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EOR - Surgery > GI/Nutrition 2 > Flashcards

GI/Nutrition 2 Flashcards

1
Q

complication of gallstones 2/2 to infected obstruction of the cbd

A

cholangitis

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2
Q

mcc of cholangitis

A

e. coli

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3
Q

charcot’s triad

A

ruq pain
jaundice
fever

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4
Q

reynold’s pentad

A

charcot’s triad
PLUS
hypotn
AMS

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5
Q

besides reynold’s pentad, 2 additional sx of cholangitis

A

light colored stool
tea colored urine

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6
Q

pruritis + jaundice =

A

primary sclerosing cholangitis

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7
Q

chronic liver dz involving inflammation/fibrosis of the intrahepatic and extrahepatic ducts

A

primary sclerosing cholangitis

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8
Q

what pt pop makes you think of primary sclerosing cholangitis

A

ulcerative colitis

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9
Q

cholangiography finding of PSC

A

fibrosis of bile ducts

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10
Q

imaging for cholangitis: initial vs gs

A

initial: US
gs: ERCP

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11
Q

indication to skip US and proceed directly to ERCP w. suspected cholangitis

A

charcot’s triad + abnl LFTs

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12
Q

management of cholangitis

A

empiric abx
ercp w. stent
post acute cholecystectomy

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13
Q

all causes of cholangitis (6)

A

cholelithiasis
post op choledocholithiasis stricture
neoplasm (ampullary carcinoma)
pancreatic pseudocyst/pancreatitis
ERCP/PTC
biliary stent

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14
Q

lab elevations associated w. cholangitis

A

elevated: WBC, bilirubin, ALP
positive blood cultures

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15
Q

what is supporative cholangitis

A

severe infxn w. sepsis
“pus under pressure”

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16
Q

tx for supporative cholangitis

A

IVF
abx
decompression: ERCP w. papillotomy vs PTC w. catheter drainage vs laparotomy w. T-tube

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17
Q

cystic collection of tissue, fluid, and necrotic debris surrounding the pancreas

A

pancreatic pseudocyst

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18
Q

2 conditions associated w. pancreatic pseudocyst

A

pancreatic (chronic > acute)
trauma to chest (ex steering wheel)

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19
Q

pancreatic pseudocysts generally occur how long after acute pancreatitis

A

2-3 weeks

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20
Q

characteristic appearance of pancreatic pseudocyst

A

fibrous capsuel w. no epithelial lining

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21
Q

PE finding of pancreatic pseudocyst

A

abdominal mass

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22
Q

indication for surgical intervention w. pseudocyst

A

if persists past 4-6 weeks:

percutaneous drainage vs pancreaticogastrostomy

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23
Q

complications of pancreatic pseudocyst (7)

A

infxn -> pertonitis
bleeding
fistula
pancreatic ascites
gastric outlet obstruction
SBO
biliary obstruction

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24
Q

mcc of pancreatic pseudocyst

A

chronic alcoholic pancreatitis

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25
Q

tumor marker associated w. liver ca

A

AFP

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26
Q

3 rf for hepatic carcinoma

A

hepatitis B and C
hemochromatosis
cirrhosis

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27
Q

benign liver lesions

A

cavernous hemagioma
hepatocellular adenoma
infantile hemangioendothelioma

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28
Q

imaging guidelines for liver lesions

A

< 1 cm: contrast MRI w. f/u US q 3 mo

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29
Q

guidelines for HCC screening

A

+/- pt’s w. cirrhosis and chronic hep B
screen w. periodic AFP and US

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30
Q

tx for HCC

A

-transplant: single tumors < 5 cm OR </= 3 cm limited to the liver
-resection - high rate of recurrence

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31
Q

epigastric pain that radiates to the back + wt loss, jaundice, pruritis

A

pancreatic ca

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32
Q

most clearly established rf for pancreatic ca

A

smoking

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33
Q

mc location for pancreatic ca

A

head of the pancreas

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34
Q

tx for pancreatic ca

A

pancreaticoduodenectomy (whipple)

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35
Q

tumor marker for pancreatic ca

A

CA-19-9

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36
Q

what is courvoisier’s sign

A

nontender, palpable gallbladder

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37
Q

mc type of pancreatic ca

A

ductal adenocarcinoma at the head of the pancreas

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38
Q

5 rf for pancreatic ca

A

cigs
etoh
pancreatitis
dm
obesity

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39
Q

what is virchow’s node

A

signal node in the left supraclavicular fossa

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40
Q

the pain of pancreatitis/pancreatic ca is relieved by

A

sitting and leaning forward

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41
Q

labs of pancreatic ca

A

-elevated: amylase, direct bilirubin, CEA, CA19-9
-glucose intolerance

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42
Q

what happens in a whipple procedure

A

removal of: antrum, part of duodenum, head of pancreas, gallbladder

results in:
-choledochojejunostomy: bile flow
-gastrojejunostomy: passage of food
-pancreaticojejunostomy: pancreatic juice flow

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43
Q

2 types of hiatal hernia

A

type 1: sliding -> mc
type 2: paraesophageal

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44
Q

describe hiatal hernia

A

both gastroesophageal junction AND portion of the stomach herniate into the thorax -> gastroesophageal junction is above the diaphragm

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45
Q

describe paraesophageal hiatal hernia

A

gastroesophageal junction remains below the diaphragm

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46
Q

which type of hiatal hernia is high risk for strangulation

A

paraesophageal

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47
Q

hiatal hernias are mc asymptomatic, but what are 3 possible sx

A

heartburn
chest pain
dysphagia

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48
Q

complications of sliding hiatal hernia

A

reflux esophagitis
barrett’s/esophageal ca
aspiration

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49
Q

3 complications of paraesophageal hiatal hernia

A

obstruction
hemorrhage
incarceration/strangulation

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50
Q

dx for hiatal hernia

A

barium upper GI studies
upper endo

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51
Q

tx for hiatal hernia - type 1 vs type 2

A

type 1: antacids, lifestyle, +/- nissen fundoplication
type 2: nissen fundoplication

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52
Q

what part of the GIT is usually spared w. crohn’s

A

rectum

if rectum is involved, think UC

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53
Q

pattern of involvement w. crohn’s vs UC

A

crohn’s: skip lesions
UC: continuous

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54
Q

which type of IBD involves bloody diarrhea

A

UC

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55
Q

which type of IBD involves severe abd pain

A

crohn’s

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56
Q

what type of IBD is associated w. perianal dz

A

crohn’s

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57
Q

which type of IBD involves fistulas

A

crohn’s

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58
Q

ulcers associated w. crohn’s vs UC

A

crohn’s: aphtoid/deep ulcers, cobblestoning
UC: erythematous/friable/superficial ulcers

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59
Q

what is this showing

A

deep ulcers -> crohn’s

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60
Q

what is this showing

A

cobblestoning -> crohn’s

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61
Q

4 radiographic findings of crohn’s

A

string sign
RLQ mass
fistula
abscesses

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62
Q

radiographic finding of UC

A

tubular lead pipe appearance

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63
Q

what is this showing

A

string sign of terminal ileum -> crohn’s

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64
Q

what is this showing

A

lead pipe apperance -> UC

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65
Q

histologic features of crohn’s vs UC

A

crohn’s: transmural, non caseating granulomas
UC: mucosa-only crypt abscesses

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66
Q

association of smoking: crohn’s vs UC

A

crohn’s: worsens
UC: protective

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67
Q

serology associated w. crohn’s vs UC

A

crohn’s: ASCA
UC: p-ANCA

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68
Q

common presentation of UC (4)

A

bloody pussy diarrhea
rectal/lower quadrant pain
fever
urgency

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69
Q

mc site for UC

A

rectum

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70
Q

lab findings of UC

A

elevated: WBC, ESR
anemia

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71
Q

2 complications of UC

A

toxic megacolon
colorectal ca

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72
Q

4 systemic sx of crohn’s

A

oral/aphtous ulcers
severe anemia
polyarthralgia
fatigue

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73
Q

mc site for crohn’s

A

terminal ileum

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74
Q

4 complication of crohn’s

A

strictures
obstruction
abscess
fistula

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75
Q

work up for IBD (3)

A

upper GI series
colonoscopy w. bx
serology

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76
Q

most valuable dx test for IBD

A

colonoscopy

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77
Q

consider _ over colonoscopy in UC to reduce risk of bowel perf

A

flex sigmoidoscopy

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78
Q

complication of UC

A

toxic megacolon

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79
Q

mainstay of pharm for IBD

A

5-aminosalicylic acid drugs (ex sulfasalazine)

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80
Q

t/f: UC is more common in smokers and ex smokers

A

t!

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81
Q

GIB, fulminant colitis, toxic megacolon

A

UC

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82
Q

fistulas and renal stones

A

crohn’s

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83
Q

mc type of small bowel carcinoma

A

adenocarcinoma in the duodenum

84
Q

mc presenting sx of small bowel tumors

A

intermittent, crampy abdominal pain

85
Q

4 rf for small bowel carcinoma

A

-hereditary nonpolyposis colorectal ca (HNPCC)
-cystic fibrosis
-crohn’s
-etoh, refined sugar, red meat, salt/smoked foods

86
Q

dx for small bowel ca

A

CT
endoscopy
fobt

87
Q

majority of small bowel cancers are positive for what tumor marker

A

CEA

88
Q

tx for small bowel ca

A

surgical resection
chemo

89
Q

first sign of jaundice

A

slceral icterus

90
Q

jaundice is seen w. serum bilirubin > _

A

2.5

91
Q

causes of jaundice (6)

A

hemolysis/ineffective erythropoiesis
liver dysfxn
biliary tract obstruction
physiologic of newborn
gilbert
dubin-johnson

92
Q

pathway of Hgb breakdown

A
  1. Hgb is broken into: heme + globin
  2. globin: broken into aa
  3. heme: broken into iron and protoporphyrin
  4. iron: recycled
  5. protoporphyrin: convrted to unconjugated bilirubin (UCB)
93
Q

what happens to UCB (unconjugated bilirubin)

A
  1. transported by albumin to the liver for conjugation by uridine glucoronyl transferase (UGT) -> creates conjugated bilirubin ->
  2. conjugated bilirubin is transferred to bile -> 3. bile is transferred to the gallbladder ->
  3. bile is converted to urobilinogen ->
  4. uriblinogen oxidized to stercobilin (stool) and uriobilin (urine)
94
Q

labs to evaluate jaundice (4)

A

Tbili and unconjugated bili
ALP/ALT/AST
PT/INR
albumin

95
Q

jaundice PLUS normal LFTs

A

rule out hepatic injury/biliary tract dz

96
Q

jaundice plus predominant ALP elevation

A

biliary obstruction
vs
intrahepatic cholestasis

97
Q

jaundice plus predominant AST/ALT elevation

A

intrinsic hepatocellular dz

98
Q

jaundice PLUS elevated INR

A

obstructive jaundice

99
Q

which type of bilirubin suggests hemolytic anemia

A

unconjugated

100
Q

think of _ when you see elevated unconjugated bilirubin/hemolytic anemia (2)

A

drugs
gilbert syndrome

101
Q

think _ when you see elevated conjugated bilirubin (4)

A

biliary obstruction
intrahepatic cholestasis
hepatocellular injury
genetic condition

102
Q

post op jaundice should clear by week _

A

3

103
Q

5 causes of PREhepatic post op jaundice

A

hemolysis (prosthetic valve)
resolving hematoma
transfusion rxn
post cardiopulmonary bpass
blood transufsion

104
Q

causes of post op hepatic jaundice (lots!)

A

drugs
hypotn
hypoxia
sepsis
hepatitis
preexisting cirrhosis
right sided heart failure
hepatic abscess
gilbert
crigler-najjar
dubin johnson
TPN

105
Q

causes of post op POSThepatic jaundice (lots!)

A

choledocholithiasis
stricture
cholangitis
cholecystitis
biliary duct injury
pancreatitis
sclerosing cholangitis
pancreatic ca
gallbladder ca
biliary stasis
ceftriaxone

106
Q

labs suggesting hemolysis

A

elevated: LDH, reticulocytes, fragmented RBCs on smear
decreased: haptoglobin Hct

107
Q

first manifestation of conjugated hyperbilirubinemia

A

tea colored urine

108
Q

what is melena

A

black tarry stool

109
Q

causes of melena (5)

A

upper GIB
peptic ulcer
esophageal ulcer
mallory weiss tear
variceal hemorrhage/portal HTN
malignancy

110
Q

what is hematochezia

A

BRBPR

111
Q

causes of hematochezia (4)

A

lower GIB
hemorrhoids
anal fissures
polyps
colorectal ca

112
Q

painless bleeding w. wiping

A

hemorrhoids

113
Q

severe rectal pain w. defecation

A

anal fissures

114
Q

painless rectal bleeding
no red flag signs

A

polyps

115
Q

type of anemia: acute GIB vs chronic GIB

A

acute: normocytic
chronic: microcytic

116
Q

gs test for hematochezia

A

colonoscopy

117
Q

gs test for melena

A

EGD

118
Q

tx for hematochezia and melena (4)

A

-endoscopic thermal probe vs clips vs injection
-angiographic embolization
-endoscopic intravariceal cyanoacrylate injxn
-band ligation

119
Q

4 cardinal signs of strangulated bowel

A

fever
tachy
leukocytosis
localized abd tenderness

120
Q

5 causes of volvulus

A

birth defect causing malrotation - mc
constipation
hirschprung dz
pregnancy
abdominal adhesions

121
Q

mc part of colon affected by volvulus

A

sigmoid colon

2nd is cecum

122
Q

order of imaging when SBO is suspected

A

abdominal XR series
abdominopelvic CT w. contrast

123
Q

XR finding of volvulus

A

coffee bean/kidney bean sign
aka bent inner tube sign

124
Q

what is this showing

A

bird beak sign -> volvulus

125
Q

management of volvulus

A

emergent surgery

126
Q

mcc of SBO in kiddos and worldwide

A

hernias

127
Q

don’t forget to r.o _ with SBO

A

incarcerated hernia

128
Q

define incomplete vs complete bowel obstruction

A

incomplete: some gas in colon
complete: no gas in colon

129
Q

initial management w. all SBO pt’s (4)

A

NPO
NGT
IVF
FC

130
Q

what 2 tests can distinguish partial vs complete bowel obstruction

A

CT w. contrast
SBFT

131
Q

ABCs of SBO

A
  1. adhesions
  2. bulge - hernia
  3. cancer
132
Q

tx for complete SBO

A

laparotomy w. lysis of adhesions

133
Q

how to remember all causes of SBO

A

give bad cramps:

gallstone illeus
intussusception
volvulus
external compression SMA syndrome

bezoars
abscess
diverticulitis

crohn’s
radiation
annular pancreas
meckel’s diverticulum
peritoneal adhesions
stricture

134
Q

mc indication for abd surgery in crohn’s pt’s

A

SBO due to strictures

135
Q

cause of SBO for pt on coumadin

A

bowel wall hematoma

136
Q

indications to lower threshold for surgery w. SBO

A

increasing leukocytosis
fever
tachycardia/tachypnea
increasing abd pain

137
Q

absolute indication for surgery w. partial SBO

A

peritoneal signs -> free air on AXR

138
Q

_ commonly mimics SBO

A

paralytic ileus -> diffuse gas distension, including colon

139
Q

dx for anal fissures

A

anoscopy

140
Q

hallmark anoscopy finding of anal fissures

A

thickened mucosa -> sentinel pile below fissure

141
Q

dx for anal abscess

A

DRE
+/- CT if recurrent

142
Q

dx for perianal fistula

A

exam
proctoscope

143
Q

tx for anal fissures (5)

A
  1. fluid/fiber
  2. stool softeners
  3. sitz baths
  4. nitroglycerin/CCB ointments
  5. botox
144
Q

tx for anal abscess

A

surgical drainage
sitz baths
analgesics
stool softeners
high fiber diet
+/- abx if high risk

145
Q

tx for anal fistula

A

fistulotomy

146
Q

what type of anal fissure is commonly due to straining during constipation

A

posterior midline

147
Q

treatment for anal fissure that does not respond to conservative management

A

lateral anal sphincterotomy

148
Q

mc location for anal fissures

A

posterior midline

149
Q

4 indications for abx post op for anal abscess

A

cellulitis
immunosuppression
DM
heart valve abnl

150
Q

what pt pop do you think of w. anal fistula

A

crohn’s

151
Q

what is goodsall’s rule

A

anterior anal fistulas: course straight and exit anteriorly
posterior anal fistulas: curved track

152
Q

thick suture placed thru anal fistulae tract to allow slow transection of sphincter muscle

A

seton

153
Q

chronic anal fissure triad

A

fissure
sentinel pile
hyertrophied anal papilla

154
Q

consider what dz’s w. chronic anal fissure (4)

A

IBD
anal ca
STIs
AIDS

155
Q

2 types of GI ulcer to know

A

gastric
duodenal

156
Q

rf for increased incidence of duodenal/gastric ulcers AND decrease in rate of healing

A

cigs

157
Q

mc type of ulcer

A

anterior/proximal duodenal

158
Q

pain decreases w. food

A

duodenal ulcer

159
Q

mcc of PUD

A

h pylori

160
Q

2 complications of posterior duodenal ulcer

A

gastroduodenal a bleed
acute pancreatitis

161
Q

rare cause of PUD

A

zollinger ellison

162
Q

4 causes of gastric ulcers

A

h.pylori - mc
NSAIDs
GERD
cigs

163
Q

common presentation of gastric ulcers

A

-gnawing/burning pain that radiates to the back
-worse w. food

164
Q

mc location for gastric ulcers

A

lesser curvature of antrum

165
Q

mcc of non-hemorrhagic GIB

A

PUD

166
Q

what type of bleeding is associated w. PUD

A

melena

167
Q

gs dx for PUD

A

upper endo w. bx

168
Q

managment of PUD

A

PPI for all
abx if h pylori
confirm eradication of h pylori

169
Q

abx options for h pylori

A

metro + omeprazole + clarithro
vs
clarithro + ampicillin + ppi

170
Q

8 rf for PUD

A

male
smoking
ASA/NSAIDs
uremia
ZE syndrome
h pylori
trauma
burns

171
Q

3 indications for surgery w. bleeding duodenal ulcer

A

intractable hemorrhage
obstruction
perforation

172
Q

what operation is used for ulcer hemorrhage/obstruction/perf

A

distal gastrectomy w. excision

173
Q

3 types of hemorrhoids

A

internal
external
strangulated

174
Q

presentation of internal hemorrhoids

A

painless brbpr
+/- mucus d.c, sensation of incomplete evacuation

175
Q

presentation of external hemorrhoids

A

pain
no bleeding

176
Q

which type of hemorrhoid is higher risk for thrombosis

A

external

177
Q

dx for hemorrhoids

A

anoscopy
+/- sigmoidoscopy vs colonoscopy

178
Q

tx for internal hemorrhoids

A

-stool softeners sitz baths, topical analgesics, hamamelis (witch hazel compress)
-bleeding: injection sclerotherapy (5% phenol in vegetable oil)
-larger/prolapsed/refractory: rubber band ligation

179
Q

indication for excision of hemorrhoid

A

thrombosed external

180
Q

3 hemorrhoid quadrants

A

left lateral
right posterior
right anterior

181
Q

degrees of hemorroids

A

first: does not prolapse
second: prolapses w. defacation, self reduces
third: prolapses w. defecation/valsalva, requires manual reduction
fourth: prolapsed, not reducible

182
Q

4 complications of hemorrhoidectomy

A

exsanguination
infxn
incontinence
stricture

183
Q

contraindication for hemorrhoidectomy

A

crohn’s

184
Q

tx for protruding internal hemorrhoids

A

rubber band ligation

185
Q

5 types of hernias to know

A

hiatal
ventral
incisional
umbilical
inguinal

186
Q

which type of hernia is mc congenital

A

umbilical

187
Q

indication for surgery w. umbilical hernia

A

persists past 2 yo

188
Q

mc type of inguinal hernia

A

indirect

189
Q

pathway of indirect hernia

A

thru internal inguinal ring -> down inguinal canal -> into scrotum

i = internal inguinal ring

190
Q

pathway of direct inguinal hernia

A

thru external inguinal ring at hesselbach triangle

191
Q

3 complications of hernias

A

obstruction
incarceration
strangulation

192
Q

dx for hernia

A

exam
US

193
Q

what type of inguinal hernia is felt on the side of the finger during exam

A

direct

194
Q

what type of inguinal hernia is felt on the tip of the finger during exam

A

indirect

195
Q

5 rf for ventral hernia

A

abd surgery
age
obesity
wound infxn
surgical drains

196
Q

which type of inguinal hernia is congenital and generally happens before 1 yo

A

indirect

197
Q

what type of hernia very rarely strangulates

A

ventral

198
Q

what type of hernia has a high incidence of strangulation

A

femoral

199
Q

toxic megacolon is mc a complication of

A

IBD: UC > crohn’s -> mc
pseudomembranous colitis

200
Q

4 sx of toxic megacolon

A

fever
distended abd
pertonitis
shock

201
Q

imaging for toxic megacolon

A

KUB showing dilated colon > 6 cm

202
Q

dx for toxic megacolon

A

at least 3 of the following:
radiographic evidence
fever > 101.5
HR > 120
neutrophilic leukocytosis
anemia

203
Q

what is this showing

A

toxic megacolon

204
Q

tx for toxic megacolon

A

decompression
+/- colostomy vs complete resection

205
Q

3 radiographic findings of toxic megacolon

A

dilated colon > 6 cm
loss of colonic haustrations
segmental colonic parietal thinning

EOR - Surgery (13 decks)

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