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Surgery > GI > Flashcards

GI Flashcards

1
Q

common causes of gastric outlet obstruction

A

gastric malignancy, peptic ulcer disease, Crohn disease, strictures secondary ot ingestion of causting agennts and gastric bezoars (even 6-12 months after)

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2
Q

diabetic gatroparesis - when

A

10 years after DM

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3
Q

psoas abscess - clinical presentation

A
  1. sabacute feve, abd/flank pain radiating to groin
  2. anorexia / weight loss
  3. abd pain with hip eptension (psoas sign)
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4
Q

psoas abscess - diagnosis

A

CT scan of abdomen + pelvis
leukocytosis, elevated inl markers
blood + abscess cultures

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5
Q

psoas abscess - treatment

A

drainage

broad spectrum antibiotcs

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6
Q

management of gallstones

A
  1. without symptoms: no treatment
  2. biliary colic symptoms: elevtice laparoscopic cholecystectomy
  3. complicaed gallstone diseae (acute cholecystitis, choledocholithiasis, gallstone pancreatitis: cholecystecomy within 72 hours
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7
Q

colonic iscemia - pathophysiology

A

nonocclusive watershed ischemia (splenic flexure + rectosigmoid area)
underlying atherosc disease
state of low blood flow

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8
Q

colonic ischemia - clinical features

A

moderate abd pain + tenderness
hematoschezia, diarrhea
leukocytosis, lactic acidosis

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9
Q

colonic iscemia - diagnosis

A

CT scan: colonic wall thickening, air in wall (pneumatosis), fat stranding
endoscopy: edematous + friable mucosa

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10
Q

colonic ischemia - management

A

IV fluids + bowel rest
antibiotcs wit enteric coverage
colonic resection in necrosis develop

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11
Q

diagnosis of scurvy / how long of def causes symptoms

A

plasma or leukocytes vit C

- 3 months

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12
Q

Pancreatic ca - RF

A
  1. smoking
  2. hereditary pancreatitis
  3. nonhereditary chronic pancreatitis
  4. obesity + lack of physical activity
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13
Q

pancreatic ca - clinical presentation

A
  1. systemic symptoms (weight loss, anorexia) (more than 85%)
  2. abdominal pain / back pain (80%)
  3. jaundice (56%)
  4. recent onset of atypical DM
  5. unexplained migratory superficial thrombophlebitis
  6. Hepatomegaly + ascites with metastasis
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14
Q

pancreatic ca - Labs

A
  1. cholestasis (elevated ALP + direct bilirubin)
  2. CA 19-9
  3. Abd U/S (if jaundice) or CT scan if no jaundice
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15
Q

acute mesenteric ishemia - presentation

A

rapid onset of periumbilical pain (often severe)
pain out of proportion to examination findings
hematoschezia (late)

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16
Q

acute mesenteric ishemia - RF

A

atherosclerosis (acute on chronic)
embolic source (thrombus, vegetations
hypercoagulable disorders

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17
Q

acute mesenteric ischemia - Labs

A

leukocytosis
elevated amylase + phosphate level
metab acidosis

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18
Q

acute mesenteric ischemia - diagnosis

A
  • CT (preferred) or MR angiography

- mesenteric angiography (if diagnosis unclear, gold standard)

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19
Q

anal fissures - etiolgy

A

local rauma (eg. constipation, prolonged diarrhea, anal sex)
IBD
malignancy

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20
Q

anal fissure - clinical presentation

A

pain with bowel movement
bright red blood on toilet paper or stool surface
most common at posterior anal midline
chronic fissure may have skin tag at distal end

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21
Q

anal fissure - treatment

A 
high fiber diet + fluids
stool softeners
sitz baths
topical anestetics (vasodilators (nifedipine, NO) 
- if refractory: surgical intervention
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22
Q

management of blunt abdominal trauma in hemodynamically stable patients

A

normal mental status?
NO: serial abd exams +/- CT
YES: FAST: if negative to serial abd exams (+/- CT scan), if (+) do CT

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23
Q

sphincter of Oddi dysfunction - gold standard to diagnose and treatment

A
  • Oddi manometry

- sphincterotomy (avoid opioids)

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24
Q

small bowel obstruction - clinical presentation

A
  1. colicky abd pain, vomiting
  2. inability to pass flatus or stool if compete
  3. hyperactive and then absent bowel sounds
  4. distended + tympanic abdomen
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25
Q

small bowel obstruction - diagnosis

A

dilated loops of bowel with air-fluid levels on plain film or CT
partial air in colon
complete: transition point, no air in colon

26
Q

small bowel obstruction - complications

A

ischemia/necrosis

bowel perforation

27
Q

small bowel obstruction - management

A

bowel rest, nasogastric tube, IV fluids

if signs of complication or unstable surgical exploration

28
Q

pilonidal disease?

A

males 15-30, esp obese, with sedentary lifestyles or occupations, and those with deep gluteal clefts

  • pain, fluctuant mass 4-5 cm *mucoid, purulent or bloody drainage)
  • despite longer healing times, open closure is preferred due to decrease recurrence rate
29
Q

paralytic ileus - etiology

A
  1. abd surgery
  2. retroperitoneal/abd hemorrhage or inflammation
  3. intestinal ischemia
  4. electrolyte abnormalities
  5. morphine
30
Q

Suspected esophageal variceal hemorrhage –> …

A

place 2 large-bore IV catheters –> give fluids, octreotide, antibiotics –> Urgent endoscopic therapy:
A. No further bleeding –> 2ry prophylaxis: β-blockers, endoscopic ligation 1-2 wks later
B. continued bleeding –> balloon tamponade –> TIPS or shunt surgery
C. early rebleeding –> repeat endoscopic therapy –> reccurent hemor –> TIPS or shunt surgery

31
Q

lab associated with gallstone pancreatitis

A

ALT more than 150

32
Q

Dumping syndrome - symptoms

A
  1. abd pain, diarrhea, nausea
  2. HYPOTENSION/TACHYCARDIA
  3. dizziness, confusion, fatique, diaphoresis
33
Q

Dumping syndrome - onset / pathogenesis

A

15-30 mins after meal

rapid emptying of hypertonic gastric contents

34
Q

Dumping syndrome - management

A
  1. small/frequent meals
  2. replace simplesugars with complex carbo
  3. incorporate (add) high fiber + protein rich foods
  4. if refractory: octreotide or reconstructive surgery
35
Q

congenital umbilical hernia - pathophysiology

A

incomplete closure of abd muscles

36
Q

congenital umbilical hernia - clinical features

A
  1. soft nontender bulge at umbilicus
  2. protrudes with increased abd pressure
  3. typically reducible
37
Q

congenital umb hernia - management

A

observe (for spontaneous closure)
elective surgery at age 5
less likely to close if larger than 1.5 in diameter or other underlying medical problems

38
Q

umbilical granuloma

A

umbilical cord has separated with a oist, red, pedunculated, friable umbilical mass
treatment: silver nitrate

39
Q

emphysematous cholecystitis - RF

A
  1. DM
  2. Vascular compromise
  3. immunosprression
40
Q

emphysematous cholecystitis - clinical presentation

A
  1. fever, RUQ pain, nausea, vomiting

2. crepitusn abd wall

41
Q

emphysematous cholecystitis - diagnosis

A
  1. air fluid levels in gallbladder, gas in wall
  2. cultures with gas forming Clostiridium, E.coli
  3. uncongugated hyperbilirub (clostiridium induced hemolysis), mildly elebated aminotranferases
42
Q

emphysematous cholecystitis - treatment

A

emergent cholecystectomy

broad spectrum antibiotcs with Clostiridium coverage (eg. ampicillin-sulbactam)

43
Q

emergent surgery in patients on warfarin

A

fresh frozen plasma pre-operatively

44
Q

duodenal hematomas

A

MC in paediatric
- following blant abd trauma
epigastric pain and vomiting 24-26 h after initial injury
managemet: gastric decompression + parental nutition

45
Q

evaluation of blunt genitourinary trauna

A

urinalysis –> if hematuria:

  • stable: Contrast CT
  • unstable: IV pyelography –> surgical evaluation
46
Q

pancreatic pseudocysts - treatment

A
  • expectant management is preferred iniitally in patients with minimal or no symptoms and without complications
  • endoscopic drainage is typically reerved for patients with significant symptoms, infected, or evidence of pseudoaneurysm
47
Q

uncomplicated diverticulitis - treatment

A
  • outpatient with bowel rest, oral antibiotcs, observation

- ihospitalization in elderly, immunosuppressed, high fever, significant leukocytosis, cormobitities

48
Q

complicated diverticulitis - treatment

A

abscess smaller than 3 cm –> iv antibiotcs and observation –> worsening symptoms –> surgery
larger than 3 cm –> CT-guided perctuaneous drainage
–> if not controlled in 5 days –> surgical drainage and debridement
fistula, perforation, obstraction, recurrent attacks –> resection

49
Q

appendicitis management

A

it is a clinical diagnosis –> immediate appendectomy (Imaging only if nonclassic symptoms, or delayed presentation

50
Q

appendicitis - when to go consevatively

A

symptoms more than 5 days usually have a phlegmn with an abscess that was walled off (delayed appendectomy)
PSOAS SIGN POSITIVE

51
Q

acalculous cholecystitis

A

in critically ill patients
similar presentation
image: wall thickening and distention + pericholecystic fluid
- antibiotcs + percutaneous chocystostomy, followed by cholecystectomy when medical condition stabilize

52
Q

Surgery and hemorophilia A

A

Give desmopresin before

53
Q

how to prevent paralytic ileus

A
  1. epidural anesethesia
  2. minimally invasive surgery
    judicious perioperative use of IV fluids (to minimise GI edema)
54
Q

adenoca in GERD if more than …. years

A

20

55
Q

esoph stricture vs ca

A

ca is asymmetric narrowing of the lumen

stricture: symmetric, circumferential narrowing on barium swallow

56
Q

gastric outlet obstruction clinical examination

A

abdominal succussion splash which is elicited by placing the stethoscope over the upper abdomen and rocking the patient back + forth at the hips

57
Q

Scurvy - manifestation

A

cutaneous: petechiae, follicular hemorrhage, bruising, coiled hairs
2. gingivical: bleeding/receding gums + dental carries
3. constitutional: arthralgias, weakness, malaise, depression
4. impaired wound healing
5. vasomotor insttability (if severe/prolonged)

58
Q

perforate viscus (eg. air under the diaphragm) - next step

A

urgent laparo

59
Q

RFs for psas abscess

A
  1. HIV
  2. IV drug use
  3. DM
  4. Crohn
60
Q

torus palatinus?

A

young individuals with fleshy immobile mass on the midline hard palate –> no medical or surgical therapy unless growth becomes symptomatic or interferes with speech or eating

Surgery (10 decks)

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