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GK General Surgery > GI > Flashcards

GI Flashcards

1
Q

What are the causes of Esophageal Stricture?

A
  • Chronic reflux esophagitis
  • Medications
  • Radiation therapy
  • Eosinophilic esophagitis
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2
Q

Dx test of choice for diverticulitis?

A

CT scan w/no oral contrast

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3
Q

s/s of external hemorrhoids

A

perianal pain aggravated w/defecation + skin tags

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4
Q

Hepatocellular Carcinoma Tx

A

Transplantation if tumors are small and few

Surgical resection may be done; however, the cancer usually recurs

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5
Q

What is the MCC of appendicitis?

A

fecalith

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6
Q

When would you use H pylori stool antigen (HpSA) test?

A

If unable to perform endoscopy

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7
Q

Gold standard Diagnostic test for PUD

A

Endoscopy w/biopsy + rapid urease test

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8
Q

What is the best initial diagnostic tool to assist in diagnosing a pt presenting with altered bowel habits?

A

history and physical exam

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9
Q

slowly progressive solid food dysphagia, regurgitation, and episodic food impaction.

What disease?

A

esophageal stricture

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10
Q

What are considered indicators of unresectability in gastric cancer?

A

vascular involvement of the aorta, hepatic artery, or proximal splenic artery, distant mets

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11
Q

Dx of choice for acure pancreatitis

A

RUQ US

*if the cause of this is biliary, ERCP is choice of dx and tx**

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12
Q

Conditions associated with pancreatic pseudocyst

A
  • chronic pancreatitis
  • can be found with acute pancreatitis classically occur 2-3 weeks after acute pancreatitis
  • trauma to chest (steering wheel trauma)
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13
Q

MCC of gastroparesis?

A

DM

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14
Q

MOA of “setron” antiemetics

A

blocks serotonin receptors (5-HT3)

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15
Q

Colonoscopy results UC vs Crohns

A

UC: pseudopolyps

Crohns: Skip lesions, _cobblestone appearance**_

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16
Q

Surgery in UC vs Crohns

A

UC: curative

Crohns: Non-curative

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17
Q

What is the most common abx associated with c.diff?

A

clindamycin

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18
Q

What is the cause of jaundice in a pt w/ Normal alkaline phosphatase and aminotransferases?

A

not due to hepatic injury or biliary tract disease

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19
Q

What is the gold standard method for diagnostic eval of PUD?

A

Histologic tissue evaluation following endoscopy

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20
Q

S/E of dopamine blockers (antiemetics)

A

QT prolongation

anticholiergic & antihistamine S/E (drowsiness)

Extrapyramidal sxs: rigidity, bradykinesia, tremor, akathisia

Dystonic Reactions (Dyskinesia) Mgmt: IV Diphenhydramine

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21
Q

What is the MCC of significant lower GI bleeding?

A

Diverticular bleeding

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22
Q

What causes jaundice?

A

bilirubin deposition in the skin as a consequence of hyperbilirubinemia

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23
Q

History/Exam of UC vs Crohns

A

UC: bloody diarrhea, LLQ colicky pain

Crohns: perianal fissures/tags/fistulas, weight loss, watery diarrhea

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24
Q

What diagnostic imaging can you order when pancreatic CA is suspected?

A
  • RUQ US
  • CT scan
  • ERCP
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25
Q

s/s of internal hemorrhoids

A

intermittent rectal bleeding

(BRBPR)

**if there is pain w/internal, suspect complications as they should normally be non-tender**

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26
Q

Internal hemorrhoids tx

A

stool softeners

sitz baths

Bleeding internal hemorrhoids: injection sclerotherapy

Rubber band ligation for larger, prolapsing hemorrhoids or those unresponsive to conservative management.

Pain: NSAIDS

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27
Q

Best diagnostic test for small bowel obstruction

A

abdominal CT w/contrast

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28
Q

When would you consider surgery for a pt with diverticular dz?

A

Surgical management may be necessary in severe cases, including peritonitis, large abscesses, fistulae, or obstruction.

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29
Q
  • painless jaundice
  • depression
  • weight loss
  • hx of smoking

What dz?

A

Pancreatic CA

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30
Q
A
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31
Q

What are risk factors for small bowel carcinoma?

A
  • Hereditary cancer syndromes: Hereditary nonpolyposis colorectal cancer (HNPCC)
  • Cystic fibrosis — Patients with cystic fibrosis have an elevated risk of small bowel cancer
  • Crohn’s disease predisposes to adenocarcinoma within the involved area of the small intestine
  • Intake of alcohol, refined sugar, red meat, and salt-cured and smoked foods
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32
Q

What is the classic presentation of Acute Ascending Cholangitis?

A
  • fever
  • jaundice
  • abd pain

CHARCOTS TRIAD

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33
Q

What is the MC presenting symptom of a small bowel tumor?

A

abdominal pain- typically intermittent and crampy in nature

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34
Q

What are the main causes of acute pancreatitis?

A

Cause: cholelithiasis, alcohol abuse, hypertriglyceridemia, PUD, drugs (antiretroviral)

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35
Q

What is the biggest RF for mallory weiss tear?

A

alcohol consumption

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36
Q

CPx of small bowel

A
  • hx of prior abdominal/pelvic surgery
  • bilious vomiting
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37
Q

Tx for esophageal CA

A

esophageal resection (chemo w/5-FU)

endoscopic screening is recommended in pts with Barrett’s esophagus every 3-5 yrs

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38
Q

What will axial CT scan show in pt with diverticulitus?

A

fat stranding, bowel wall thickening

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39
Q

What are possible causes of melena (black tarry stool)?

A

Upper GI bleed:

  • peptic ulcer
  • esophageal ulcer
  • Mallory-Weiss tear
  • Malignancy
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40
Q

What other sxs can be associated with acute cholecystitis?

A

Fever/N/V

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41
Q

What will labs show in acute ascending cholangitis?

A
  • elevated WBC w/neutrophilia
  • elevated alk phos, GGT, bilirubin (cholestatic pattern of elevated liver enzymes)
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42
Q

What is the test of choice for pancreatic pseudocyst?

A

CT scan

may start with US initially

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43
Q

Tx for C diff

A

Vancomycin or Metronidazole

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44
Q

What tumor marker may be used for liver cancer?

A

alpha-fetoprotein

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45
Q

What is obstipation?

A

severe or complete constipation

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46
Q

Which anti-diarrheals are safe in dysentery?

A

bismuth-subsalicylate

  • pepto-B, Kaopectate
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47
Q

Other than Courvoisier sign, what other PE findings will you see in a patient with Pancreatic CA?

A
  • Trousseaus Syndrome: migratory thrombophlebitis
  • Sister Mary Joseph Sign: palpable nodule bulging into the umbilicus
  • Virchow’s node: Node in the L supraclavicular fossa
    • Supply is from lymph vessels in the abdominal cavity
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48
Q

MC type of pancreatic CA

A

Ductal Adenocarcinoma (worst prognosis) @ head of pancreas

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49
Q

When are anti-motility agents recommended?

A

if pt is < 65 y/o w/ moderate to severe signs of volume depletion

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50
Q

What is the site of involvement in UC vs Crohns?

A

UC: rectum + proximal extension in continuous fashion

Crohns: any portion of GI tract, mainly ileocecal region in a discontinuous pattern (skip lesions). Rectum is spared. Transmural inflammation is seen, which can lead to fistulas to other organs.

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51
Q

What establishes the diagnosis of Pyloric Stenosis?

A

Abdominal US: increased pyloric muscle thickness, length and diameter “target sign”

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52
Q

What class do these drugs belong to?

  • Prochlorperazine
  • Promethazine
  • Metoclopramide
A

Dopamine Blockers

Blocks CNS dopamine receptors D1, D2

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53
Q

Dx test of choice for C.diff

A

PCR , culture

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54
Q

HCC Screening

A

high risk patients: AFP + US q 3 mos sometimes recommended

Common screening method: US q 6-12 mos

**Many experts advise screening patients with long-standing hepatitis B even when cirrhosis is absent.**

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55
Q

The following are risk factos for which disease?

  • straining during defecation (constipation)
A

hemorrhoids

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56
Q

What lab tests should be ordered for pt w/ GI bleeding?

A
  • CBC
  • liver tests
  • anti-coag studies
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57
Q

Is there hematochezia in diverticulitis?

A

No

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58
Q

What are the Preferred Diagnostic Tests for Cholecystitis?

A

Initial: US

Gold Standard: HIDA Scan

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59
Q

What will labs show for chronic pancreatitis?

A

elevated amylase early on, but will decrease

abdominal xray/CT (calcifications)

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60
Q

_____________will present as → a 67-year-old man with a long history of constipation presents with steady left lower quadrant pain. Physical exam reveals low-grade fever, midabdominal distention, and lower left quadrant tenderness. Stool guaiac is negative. An absolute neutrophilic leukocytosis and a shift to the left are noted on the CBC.

A

Diverticulitis

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61
Q

S/S of small bowel intussesception

A

Sudden onset of significant, colicky abdominal pain that recurs every 15 to 20 min, often with vomiting.

Affects children after viral infections or adults with cancer

Occurs during first 2 weeks post op

Currant jelly stools

sausage-like mass in abdomen

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62
Q

What is the MC presentation of diverticula?

A

LLQ pain and tenderness

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63
Q

What diagnostic test should be used if unable to perform endoscopy in PUD?

A

urea breath test:

H pylori converts Urea to CO2

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64
Q

What does a standard workup prior to a surgical antireflux procedure include?

A

Endoscopy with biopsy is the gold standard for diagnosis

manometry

24-hour ambulatory pH probe testing

barium esophagography

X-ray

Esophageal motility testing

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65
Q

_________ is associated with forceful retching.

A

Malloer Weiss Syndrome

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66
Q

MCC of PUD?

A

H. pylori and NSAIDS

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67
Q

S/S for internal vs external hemorrhoids

A

Internal (above dentate line): bleeding + no pain, bleeding after defecation

External(below dentate line): significant pain + no bleeding

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68
Q

What is a positive Courvoiser sign?

A

Presence of painless, palpable gallbladder in the RUQ

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69
Q

H. pylori infection tx

A

Triple therapy: “CAP”

  • Clarithromycin
  • Amoxicillin
  • PPI
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70
Q

Esophageal is usually a complication of what?

A

GERD/Barrett’s esophagus

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71
Q

Mgmt for diverticulosis

A

supportive care (most bleeding stops spontaneously)

*surgery if persistent bleeding

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72
Q

_______________ will present as →a 63-year-old male who is being evaluated in the emergency department for an episode of painless bright red blood per rectum for two hours.

A

Diverticulosis

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73
Q

Firm olive like mass

What disease?

A

Pyloric Stenosis

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74
Q

Tx for gastroparesis

A
  • Low-fiber and low-residue diets, restrict fat intake, smaller meals spaced 2-3 h apart
  • Metoclopramide (D2 receptor antagonist) inc GI motility
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75
Q

GOLD STANDARD diagnostic test for acute cholecystitis

A

HIDA scan (assesses the patency of the cystic duct)

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76
Q

What is the difference between acute cholecystitis and biliary colic?

A

Biliary colic has temporary pain

Acute cholecystitis has pain that does not resolve, usually with elevated WBCs, fever, and signs of acute inflammation on U/S

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77
Q

C. Diff tx

A

IV metronidazole or PO vanco

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78
Q

What is the difference in presentation between a duodenal versus a gastric ulcer?

A

Gastric Ulcer: pain immediately after meals

Duodenal Ulcer: pain relieved by food (MC than gastric)

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79
Q

Mgmt of Reye

A

supportive + Mannitol (lower ICP)

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80
Q

S/S and PE of pancreatic pseudocyst

A

abdominal pain

PE: abdominal mass

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81
Q

Sxs of Pyloric Stenosis

A
  • forceful nonbilious vomiting “projctile vomiting” immediately after eating
    • infant appears hungry
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82
Q

Dx for Mallory Weis tear?

A

Upper endoscopy

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83
Q

What is a hemorrhoid?

A

engorgement of venous plexus

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84
Q

What diet is recommended for diarrhea?

A

BRAT diet

Banana

Rice

Applesauce

Toast

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85
Q

What labs will be abnormal in Pancreatic CA?

A

Increased Amylase (if tumor obstructs ducts)

Tumor Marker CA 19-9 (not diagnostic but can be used to follow response to therapy)

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86
Q

What will labs show in acute pancreatitis?

A

elevated lipase x 3

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87
Q

How does esophageal CA present?

A

difficulty swallowing solids that progresses to liquids and lymphadenopathy

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88
Q

Which drug for Crohns and UC works primarily in the colon?

A

Sulfasalazine (5-ASA)

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89
Q

Linitis plastica:“leather bottle” appearance

A

gastric carcinoma

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90
Q

MCC of acute ascending cholangitis?

A

choledocolithiasis leading to bacterial infection: E coli

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91
Q
A
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92
Q

Tx for Pyloric Stenosis

A

Supportive, treat electrolyte imbalances

Pyloromyotomy

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93
Q

MOA of bismuth subsalicylate

  • pepto-bismol
  • Kaopectate
A
  • antimicrobial
  • salicylate: anti-secretory + anti-inflammatory
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94
Q

S/E of opioid agonists

A

centra opiate effects

constipation

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95
Q

Tx for UC vs Crohns

A

UC and Crohns BOTH:

5-ASA agents (sulfasalazine, mesalamine)

corticosteroids

immunomodulating agents (azathioprine) for refractory disease

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96
Q

S/S of gastroparesis

A

nausea and a full feeling after little food is eaten

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97
Q

Extraintestinal manifestations of UC vs Crohns

A

UC: primary sclerosing cholangitis(inflammation and scarring of bile ducts), aphthous stomatitis, Colon CA, toxic megacolon, smoking DECREASES risk***

Crohns: erythema nodosum, + fistulas to skin, bladder, or b/w loops (perianal dz), granulomas, Fe + B12 deficiency

98
Q

Why should the gallbladder specimen be opened in the operating room?

A

Looking for gallbladder cancer, anatomy

99
Q

A pt with pancreatic CA will usually have a history of what?

A

smoking

100
Q

Labs UC vs Crohns

A

UC: + P-ANCA

Crohns: + ASCA

101
Q

What is the source of an external hemorrhoid vein?

A

inferior hemorrhoid vein distal to the dentate line

102
Q

S/s for toxic megacolon

A

Pt will present with FEVER, markedly distended abdomen with peritonitis and shock

103
Q

Toxic Megacolon Tx

A
  • Decompression of the colon is required.
  • In some cases, colostomy or even complete colonic resection may be required
  • IVF, ABX, IV corticosteroids
104
Q

What is the MCC of peptic strictures?

A

Long standing gastric reflux

105
Q

A pt presenting with diverticulosis will have a PMH significant for what?

A
  • high dietary consumption of red meat
  • low dietary fiber
  • sedentary lifestyle
  • BMI > 25
  • cigarette smoking
106
Q

Cpx of Esophageal CA

A

difficulty swallowing solids that progresses to liquids and lymphadenopathy

107
Q

What is the MCC of traveler’s diarrhea?

A

enterotoxigenic E. Coli (ETEC)

108
Q

What test is important to establish the dx of jaundice?

A

fractionated bilirubin test

109
Q

fever, pain that began periumbilical then moved to RLQ, nausea, and anorexia

What disease?

A

Appendicitis

110
Q

onset of diarrhea and vomiting during or closely following a course of antibiotics

What do you suspect?

A

clostridium difficile

111
Q

Dx test of choice for toxic megacolon

A

AXR

Kidney Ureter Bladder X ray shows dilated colon >6cm

+

At least three of the following:

Fever (>101.50F)

Heart rate > 120/min

Neutrophilic leukocytosis (>10.5 x 109/L)

Anemia

112
Q

What is Reynold’s pentad?

A

Seen in acute ascending cholangitis:

  1. fever
  2. abd pain
  3. jaundice
  4. confusion
  5. hypotension
113
Q

What differential dx should you have in the instance of Conjugated hyperbilirubinemia?

A

biliary obstruction, intrahepatic cholestasis, hepatocellular injury, or an inherited condition

114
Q

Toxic megacolon is usually a complication of what disease?

A

Ulcerative Colitis or Crohn’s disease (rarely)

115
Q

Test of choice for small bowel carcinoma

A

CT scan

wireless capsule endoscopy

fecal occult blood

tumor marker CEA +

116
Q

What is hematochezia?

A

passage of fresh blood through the anus

117
Q

intermittent cramping abdominal pain in the upper-right quadrant

right-upper-quadrant pain, guarding, and a positive Murphy’s sign

Precipitated by fatty foods or large meals

+ Boas sign

A

Acute Cholecystitis

118
Q

What often accompanies pts who have gastric carcinoma?

A

iron deficiency anemia

119
Q

What is the mgmt for small bowel obstruction?

A

nonstrangulated: NPO (bowel rest), IV fluids

Strangulated: surgical intervention

120
Q

Ileus Tx

A

Physiologic ileus spontaneously resolves within 2-3 d, after sigmoid motility returns to normal

Physiological ileus is a term used to portray the normal absence of motility and propulsion in the small and large intestine.

D/C opiates

121
Q

What is management of a thrombosed hemorrhoid presenting within 72 hours of the onset of symptoms?

A

elliptical excision

Anesthetize, make an elliptical incision of skin overlying clot, remove clot.

122
Q

What is a Mallory-Weiss Tear?

A

tear in the esophageal mucosa often following forceful vomiting

123
Q

What are diverticula?

A

Outpouchings of the GI tract that can occur anywehre from the esophagus to the rectum

124
Q

What PE sign is a specific indicator that a pt with acute cholecystitis has had a perforation?

A

Hypoactive bowel sounds

125
Q

What is the primary cause of appendicitis?

A

Appendiceal obstruction.

126
Q

What is a + Boas sign and in what dz do you see it?

A

referred pain to right subscapular area due to phrenic nerve irritation

acute cholecystitis

127
Q

What are the S/S of acute pancreatitis?

A

epigastric pain radiating to back; better leaning forward;

N/V, fever,

peritonitis symptoms,

hypovolemia, tachycardia,

Grey Turner Sign/Cullen Sign (hemorrhagic pancreatitis)

128
Q

RF for pancreatic CA

A
  • smoking
  • alcohol
  • obestiy
  • chronic pancreatitis
129
Q

What portion of the esophagus is involved in squamous cell esophageal cancer?

A

Upper 1/3 of esophagus

130
Q

What is the most imp first step in caring for a pt w/ GI bleeding?

A

obtaining IV access:

  • allows blood to be drawn for a type and screen, coagulation studies, and determination of hematocrit and hemoglobin levels.
  • It also allows for fluid resuscitation to maintain intravascular volume.
131
Q

What is a pancreatic pseudocyst?

A

Cystic collection of tissue, fluid, and necrotic debris surrounding the pancreas.

132
Q

What is Rosvings sign?

A

Pain in the RLQ w/palpation of the LLQ

133
Q

Diagnostic test of choice for gastric carcinoma

A

upper endoscopy w/biopsy

134
Q

Dx approach for hepatic lesion < 1cm

A

Image w/ MRI w/contrast

If negative, obtain f/u US q 3 months

135
Q

What is postoperative adynamic ileus or paralytic ileus?

A

Ileus that persists for more than 3 days following surgery

136
Q

Dx Test of choice for hematochezia?

A

colonoscopy

137
Q

Patient will present as → a 68-year-old smoker with a 25 lb weight loss over the last three months that is associated with a burning pain deep in the epigastrium after eating, diarrhea, and jaundice. Physical exam reveals a palpable non-tender gallbladder and clay-colored stool. Labs show a total bilirubin of 8, alkaline phosphatase of 450, and an ALT of 150

What disease?

A

Pancreatic CA

138
Q

What are the risk factors for gastric carcinoma?

A

*H. Pylori*

salted, cured, smoked, pickled foods containing nitrites/nitrates

139
Q

What are the S/S of chronic pancreatitis?

A

calcification, steatorrhea, diabetes mellitus

CLASSIC TRIAD

140
Q

What will Labs show for acute cholecystitis?

A
  • Increased WBC
  • elevated Alk Phos, LFTs
  • elevated amylase, T bilirubin
141
Q

________ is a clinical manifestation of hyperbilirubinemia.

A

jaundice

142
Q

Complications of bismuth-salicylates in children

A

Reye Syndrome: hepatoencephelopathy asssociated with ASA/salicylate use after viral illness resulting in increased ICP (vomiting, stupor, coma, death), hepatomegaly, fulminant liver failure.

143
Q

What class are these drugs?

Pepto-Bismol

Kaopectate

A

bismuth subsalicylate (anti-diarrheals)

144
Q

MCC of gastric carcinoma

A

H.pylori

145
Q

What is the most commonly affected area in diverticulitis?

A

sigmoid and descending colon

146
Q

Dx in UC vs Crohns

A

UC: flex sig test of choice in acute disease _*colonoscopy CI in acute colitis–> causes perforation, barium enema CI in acute colitis*_

Crohns: Upper GI series w/small bowel follow though in acute dz

147
Q

What is the source of an internal hemorrhoid?

A

superior hemorrhoid vein

148
Q

Tx for small bowel carcinoma

A

Surgery — Localized adenocarcinomas of the small bowel are best managed with wide segmental surgical resection

Adjuvant chemotherapy to patients with lymph node-positive

149
Q

a 52-year-old female with a history of cirrhosis secondary to long-standing alcohol abuse visits your office to discuss a 15-pound weight loss over the last 6 months. She reports early satiety, jaundice and vague abdominal discomfort. Her ascites, generally stable and small, has worsened in the last 3 weeks.

What disease?

A

Hepatocellular carcinoma (HCC)

150
Q

a 62-year-old man with a history of alcoholism complains of difficulty swallowing solids that has progressed to difficulty swallowing liquids. He has smoked 1-2 packs of cigarettes per day for the past 38 years. In addition he reports occasional bouts of hematemesis and hoarseness, along with progressive weight loss and weakness.

What does he have?

A

Esophageal Cancer

151
Q

What is the Ransom Criteria?

A

Used to determine prognosis for acute pancreatitis:

Poor prognosis if 3 or more = severe case

  • leukocyte >16K
  • glucose >200
  • AST >250
  • LDH >350
  • age>55

at 48 hours

  • arterial PO2 <60
  • HCO3: <20
  • Ca: <8
  • BUN increasing by 1.8+
  • Hct: decrease by >10%
  • Fluid sequestration >6L
152
Q

must avoid these anti-diarrheals in patients with acure dysentery

A

opioid agonists

153
Q

What is jaundice caused by if there is Predominant alkaline phosphatase elevation?

A

Elevation of the serum alkaline phosphatase out of proportion to the serum aminotransferases suggests biliary obstruction or intrahepatic cholestasis

154
Q

PE of ileus

A

absent bowel sounds

155
Q

Dx test of choice for esophageal CA

A

upper endoscopy w/biopsy

CT scans are used for staging

156
Q

intussusception tx

A

barium enema

NPO, IVF, NG

manual reduction

157
Q

What is jaundice caused by if there is a Predominant aminotransferase elevation?

A

intrinsic hepatocellular disease

158
Q

What is 1st line for hemorrhoids?

A
  1. conservative tx: high fiber diet, increased fluids. Warm sitz baths
  2. If failed above, debilitating pain, strangulation or stage IV: rubber band ligation
  3. Hemorrhoidectomy for all stage IV or those not responsive to above
159
Q

What differential dx should you have in the instance of Unconjugated hyperbilirubinemia?

A

evaluation for hemolytic anemia, drugs that impair hepatic uptake of bilirubin, and Gilbert syndrome

160
Q

How is an IOC performed?

A
  1. Place a clip on the cystic duct- gallbladder junction
  2. Cut a small hole in the distal cystic duct to cannulate
  3. Inject half-strength contrast and take an x-ray or fluoro
161
Q

What is jaundice caused by if you have an elevated INR that corrects with vitamin K administration?

A

impaired intestinal absorption of fat-soluble vitamins and is compatible with obstructive jaundice

162
Q

Tx for diverticulitis

A

metronidazole + ciprofloxacin

OR

moxifloxacin monotherapy

163
Q

Side Effects of bismuth salicylates

A

dark stools, dark tongue

164
Q

What are possible causes of hematochezia (bright red blood per rectum)?

A

Lower GI bleed:

  • Hemorrhoids
  • Anal Fissures
  • Polyps
  • Colorectal CA
165
Q

Tx for acute cholecystitis

A

If asymptomatic: observe, CCY not recommended

Symptomatic: IVFs, Abx, CCY early

166
Q

What class are these drugs?

  • phenobarbital
  • Hyoscyamine
  • Atropine
  • Scopolamine
A

Anticholinergics, antispasmodics

167
Q

Dx test of choice for diverticulitis?

A

abdominal CT scan w/oral and IV contrast

CT can also evaluate for abscesses, perforation, fistula, obstruction, and ileus​

168
Q

What is the main dx test of choice for acute pancreatitis?

A

US

169
Q

What is a contraindication of anti-motility drugs?

A

do not give to pts with invasive diarrhea due to toxicity

170
Q

What are basis are internal hemorrhoids classified with?

A

Based on the degree of prolapse from the anal canal:

I. no prolapse

II. prolapses w/defecation or straining w/ spontaneous reduction

III. prolapses w/defecation or straining, requires manual reduction

IV. Irreducible & may strangulate

171
Q

What is the optimal timing for cholecystectomy following an acute presentation of cholecystitis?

A

Depending on the stabilization of the patient, earlier surgery within 48-72 hours of diagnosis is recommended to avoid complications.

172
Q
A
173
Q

Dx test of choice for melena?

A

EGD

174
Q

What imaging should be ordered to confirm appendicitis?

A

US, CT scan

175
Q

Most common type of esophageal CA

A

squamous cell adenocarcinoma

176
Q

Which drug is best for maintenance of both UC and Crohns?

A

Oral Mesalamine (5-ASA)

177
Q

What disease processes can cause jaundice?

A

increased bilirubin overproduction (hemolysis)/ineffective erythropoiesis

decreased hepatic bilirubin uptake

impaired conjugation

biliary tract obstruction

viral hepatitis

physiologic jaundice of newborn

gilbert syndrome

Dubin-johnson

178
Q

What diagnostics should you order for a suspected esophageal stricture?

A

1st: Barium Swallow
2nd: Upper endoscopy

179
Q

Tx of traveler’s diarrhea

A

rehydration and ciprofloxacin or azithromycin (pregnant women and children)

180
Q

What is the cause of acute cholangitis?

A

biliary tract onstruction, stasis and infection

181
Q

A rise in ________ in a patient with cirrhosis or hepatitis B should raise concern that HCC has developed.

A

AFP

182
Q

What are risk factors of Hepatocellular carcinoma?

A
  • chronic liver disease
  • cirrhosis
  • Hepatitis B or C infections
183
Q

What is the next step if no radiologic hallmarks of HCC are seen?

A

biopsy

184
Q

Barium Studies UC vs Crohns

A

UC: “stovepipe sign”

Crohns: “string sign”

185
Q

Indications for surgical tx for GERD:

A

Intractability (failure of medical treatment)

Respiratory problems as a result of reflux and aspiration of gastric contents (e.g., pneumonia)

Severe esophageal injury (e.g., ulcers, hemorrhage, stricture, +/- Barrett’s esophagus)

186
Q

What is the most common cause of upper GI bleed?

A

Peptic Ulcer Disease

187
Q

Dx test of choice for small bowel intussusception

A

abdominal x ray/US: crescent sign or bulls eye/target sign/coiled spring lesion

188
Q

Complications of acute cholecystitis

A
  • Abscess Perforation
  • Choledocholithiasis
  • Cholecystenteric fistula formation
  • Gallstone ileus
189
Q

What are the main differences in s/s between small and large bowel obstruction?

A

Small bowel: colicky abd pain, bilious vomiting, hyperactive bowel sounds

Large bowel: gradually inc abd pain, longer intervals between episodes of pain, less vomiting (feculent)

190
Q

Definitive dx for acute ascending cholangitis

A

Charcots triad + biliary dilation on US

191
Q

Tx for pseudocyst

A

If pseudocyst persists for 4 to 6 weeks or continues to enlarge:

  • Percutaneous drainage
  • Surgical decompression (pancreaticogastrostomy)
  • Cyst fluid is drained into the stomach or bowel
  • Can become infected and lead to peritonitis
192
Q

What is gastroparesis?

A

A condition that affects the stomach muscles and prevents proper stomach emptying

193
Q

Dx test of choice for gastroparesis

A

gastric emptying scan

194
Q

What is definitive treatment of acute ascending cholangitis?

A

ERCP w abx (Zosyn)

195
Q

_______ hemorrhoids may become thrombosed

A

external

196
Q

What will US show in acute cholecystitis?

A
  • Thickened gallbladder wall (3 mm)
  • Pericholecystic fluid
  • Distended gallbladder
  • Gallstones present/cystic duct stone
  • Sonographic Murphy’s sign (pain on inspiration after placement of ultrasound probe over gallbladder)
197
Q

When should a patient you suspect has GERD undergo diagnostic testing?

A

Those with long-standing or atypical symptoms (wheezing, cough, hoarseness), recurrence of disease after the cessation of medical therapy, or unrelieved symptoms when taking maximal-dose PPIs

198
Q

Tx for acute pancreatitis

A

supportive therapy

  • NPO
  • IV Fluids
  • antibiotics (zosyn: pieracillin + tazobactam)
    • no Alc
199
Q

What class are these drugs?

Diphenoxylate, Loperamide

A

opioid agonists

200
Q
A
201
Q

What is the 1st line diagnostic Test for acute cholecystitis?

A

US: will show stones

202
Q

What are large outpouchings of the mucosa in the colon called?

A

Diverticula

203
Q

What complication can chronic cholecystitis lead to?

A

Porcelain GB (premalignant condition)

204
Q

Dx test of choice for ileus

A

CT scan w/gastrografin (must excluse mechanical obstruction)

205
Q

Tx for pancreatic CA

A
  • If confined to pancreas and can be removed: Whipple Procedure (pancreaticoduodenectomy):
  • If confined to pancreas and CAN NOT be removed: combination of radiation therapy + chemo
206
Q

What type of cancer is MC in small bowel cancers and where are they usually located?

A

Adenocarcinomas represent from 25 to 40 percent of small bowel cancers - highest in the duodenum

207
Q

Tx for melena/hematochezia

A

Endoscopic thermal probe: This involves burning the blood vessel or tissue that’s causing an ulcer.

Endoscopic clips: These can close a bleeding blood vessel or other sources of bleeding in the tissue in your GI tract.

Endoscopic injection: Injection of liquid near the source of bleeding that will stop the flow of blood.

Band ligation: This procedure involves placing small rubber bands around hemorrhoids or swollen veins (esophageal varices) to cut off their blood supply, which will make them dry up and fall off.

208
Q

Esophageal varices are complications of what?

A

portal vein hypertension

209
Q

Whats the MC risk factor for esophageal varices in adults?

A

cirrhosis

210
Q

Dx for esophageal varices

A

upper endoscopy, enlarged veins

+red wale markings and cherry red spots

211
Q

1st line tx of esophageal varices

A
  1. endoscopic ligation
  2. octreotide: pharmacologic drug of choice in acute bleeding
  3. surgical decompression: trans jugular intrahepatic portosystemic shunt (TIPS)
212
Q

Tx for rebleeds in esophageal varices

A
  1. nonselective beta blockers: propanolol, nadolol

**do not use in acute bleeds***

2. isosorbide: long acting nitrate

213
Q

Abx prophylaxis for esophageal varices

A

fluoroquinolone or ceftriaxone

214
Q

What is the cause of gastritis?

A

1 cause: H. Pylori

imbalance between increased aggressive and decreased protective mechanisms of the gastric mucosa

215
Q

What is the most effective drug to treat PUD?

A

PPIs “prazoles”

216
Q

MOA of PPIs

A

blocks H+/K+ ATP-ase (proton pump) of parietal cell, reducing acid secretion.

217
Q

What is the main side effect of PPIs?

A

B12 deficiency

218
Q

Omemprazole causes ______, which increases levels of warfarin and other drugs

A

Omemprazole causes CP450 inhibition, which increases levels of warfarin and other drugs.

219
Q

MOA of H2 receptor antagonists

A

reduces acid/pepsin secretion

220
Q

SES of H2 receptor antagonists

A

drug interactions with cimetidine: CP450 inhibition

Anti-androgen effects of cimetidine: gynecomastia, impotence

221
Q

Which medication is good for preventing NSAID-induced ulcers but not for healing already existing ulcers?

A

misoprostol

222
Q

Misoprostol is CI in what population?

A

premenstrual women because it is abortifacent and causes cervical ripening

223
Q

Causative factors for Duodenal vs Gastric ulcers

A

Duodenal: increase in damagin factors: acid, pepsin, H.pylori

Gastric: decrease in mucosal protective factors: mucus, bicarb, prostaglandins; NSAIDs

224
Q

Incidence of gastric vs duodenal ulcers

A

gastric: 4% malignant
duodenal: 4x more common

225
Q

Younger patients will have which type of peptic ulcer?

A

duodenal > gastric

226
Q

Where are gastrinomas most commonly seen?

A

duodenal wall, >66% are malignant

227
Q

s/s of zollinger-ellison syndrome

A

multiple peptic ulcers, refractory ulcers, “kissing” ulcers

diarrhea

228
Q

Dx for zollinger-ellison syndrome

A

test of choice: increased fasting gastrin level

+secretin test: increased gastrin release with secretin seen in gastrinomas

229
Q

Tx for local vs metastatic dz of zollinger-ellison syndrome

A

local: surgical resection
mets: PPIs, surgical resection if +liver involvement

MC sites for mets are liver and abd lymph nodes

230
Q

Risk factors for gastric carcinoma

A

H. Pylori = main RF

salted, cured, smoked, pickled foods containing nitrites/nitrates

231
Q
A
232
Q

What is linitis plastica?

A

Linitis plastica: diffise thickening of the stomach wall “leather bottle” appearance

gastric carcinoma

233
Q

Most likely dx when AST/ALT is >2 and AST is very high

A

EtOH hepatitis

234
Q

Labs: ALT>AST

ALT + AST >1000

what should you be thinking?

A

viral/toxic/inflammatory processes regarding the liver

235
Q

Increased Alk Phos + inc GGT suggests what?

A

biliary obstruction or intrahepatic cholestasis

236
Q

ALT > 100

+ANA

+Smooth muscle Ab

responds to Corticosteroids

What is most likely dx?

A

autoimmune hepatitis

237
Q

What are 2 complications of choledocolithiasis?

A
  1. acute pancreatitis: epigastric pain, increased amylase and lipase
  2. acute cholangitis: charcots triad of fever, jaundice and RUP pain.
238
Q

Diagnostic test of choice for choledocolithiasis?

A
  • ERCP
    • (diagnostic and therapeutic: allows for strone extraction)
    • obtained AFTER initial transabdominal US
239
Q

MC organism responsible for acute cholangitis?

A

E coli: gram — enteric organism

240
Q

labs in acute cholangitis

A

increased alk phos, GGT, bilirubiin

241
Q

gold standard dx for acute cholangitis

A

ERCP– common bile duct decompression/stone extraction: (pt must be stabilized and afebrile for 48 hrs after IV abx)

others(usually done initially):

US

CT scan

242
Q

Mgmt for acute cholangitis

A

abx

GK General Surgery (11 decks)

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