GI EOR Flashcards
Anal fissures are most commonly found at:
Posterior midline
Treatment for anal fissure
Sitz bath
Topical diltiazem
Topical glyceryl trinitrate ointment
Botox
What is the 90% rule
For anal fissures:
90% posterior
90% heal with medical treatment
90% of patients that undergo LIS heal successfully
What is a sentinel pile
Thickened mucosa/skin at distal end of anal fissure
Often confused with small hemorrhoid
Treatment for rectal abscess
Surgical drainage and antibiotics
50% of patients with rectal abscess develop ______ within 6 months of surgery
Fistula in ano
Where are rectal fistulas located
Within 3 cm of anal margin
How do you diagnose a rectal fistula in the OR
Inject H2O2 (or methylene blue) into the external opening and look for bubbles coming out of the internal opening
What is Goodsall’s rule
Rectal fistulas:
Anterior: course straight
Posterior: curved tract
Treatment for rectal fissure
Surgical fistulotomy
Causes of anorexia
Appendicitis Gastric ulcer Duodenal ulcer Gastric cancer Lower GI bleed Carcinoma of the gallbladder Pancreatic carcinoma
With appendicitis, which comes first, the pain or the N/V
Periumbilical pain —> N/V —> anorexia —> RLQ pain
Describe the abdominal exam in acute appendicitis
Soft
Non-distended
TTP at mcburneys point
Rovsing sign:
RLQ pain with LLQ palpation
Obturator sign
RLQ pain with internal and external hip rotation with flexed knee
Psoas sign
RLQ pain with right hip flexion/extension
Most sensitive test for appendicitis
CT with contrast
Treatment for non-perforated appendicitis
Lap appy, antibiotics 24 hours
Treatment for perforated appendicitis
Lap appy, antibiotics 3-7 days
What is the perforation risk with time associated with appendicitis
24 hours = 25% risk
36 hours = 50% risk
48 hours = 75% risk
What is the parasite that closely mimics acute appendicitis
Yersinia enterolytica
Most common cause of emergent abdominal surgery
Appendicitis
Where does a pregnany woman have pain with acute appendicitis
RUQ
Lifetime incidence of appendicitis
7%
How does a patient with acute appendicitis present
Abdominal pain
N/V
Anorexia
Umbilical pain that localizes to RLQ
Low grade fever
Mild leukocytosis
Most common cause of appendicitis
Lymphoid hyperplasia
Indications for bariatric surgery
BMI > 40
BMI > 25 + medical problem related to obesity
Must have failed medical treatment
Most common bariatric surgery
Roux-en-Y
Early complications of bariatric surgery
anastomotic leak
DVT/PE
Bleeding
Infection
Splenic injury
Late complications of bariatric surgery
Malnutrition
Marginal ulcer and anastomotic strictures
Internal hernia
Cholelithiasis
Band slippage
Band erosion
Esophageal dilation
