GI/Bowel

Question 1

Pancreatitis diagnostics

Answer 1

Lipase

Less amylase
Imaging at some point

Question 2

Diverticulitis management

Answer 2

Surgical indications:
2 or more attacks
Complications (perf, abscess, obstruction, fistula, stricture)
Failure to improve w/in 3-4 days

Nonop: Oral antibiotics (broad spectrum), clear liquids, low residue diet

Question 3

Bright red blood per rectum

Answer 3

Internal hemorrhoids
Diverticulosis
Ulcerative colitis
Fissures - pain

Question 4

Complication of paraesophageal hernia

Answer 4

Volvulus (most likely to kill), incarceration, gastric outlet obstruction

Question 5

Steps in lap cholecystecomy

Answer 5

Dissect peritoneum
(identify) Ligate cystic artery, cannulate cystic duct
Division of cystic duct
Dissect gall bladder from liver bed
Cauterize, irrigate, suction –> hemostabilize
Remove gall bladder through umbilical / subxyphoid trocar

Question 6

Steps in appendectomy

Answer 6

Identify appendix
Staple mesoappendix
Staple and transect the appendix at the base
Remove appendix 
Irrigate and aspirate until clear

Question 7

Indications for surgical management of diverticulitis

Answer 7

Recurrent attacks
Right sided
Complications
Failure to improve with conservative management within 3-4 days

Question 8

Hartmann’s procedure

Answer 8

Colostomy with distal end oversewn and placed in peritoneal cavity as blind limb

Question 9

Grades of internal hemorrhoids

Answer 9

1: prominent blood vessels only
2: prolapse if bearing down, spontaneously reduce
3: prolapse if bearing down, manually reduce
4: cannot manually reduce

Question 10

Triad of SMA embolism?

Answer 10

Abdominal pain with minimal exam findings
bowel emptying
hx cardiac dz

stool guiac positive/bloody

Question 11

Red flags SBO

Answer 11

pneumoperitoneum
retroperotineal air
sepsis/shock
peritoneal signs