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EOR - Surgery > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

1
Q

epigastric pain that radiates to right subscapula

A

cholecystitis

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2
Q

7 causes of epigastric pain

A

PUD
gastritis
MI
pancreatitis
biliary colic
gastric volvulus
mallory-weiss tear

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3
Q

mcc of llq pain

A

diverticulitis

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4
Q

mcc of rlq pain

A

appendicitis

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5
Q

RUQ pain + fever + leukocytosis

A

cholecystitis

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6
Q

5 f’s of cholecystitis

A

female
fat
forty
fertile
fair

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7
Q

preferred imaging vs gs imaging for cholecystitis

A

preferred: US
gold standard: HIDA

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8
Q

3 US findings of cholecystitis

A

gallbladder wall > 3 mm
pericholecystic fluid
gallstones (duh)

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9
Q

complication of chronic cholecystitis

A

porecelain gallbladder

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10
Q

epigastric pain that radiates to the back + n/v

A

pancreatitis

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11
Q

2 etiologies of pancreatitis that Smarty PANCE wants us to know

A

cholelithiasis
etoh

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12
Q

gs imaging for pancreatitis

A

CT

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13
Q

what is this sign

A

grey turner’s -> pancreatitis

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14
Q

what is this sign

A

cullen’s -> pancreatitis

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15
Q

ranson’s criteria for poor prognosis w. pancreatitis

A

at admit:
age > 55
leukocytosis > 16,000
glucose > 200
LDH > 350
AST > 250

at 48 hr:
arterial PO2 < 60
HCO3 < 20
Ca < 8.0
BUN increase by 1.8
Hct decrease by > 10%
fluid sequestration > 6 L

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16
Q

what is this showing

A

pancreatic pseudocyst: circumscribed collection of fluid rich in pancreatic enzymes, blood, necrotic tissue

complication of pancreatitis

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17
Q

chronic pancreatitis triad

A

pancreatic calcification
steatorrhea
DM

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18
Q

3 anal topics to know

A

fissure
abscess
fistula

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19
Q

hallmark sx of anal fissure

A

blood on outside of stool or in toilet following BM

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20
Q

anal fissures are extremely common in what pt pop

A

infants

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21
Q

mc type of anal fissure

A

vertical

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22
Q

horizontal anal fissures make you think of (2)

A

crohn’s
HIV

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23
Q

tx for anal fissures (3)

A

most self resolve
stool softeners
pteroleum jelly

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24
Q

complication of anal fissure

A

anal abscess

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25
Q

2 mcc of anorectal abscess

A

STDs
blocked anal glands

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26
Q

2 mcc of deep rectal abscesses

A

crohn’s
diverticulitis

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27
Q

tx for anorectal abscess (4)

A

I&D
sitz bath
pain control
abx

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28
Q

complication of deep anorectal abscess

A

anorectal fistula

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29
Q

Smarty PANCE wants you to think about _ w. anorexia

A

appendicitis

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30
Q

classic progression of appendicitis

A

periumbilical -> n/v -> anorexia -> RLQ pain
over 24 hr

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31
Q

besides appendicitis, what other conditions does anorexia make you think of (5)

A

ulcers
lower GI bleed
GI cancers
thyroid dz
meds

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32
Q

mnemonic for sx of gastric ca

A

weapon:
weight loss
emesis
anorexia
pain
obstruction
nausea

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33
Q

6 sx of lower GI bleed

A

brbpr
anorexia
fatigue
syncope
SOB
shock

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34
Q

sx of pancreatic carcinoma

A

painless jaundice
wt loss
abd pain
back pain weak
pruritis
acholic stool
dark urine
DM

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35
Q

6 meds associated w. anorexia

A

sedatives
digoxin
laxatives
thiazides
narcotics
abx

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36
Q

4 PE signs associated w. appenditicis

A

mcburney’s point: rebound tenderness
rovsing: RLQ pain w. palpation of LLQ
obturator: RLQ pain w. internal hip rotation
psoas: RLQ pain w. hip extension

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37
Q

CBC finding of appendicitis

A

neutrophilia

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38
Q

mcc of pancreatitis: acute vs chronic

A

acute: gallstones
chronic: etoh

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39
Q

1/3 of pancreatic ca can be attributed to (2)

A

smoking
etoh

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40
Q

tumor marker present in 80% of pancreatic ca

A

CA 19-9

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41
Q

what is PONV

A

post op nausea/vomiting

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42
Q

3 emotogenic drugs commonly used in anesthesia

A

nitrous oxide (N2O)
opioids
phyostigmine

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43
Q

3 surgeries mc associated w. PONV

A

cholecystectomy
gynecologic
laparoscopic

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44
Q

least emetogenic general anesthetic

A

propofol

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45
Q

dx for PONV

A

PONV scale:
female
nonsmoker
hx of motion sickness/prev PONV
expected use of postop opioids

score of 0,1, 2 ,3 ,4 = 10-80% risk respectively

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46
Q

tx for PONV (2)

A

preoperative fasting x 2-6 hr
antiemetics

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47
Q

name 5 antiemetics

A

scopolamine patch
dexamethasone
ondansetron
prochlorperazine
droperidol

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48
Q

name 2 rescue antiemetics administered in PACU

A

prochlorperazine
droperidol

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49
Q

sx of upper GI bleed

A

coffee ground hematemesis
+/- melena

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50
Q

first consideration in eval of upper GI bleed

A

evaluate hemodynamic stability

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51
Q

5 symptoms that suggest severe upper GIB

A

orthostatic hypotn
confusion
angina
palpitations
cold/clammy extremities

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52
Q

5 causes of upper GIB

A

peptic ulcer
esophageal ulcer
mallory-weiss tear
variceal hemorrhage
malignancy

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53
Q

sx of blood loss based on severity: 15% loss - 40% loss

A

15%: resting tachy
15-39%: orthostatic hypotn
>/= 40%: supine hypotn

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54
Q

define orthostatic hypotn

A

decrease in systolic bp > 20 mmHg and/or increase in HR of 20 bpm moving from sitting to standing

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55
Q

management of upper GIB (2)

A

IVF asap
transfusion

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56
Q

indications for transfusion (5)

A

hemodynamically unstable despite IVF
Hgb < 9 in high risk pt
Hgb < 7 in low risk pt (most pt’s)
active bleeding + PLT < 50,000
INR > 2.0 not due to cirrhosis

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57
Q

appendicitis is unlikely if the patient is _

A

hungry

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58
Q

what is obstipation

A

severe or complete constipation

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59
Q

2 XR findings of bowel obstruction

A

air fluid levels
dilated loops of bowel

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60
Q

2 types of bowel obstruction

A

small
large

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61
Q

5 sx of SBO

A

colicky abd pain
nausea w. bilious vomiting
obstipation
abd distension
high pitched BS -> hypoactive BS

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62
Q

5 sx of LBO

A

gradually increasing abd pain
longer intervals btw pain
abd distension
obstipation
less vomiting than SBO

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63
Q

3 hallmark sx of bowel obstruction

A

vomiting partially digested food
svere abd distension
hyperactive BS -> hypoactive BS

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64
Q

what is this showing

A

dilated loops of bowel
air fluid levels
little/no gas in colon

bowel obstruction

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65
Q

management of bowel obstruction (3)

A

NGT
hemodynamic monitoring
laparotomy

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66
Q

indication for surgery w. bowel obstruction

A

no resolution w. 24-48 hr of conservative managment

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67
Q

sudden onset of significant, colicky abd pain that recurs q 15-20 min w. vomiting

A

small bowel intussusception

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68
Q

3 pt pops that make you consider intussusception

A

post GI op
kiddos after viral infxn
adults w. cancer

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69
Q

90% of intussusception involves what part of the bowel

A

ileocecal junction

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70
Q

2 hallmark sx of intussusception

A

currant jelly stool
sausage like mass in abd

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71
Q

3 imaging findings of intussusception

A

crescent sign
bull’s eye/target sign
coiled spring lesion

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72
Q

what is this showing

A

target sign -> intussusception

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73
Q

what is this showing

A

meniscus/crescent sign -> intussusception

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74
Q

dx AND tx for intussusception in kiddos

A

barium enema

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75
Q

general management of intussusception (5)

A

-NPO
-NGT
-IVF
-barium enema
-manual reduction/resection w. anastomosis

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76
Q

clinical definition of post op adynamic ileus/paralytic ileus

A

ileus that persists > 3 days post op

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77
Q

what is an ileus

A

hypomotility of GIT in absence of mechanical bowel obstruction

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78
Q

hallmark sx of ileus

A

absent bowel sounds

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79
Q

gs imaging for ileus

A

CT w. gastrografin

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80
Q

management of ileus

A

mc self resolves x 2-3 days

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81
Q

condition that affects stomach muscles and prevents proper stomach emptying

A

gastroparesis

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82
Q

mcc of gastroparesis

A

DM

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83
Q

all causes of gastroparesis (6)

A

dm
anorexia
bulimia
scleroderma
ehlers-danlos
abd surgery

84
Q

2 hallmark sx of gastroparesis

A

nausea
early satiety

85
Q

dx for gastroparesis (3)

A

gs: gastric emptying scan
KUB
manometry

86
Q

management of gastroparesis (3)

A

low fiber/low residue diet/low fat diet
small, frequent meals
metoclopramide (reglan)

87
Q

moa for reglan

A

d2 receptor antagonist -> increases contractility/resting tone in GIT

88
Q

inflammation of the colon caused by cdiff

A

pseudomembranous colitis

89
Q

3 abx mc associated w. pseudomembranous colitis

A

pcn
cephalosporins
broad spectrum abx

90
Q

what pt pop should you think about w. pseudomembranous colitis

A

elderly hospitalized

91
Q

pseudomembranous colitis relies on the secretion of what 2 toxins, which dusrupt normal colinic flora

A

A - enterotoxin
B- cytotoxin

92
Q

hallmark sx of pseudomembranous colitis

A

mild foul-smelling watery diarrhea
>3 but < 20/day

93
Q

t/f: pseudomembranous colitis is commonly associated w. fever

A

t!

94
Q

dx for pseudomembranous colitis

A

PCR

95
Q

which cdiff toxin is clinically important

A

toxin b

96
Q

tx for pseudomembranous colitis

A

IV metro
vs
PO vanco

97
Q

2 complications of pseudomembranous colitis

A

bowel perf
toxic megacolon

98
Q

only proven method to reduce and maintain wt loss and reduce obesity related morbidities/mortalities

A

bariatric surgery

99
Q

NIH guidelines for indications for bariatric surgery (5)

A

BMI > 40
BMI > 35 + obesity related problem
failed non surgical wt. loss programs
psychologically stable to follow post op care
obesity NOT due to medical dz (ex endocrine)

100
Q

3 mechanisms that bariatric surgery uses to reduce energy intake in obese pt’s

A

restrictive
malabsorptive
combo: restrictive + malabsorptive

101
Q

3 types of restrictive bariatric surgery procedures

A

adjustable gastric banding (AGB)
vertical banded gastroplasty (VBG)
sleeve gastrectomy (SG)

102
Q

2 types of bariatric malabsorptive procedures

A

-biliopancreatic diversion (BPD)
-biliopancreatic diversion w/w.o duodenoal switch (BPD/DS)

103
Q

combo malabsorptive/restrictive bariatric surgery procedure

A

roux-en-y gastric bypass (RNYGB)

104
Q

4 mc bariatric procedures used in the US

A

RNYGB
AGB
VSG
BPD/DS

105
Q

describe roux-en-y

A

-bypass: stomach, duodenum, 100-150 cm of SI
-creates a restrictive pouch
-roux limb (gastrojejunostomy): limits absorption

106
Q

2 complications of RYGB that Smarty PANCE stresses

A

dumping syndrome
mortality 1/500

107
Q

what gastric bypass procedures is restrictive and hormonal

A

VSG

108
Q

describe VSG

A

-resection stomach along greater curvature, including fundus ->
-reduces stomach to < 25% volume
-decreased ghrelin due to removal of fundus

109
Q

what type of bariatric surgery is restrictive only

A

ABG

110
Q

ideal candidate for ABG

A

volume eater

trains pt to eat and chew slower

111
Q

downsides of ABG (4)

A

regurgitation
annual barium swallow study
less wt loss
hiatal hernias must be repaired first

112
Q

3 complications of ABG

A

band slippage
prolapse
dilation

113
Q

mc bariatric surgery for tx of severe obesity in US

A

RNYGB

114
Q

what type of bariatric surgery leaves the pylorus and stomach innervation intact

A

SG

115
Q

what types of bariatric surgeries are not commonly used due to complications and malnutrition

A

BPD
DS

116
Q

5 early complications of bariatric surgery

A

anastomitic leak
DVT/PE
bleeding
infxn
splenic injury

117
Q

8 late complications of bariatric surgery

A

malnutrition
ulcer
anastomotic strictures
internal hernia
cholelithiasis
band slippage
band erosion
esophageal dilatation

118
Q

mcc of esophageal stricture

A

GERD

119
Q

2 PMH clues for esophageal stricture

A

solid food dysphagia
GERD

120
Q

infectious esophagitis causes what type of esophageal stricture (2)

A

proximal
mid

NOT distal

121
Q

schatzki ring is mc associated w. what condition

A

hiatal hernia

122
Q

triad of plummer-vinson syndrome

A

dysphagia
esophageal webs
IDA

123
Q

thin membrane in mid-upper esophagus that is congenital vs acquired

A

esophageal web

124
Q

esophageal strictures are often due to

A

healing process of ulcerative esophagitis

125
Q

diaphragm like mucosal ring that forms at the esophagogastric junction (B ring)

A

schatzki ring

126
Q

when do sx usually occur w. schatzki ring based on size

A

> 20 mm: few sx
< 13 mm: severe/chronic sx

127
Q

schatzki rings are found in 6-15% of pt’s who have undergone

A

barium swallow study

128
Q

typical presentation of schatzki ring

A

intermittent/nonprogressive dysphagia for solids after consuming heavy meal w. meat that was wolfed down

steakhouse syndrome

129
Q

dx and tx for schatzki ring

A

dx: barium swallow/endoscopy
tx: dilation via rupture

130
Q

what is this showing

A

esophageal web

131
Q

first line diagnostic study in elderly man presenting w. dysphagia

A

esophagoscopy

132
Q

major risk factor for adenocarcinoma of the esophagus leading to barrett esophagus

A

GERD

133
Q

adenocarcinoma of the esophagus mc occurs at what part of the esophagus

A

lower third

134
Q

2 main types of esphageal ca

A

squamous cell carcinoma
adenocarcinoma

135
Q

mcc of both types of esophageal ca

A

adenocarcinoma: GERD/barrett’s
squamous cell: smoking vs etoh

136
Q

7 sx of esophageal ca

A

dysphagia of solids -> liquids
regurgitation
heartburn
LAD
wt loss
hematemesis
chest pain unrelated to eating

137
Q

dx for esophageal ca (3)

A

barium swallow
endoscopy/bx
MRI vs thoracic CT

138
Q

tx of choice for esophageal ca that has NOT metastasized

A

surgery

139
Q

mc type of esophageal ca worldwide vs US

A

worldwide: squamous
US: adeno

140
Q

gs dx for esophageal ca

A

upper endoscopy w. bx

141
Q

indication for endoscopic screening for esophageal ca

A

pt’s w. barrett’s q 3-5 years

142
Q

90% of gallstones are:
10% are:

A

90%: cholesterol
10%: pigmented

143
Q

10 rf for cholelithiasis

A

5 f’s
ocp’s
chronic hemolysis
cirrhosis
infxn
rapid wt loss
ibd
tpn
fibrates
elevated TG

144
Q

3 complications of cholelithiasis

A

cholecystitis
choledocholithiasis
cholangitis

145
Q

when should US for cholelithiasis be performed

A

after 8 hr of fasting

distended/bile filled gallbladder is best to visualize stones

146
Q

2 types of pigmented gallstones

A

black: calcium bilirubinate
brown: biliary tract infxn

147
Q

2 causes of black gallstones

A

cirrhosis
hemolysis

148
Q

t/f: hypercholesterolemia is a rf for gallstones

A

f!

hyperlipidemia is tho

149
Q

referred right subscapular pain of biliary colic

A

boas sign -> cholelithiasis

150
Q

4 complications of lap chole

A

cbd injury
right hepatic duct/artery injury
cystic duct leak
biloma

151
Q

3 indications for cholecystectomy in asymptomatic pt

A

ssa
porecelain gallbladder
kiddo

152
Q

gs dx/tx for choledocholithiasis

A

ercp

153
Q

what med may dissolve cholesterol gallstone

A

chenodeoxycholic acid (actigall)

154
Q

screening recs for colorectal carcinoma

A

all adults 45-75 yo
+/- 76-85 yo

155
Q

screening options for pt’s with no rf for colorectal ca (4)

A

colonoscopy q 10 years
flexible sigmoidoscopy q 5 years
double contrast barium enema q 5 years
circulating tumor cells q 5 years

156
Q

screening for colorecta cal for pt w. adenomatous polyps OR colon ca in first degree relative

A

colonoscopy at 40 or 10 years younger than first relative was dx

157
Q

3 highest risk factors for colorectal ca that indicate colonoscopy at any age

A

IDB
hereditary non polyposis colorectal ca
familial adenomatous polyps

158
Q

progression of adenomatous polyp into malignancy (adenocarcinoma) usually occurs w.in _ years

A

10-20 years

159
Q

7 known rf for colorectal ca

A

age > 45
IBD
polyps
low fiber diet
high animal fat diet
smoking
etoh

160
Q

2 hallmark sx of colorectal ca

A

painless rectal bleeding
change in bowel habits

161
Q

3 stool tests for colorectal ca

A

guaiac based fecal occult (FOBT) annually
fecal immunochemical test (FIT) annually
FIT-DNA q 1-3 years

162
Q

what is this showing

A

apple core lesion on barium enema -> colorectal adenocarcinoma

163
Q

2 lab findings of colorectal carcinoma

A

elevated CEA
anemia

164
Q

tx for colorectal carcinoma (3)

A

surgical resection
5 FU chemo
monitor CEA

165
Q

what is lynch syndrome

A

-hnpcc: hereditary non polyposis colon ca
-autosomal dominant
-high risk of colon ca

166
Q

sx of colon ca: right vs left sided lesion

A

right: microcytic anemia, (+) FOBT, melena, postprandial discomfort, fatigue

left: change in bowel habits, colicky pain, obstruction, abd mass, BRBPR, hematemesis, constipation

167
Q

melena is mc from what type of colorectal ca

A

right sided

168
Q

hematochesia is mc w. what type of colon ca

A

left sisded

169
Q

microcytic anemia is _ until proven otherwise in a man or postmenopausal woman

A

colorectal ca

170
Q

3 mcc of colonic obstruction in adults

A

colon ca
diverticular dz
colonic valvulus

171
Q

mc type of gastric carcinoma

A

adenocarcinoma

172
Q

4 rf for gastric ca

A

fam hx
gastric ulcers
h pylori
prenicious anemia

173
Q

5 sx of gastric ca

A

LOA
progressive dysphagia
vague feeling of abd fullness/early satiety
n/v
wt loss

174
Q

dx for gastric carcinoma

A

egd w. bx
cbc
fobt

175
Q

what type of anemia is associated w. gastric ca

A

microcytic hypochromic

176
Q

only curative tx for gastric carcinoma

A

surgery

177
Q

gastric carcinoma is extremely high in what 3 countries

A

japan
chile
iceland

178
Q

sx that gastric ca has metastasized

A

virchow node
sister mary joseph nodule

179
Q

what is this showing

A

sister mary joseph nodule

180
Q

2-3 week old well fed infant who presents w. non bilious vomiting after most/every feeding

A

pyloric stenosis

181
Q

common presentation of pyloric stenosis (3)

A

< 3 months old
projectile non bilious vomiting
olive shaped mass - pathognomonic

182
Q

lab finding of pyloric stenosis

A

hypochloremic hypokalemic metabolic alkalosis

183
Q

dx for pyloric stenosis

A

US vs UGI barium series

184
Q

hallmark imaging sign of pyloric stenosis: US vs barium studies

A

US: double track
barium: string sign

185
Q

what is this showing

A

string sign -> pyloric stenosis

186
Q

tx for pyloric stenosis

A

pyloromyotomy - ramstedt procedure

187
Q

hypertrophy of smooth muscle of pyloris -> obstruction of outflow

A

pyloric stenosis

188
Q

rf pyloric stenosis

A

first born male

189
Q

why is vomiting w. pyloric stenosis non bilious

A

obstruction is proximal to ampulla of vater

190
Q

4 complications of pyloromyotomy

A

duodenal damage
bleeding
infxn
aspiration pna

191
Q

post op feeding for pyloromyotomy

A

6-12 hr post op: pedialyte
24 hr: full strength formula

192
Q

diverticulosis is mc found in the

A

sigmoid colon

193
Q

s/sx of diverticulitis

A

f/c
n/v
left sided abd pain

194
Q

2 hallmark imaging findings of diverticulitis

A

fat stranding
bowel wall thickening

195
Q

mcc cause of lowr GIB

A

diverticulitis

196
Q

abx used for diverticulitis

A

cipro vs augmentin
+/- flagyl

197
Q

4 indications for colon resection w. diverticulitis

A

recurrent
perforation
fistula
abscess

198
Q

lifestyle management of diverticulitis

A

high fiber diet

199
Q

t/f: nuts and seeds are associated w. an increasein risk of diverticulosis, diverticulitis, or diverticular bleeding

A

f!!!!!!

thank you for acknowledging this Smarty PANCE!

200
Q

the presence of what 3 factors acurately predicts acute diverticulitis

A

absence of vomiting
CRP > 5
tenderness limited to LLQ

201
Q

gs dx for diverticulitis

A

CT w. contrast

202
Q

what is absolutely contraindicated if you suspect diverticulitis in an acute setting

A

colonoscopy

risk of bowel perf

203
Q

6 complications of diverticulitis

A

abscess
peritonitis
fistula
obstruction
perforation
stricture

204
Q

mc fistula associated w. diverticulitis

A

colovesical (to bladder)

205
Q

surgery mc performed for acute diverticulitis w. complications

A

hartmann’s: resection w. end colostomy

206
Q

2 mc oragnisms associated w. development of diverticulitis

A

e. coli
b. fragilis

EOR - Surgery (13 decks)

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