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Surgery > GI > Flashcards

GI Flashcards

1
Q

treatment of idiopathic thrombocytopenia purpura if asymptomatic with platelets >30,000 vs symptomatic and <30,000

A

asymp: expectant management
symp: steroids (splenectomy if real bad)

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2
Q

indication for appendix cancer

A

right hemicolectomy

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3
Q

initial management of achalasia

A

meds (CCBS, nitrates), endoscopic dilatiioin, botox

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4
Q

safest and most effective treatment of achalasia

A

surgical esophagomotomy- Heller myotomy

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5
Q

definitive treatment for UC

A

total proctocolectomy with ileal puch anal astomosis and diverting ileostomy

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6
Q

treatment for pancreatic pseudocyst

A

abx and drainage

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7
Q

most serious complication of colostomy

A

parastomal hernia- when colostomy put lateral to rather than through rectus muscle

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8
Q

painless jaundice with weight loss is suspicious for

A

pancreatic cancer- head or uncinate

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9
Q

best study to evaluate pancreatic mass

A

helical contrast enhanced CT

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10
Q

which test useful for bowel perf or obstruction

A

acute abdominal series

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11
Q

which test useful in evaluating obstructive jaundice without a detectable mass on CT?

A

ERCP

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12
Q

procedure of choice for perforated duodenal ulcer?

A

simple closure with omental patch

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13
Q

dumping syndrome

A

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

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14
Q

early vs late dumping syndrome timing

A

early: within 20-30 min of eating
late: 2-3 hrs after- resemble hypoglycemic shock

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15
Q

dumping syndrome management

A

reassurance- 3 mo

frequent small meals, avoid sugars, separate fluids and solids

octreotide but costly

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16
Q

what meds can decrease splanchnic blood flow during variceal bleed

A

octreotide, vasopressin

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17
Q

best option for long term management of recurring esophageal varices from poorly compensated liver disease, and what if well-compensated liver dz

A

transjugular intraheaptic portosystemic shunting (TIPS)- poor

well compensated: portosystemic shunt

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18
Q

treatment for persistent gastric ulcer

A

distal gastrectomy with gastroduodenostomy (billroth I reconstruction)

or with gastrojejunostomy (billroth II)

to rule out malignancy

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19
Q

which hernia is in the cremaster muscle

A

indirect inguinal

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20
Q

findings of air in the biliary tree of a nonseptic patient is diagnostic of

A

biliary enteric fistula –> small bowel obstruction from stone

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21
Q

which syndrome: intestinal polyposis (hamartomas) and melanin spots of oral mucosa

A

peutz jeghers

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22
Q

treatment for gallstone ileus –> small bowel obstruction

A

ileotomy
stone removal
cholecystectomy if possible

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23
Q

indications for surgical intervention (hartmann) for diverticular dz

A

hemorrhage sexondary to diverticulosis

recurrent diverticultiis

intractable to meds

complicated diverticulitis- perf w/ or w/o abscess,fistula

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24
Q

eval of choice if RUQ pain and fatty food intolerance but no evidence of gallstones and nl liver

A

CCK-HIDA scan for biliary dyskinesia`

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25
Q

hematoma of rectus sheath presentation

A

elderly, history of trauma, sudden muscular exertion, anticoagulation

sudden onset, sharp pain

abdominal mass, doesnt change with contraction of muscles

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26
Q

hematoma of rectus sheath diagnosis and management

A

CT, US

conservative unless severe or bleeding-surgery

27
Q

what is important imaging before surgery for GERD/hiatal hernia

A

endoscopy

28
Q

should you electively repair femoral hernias, even if asymptomatic?

A

yes, fear of strangulation

29
Q

painful fluctuant mass in midline between gluteal folds

A

pilonidal abscess

30
Q

CABG stands for

A

coronary artery bypass graft

31
Q

ischemic colitis presentation

A

hematochezia, fever, abdominal pain

32
Q

management of ischemic colitis

A

expectant with supportive care

surgery only if: full thickness necrosis, perf, refractory bleeding

33
Q

are there long term changes with sigmoidectomy?

A

no because reserve for water absorption in colon is greater than requirement

and right colon absorbs more water than left

34
Q

hepatic adenomas associated with

A

OCPs

35
Q

treatment of focal nodular hyperplasia of liver?

A

nothing unless symptomatic

36
Q

what provides the most info on T staging for an esophogeal tumor

A

endoscopic US

37
Q

how to confirm Zollinger ellison?

A

measure gastrin at baseline
then add secretin
measure gastrin post at dif times

38
Q

gastrinomas are usually located where

A

junction of 2nd and 3rd part duodenum, pancreas, cystic and bile duct

39
Q

nigro protocol

A

combined radiation plus chemo (flurouracil and mitomycin)

40
Q

“air filled kidney bean shaped structure in LUQ post-abdominal surgery.” think…

A

volvolus

41
Q

how to treat above volvolus

A

right hemicolectomy

42
Q

definitive treatment of echinoccous cysts

A

surgical resection or evaucation

43
Q

most common nonobstetric surgical disease of the abdomen during pregnancy

A

appendicitis

44
Q

ogilvie syndrome

A

colon dilatation without mechanical obstruction

45
Q

1st line therapy for major hemobilia

A

transarterial embolization (TAE)

46
Q

crpt abscesses and superficial ulcerations are common in UC or crohns

A

UC

47
Q

therapy of choice for paraesophageal hernias

A

surgery

48
Q

therapy of choice for pancreatic tumors around critical peripancreatic arteries

A

unresectable- chemo and radiation

49
Q

most common cause of small intestinal bleeding in patients under 30 yo

A

Meckel diverticulum

50
Q

diagnostic modality for meckel diverticulum

A

99mTc pertechnetate scan

51
Q

findings on endoscopy for stress gastritis

A

multiple shallow lesions with erythema, hemorrhage in fundus

52
Q

what to do if antibiotic refractory cholangitis

A

ERCP- endoscopic drainage of obstructed common bile duct

if that doesn’t work or PTBD, then do surgery- place T tube into duct

53
Q

Charcot triad

A

cholangitis- fever , jaundice, RUQ pain

54
Q

how can cholecystitis be treated if you want to avoid general surgery (high comorbidities)

A

tube cholecystectomy- with local anesthetic or percutaneous

55
Q

how do you manage pancreatic pseudocysts

A

typically self resolved within 6 weeks

56
Q

Dieulafoy lesion

A

abnormally large submucosal artery that protrudes thru small mucosal defect

typically 6 cm distal to gastroesophageal junction

57
Q

carcinoid tumors on the appendix should be treated with right hemicolectomy (versus appendectomy) when they are bigger than how many cm?

A

1 cm

58
Q

polypoid gall bladder lesion features

A

30s-50s y/o
small, dont show shadow on US
90% benign, but can be malignant

surgery if symptomatic

59
Q

management for asymptomatic hepatic hemangiomas

A

observation

60
Q

CEA elevated in which cancer recurrences

A

colon, pancreatic, gyn, gastric, lung

61
Q

indications for surgery for UC

A

high grade dysplasia or carcinoma
toxic megacolon
massic colonic bleeding
med-refratory

62
Q

surgery of choice for UC

A

proctocolectomy with either:

  • end ileostomy
  • ileoanal J pouch anastomosis
63
Q

toxic megacolon symptoms

A

fever
abdominal pain
marked dilatation of large bowel

64
Q

what surgery do you do for distal anal cancers with fecal incontinence

A

APR (because sphincter-sparing surgery contraindicated)

Surgery (22 decks)

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