgery) or hernias

40
Q

How do we diagnose SBO?

A

upright KUB (air fluid levels)

CT with contrast (to tell if it’s complete or not)

41
Q

How do we treat SBO?

A

incomplete (contrast gets to the rectum) watch & wait + NG tube, IV fluids, and make sure K is stable

Complete = surgery

42
Q

A pt has BRB per rectum and you note an anal mass/prolapse – what must you do to dx & r/o?

A

Should always get a colonoscopy to R/O colon/anal cancer

43
Q

Which type of hemorrhoid is painful?

A

External

44
Q

The grading system of hemorrhoids is for what type of hemorrhoid?

A

INTERNAL

45
Q

If a hemorrhoid does not prolapse down – what degree?

A

1st

46
Q

If a hemorrhoid does prolapse but return on it’s own – what degree?

A

2nd

47
Q

if a hemorrhoid requires manual reduction – what degree?

A

3rd

48
Q

How do we initially treat hemorrhoids?

A

High-fiber, anal hygiene, topical steroids, and sitz baths

49
Q

if patient has pain in the anus, with excruciating pain during BM, with blood present, and you note a tear in the skin on exam – dx?

A

Anal fissure

50
Q

How do we treat an anal fissure?

A

Sitz baths, stool softeners, high fiber diet, excellent hygiene, topical nifedipine or Botox

51
Q

Pain out of proportion on exam should make you think of what? What is it often associated with?

A

Ischemic bowel

Consider pts with Afib & post AAA surgery

52
Q

Fistulas and skip lesions are associated with what?

A

Chron’s – AKA ANYWHERE in the intestines (transmural)

53
Q

Continuous inflammation of the colon?

A

Ulcerative colitis

Involves the superficial mucosa

54
Q

When do we start colonoscopies?

A

Start at age 50, Every 10 years (if normal)

55
Q

Besides every 10 years, when else should we do a colonoscopy?

A

Postmenopausal woman or man with iron def anemia

Change in caliber of stools, alternating bowel habits, and weight loss

56
Q

if a pt is found to have 1-2 benign polyps on colonscopy – when do you repeat?

A

Colonoscopy in 5 years

57
Q

If a pt is found to have a premalignant colonscopy – when do you repeat colonscopy?

A

3 years

58
Q

if a pt is found to have lots of polyps or dysplasia when do you repeat colonoscopy?

A

1 year

59
Q

What are some descriptive terms for bad polyps?

A

Sessile, no stalk, large, villous

60
Q

If polyps are found to be pedunculated or tubular – are they good or bad?

A

Good

61
Q

What is often times the cause of anal cancer?

A

HPV

62
Q

How do we treat pilonidal cyst?

A

I&D or resect the cyst

63
Q

A pt epigastric pain that is worse when he lies flat & better with being upright & anti-acids – Dx?

A

GERD

64
Q

When you suspect GERD what should you ask about?

A

Nocturnal sxs

65
Q

How do we treat GERD?

A

Avoid caffeine, peppermint, chocolate

PPI

EHOB

66
Q

If you’re thinking a pt has GERD but they also mention sxs of N/V/weight loss or anemia – what should you think?

A

Alarming symptoms!

67
Q

What is the pathology behind GERD?

A

weakened LES → Acid Reflux → Burn

68
Q

What is the pathology behind achalasia?

A

LES won’t relax

69
Q

How do you diagnose achalasia?

A

1st barium swallow – see BIRDS BEAK

2nd manometry

3rd endoscopy

70
Q

How do you treat achalasia?

A

Dilation

71
Q

What types of cancers cause upper vs lower esophageal?

A

upper 1/3 = SCC

Lower = Adeno (due to GERD)

72
Q

What is the classic difference between duodenal & gastric ulcer sxs as related to food ingestion?

A

Duodenal = decreased with food

Gastric = increased with food

73
Q

If a pt has excessive vomiting and then begin to vomit blood/bile – Dx?

A

Mallory Weiss tear

74
Q

A pt that is a career vomiter (eating disorder) is susceptible to what type of disorder? Dx? Tx?

A

Boerhaave’s

Dx = CXR with air in the mediastinum

Tx = OR ASAP!

Surgery EOR (7 decks)

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