GI Flashcards
treatment of idiopathic thrombocytopenia purpura if asymptomatic with platelets >30,000 vs symptomatic and <30,000
asymp: expectant management
symp: steroids (splenectomy if real bad)
indication for appendix cancer
right hemicolectomy
initial management of achalasia
meds (CCBS, nitrates), endoscopic dilatiioin, botox
safest and most effective treatment of achalasia
surgical esophagomotomy- Heller myotomy
definitive treatment for UC
total proctocolectomy with ileal puch anal astomosis and diverting ileostomy
treatment for pancreatic pseudocyst
abx and drainage
most serious complication of colostomy
parastomal hernia- when colostomy put lateral to rather than through rectus muscle
painless jaundice with weight loss is suspicious for
pancreatic cancer- head or uncinate
best study to evaluate pancreatic mass
helical contrast enhanced CT
which test useful for bowel perf or obstruction
acute abdominal series
which test useful in evaluating obstructive jaundice without a detectable mass on CT?
ERCP
procedure of choice for perforated duodenal ulcer?
simple closure with omental patch
dumping syndrome
following surgery of stomach/pyloric sphincter removal/alteration
GI symtpoms (bloating, cramp, diarrhea) vasomotor symp (weak flushing palpitations, sweat dizzy)
after ingestion of meal, for 3 months
early vs late dumping syndrome timing
early: within 20-30 min of eating
late: 2-3 hrs after- resemble hypoglycemic shock
dumping syndrome management
reassurance- 3 mo
frequent small meals, avoid sugars, separate fluids and solids
octreotide but costly
what meds can decrease splanchnic blood flow during variceal bleed
octreotide, vasopressin
best option for long term management of recurring esophageal varices from poorly compensated liver disease, and what if well-compensated liver dz
transjugular intraheaptic portosystemic shunting (TIPS)- poor
well compensated: portosystemic shunt
treatment for persistent gastric ulcer
distal gastrectomy with gastroduodenostomy (billroth I reconstruction)
or with gastrojejunostomy (billroth II)
to rule out malignancy
which hernia is in the cremaster muscle
indirect inguinal
findings of air in the biliary tree of a nonseptic patient is diagnostic of
biliary enteric fistula –> small bowel obstruction from stone
which syndrome: intestinal polyposis (hamartomas) and melanin spots of oral mucosa
peutz jeghers
treatment for gallstone ileus –> small bowel obstruction
ileotomy
stone removal
cholecystectomy if possible
indications for surgical intervention (hartmann) for diverticular dz
hemorrhage sexondary to diverticulosis
recurrent diverticultiis
intractable to meds
complicated diverticulitis- perf w/ or w/o abscess,fistula
eval of choice if RUQ pain and fatty food intolerance but no evidence of gallstones and nl liver
CCK-HIDA scan for biliary dyskinesia`
hematoma of rectus sheath presentation
elderly, history of trauma, sudden muscular exertion, anticoagulation
sudden onset, sharp pain
abdominal mass, doesnt change with contraction of muscles
hematoma of rectus sheath diagnosis and management
CT, US
conservative unless severe or bleeding-surgery
what is important imaging before surgery for GERD/hiatal hernia
endoscopy
should you electively repair femoral hernias, even if asymptomatic?
yes, fear of strangulation
painful fluctuant mass in midline between gluteal folds
pilonidal abscess
CABG stands for
coronary artery bypass graft
ischemic colitis presentation
hematochezia, fever, abdominal pain
management of ischemic colitis
expectant with supportive care
surgery only if: full thickness necrosis, perf, refractory bleeding
are there long term changes with sigmoidectomy?
no because reserve for water absorption in colon is greater than requirement
and right colon absorbs more water than left
hepatic adenomas associated with
OCPs
treatment of focal nodular hyperplasia of liver?
nothing unless symptomatic
what provides the most info on T staging for an esophogeal tumor
endoscopic US
how to confirm Zollinger ellison?
measure gastrin at baseline
then add secretin
measure gastrin post at dif times
gastrinomas are usually located where
junction of 2nd and 3rd part duodenum, pancreas, cystic and bile duct
nigro protocol
combined radiation plus chemo (flurouracil and mitomycin)
“air filled kidney bean shaped structure in LUQ post-abdominal surgery.” think…
volvolus
how to treat above volvolus
right hemicolectomy
definitive treatment of echinoccous cysts
surgical resection or evaucation
most common nonobstetric surgical disease of the abdomen during pregnancy
appendicitis
ogilvie syndrome
colon dilatation without mechanical obstruction
1st line therapy for major hemobilia
transarterial embolization (TAE)
crpt abscesses and superficial ulcerations are common in UC or crohns
UC
therapy of choice for paraesophageal hernias
surgery
therapy of choice for pancreatic tumors around critical peripancreatic arteries
unresectable- chemo and radiation
most common cause of small intestinal bleeding in patients under 30 yo
Meckel diverticulum
diagnostic modality for meckel diverticulum
99mTc pertechnetate scan
findings on endoscopy for stress gastritis
multiple shallow lesions with erythema, hemorrhage in fundus
what to do if antibiotic refractory cholangitis
ERCP- endoscopic drainage of obstructed common bile duct
if that doesn’t work or PTBD, then do surgery- place T tube into duct
Charcot triad
cholangitis- fever , jaundice, RUQ pain
how can cholecystitis be treated if you want to avoid general surgery (high comorbidities)
tube cholecystectomy- with local anesthetic or percutaneous
how do you manage pancreatic pseudocysts
typically self resolved within 6 weeks
Dieulafoy lesion
abnormally large submucosal artery that protrudes thru small mucosal defect
typically 6 cm distal to gastroesophageal junction
carcinoid tumors on the appendix should be treated with right hemicolectomy (versus appendectomy) when they are bigger than how many cm?
1 cm
polypoid gall bladder lesion features
30s-50s y/o
small, dont show shadow on US
90% benign, but can be malignant
surgery if symptomatic
management for asymptomatic hepatic hemangiomas
observation
CEA elevated in which cancer recurrences
colon, pancreatic, gyn, gastric, lung
indications for surgery for UC
high grade dysplasia or carcinoma
toxic megacolon
massic colonic bleeding
med-refratory
surgery of choice for UC
proctocolectomy with either:
- end ileostomy
- ileoanal J pouch anastomosis
toxic megacolon symptoms
fever
abdominal pain
marked dilatation of large bowel
what surgery do you do for distal anal cancers with fecal incontinence
APR (because sphincter-sparing surgery contraindicated)
