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2 Gen surg > GI Surg > Flashcards

GI Surg Flashcards

1
Q

Diverticular disease- Eti

A

DiverticuliItis- acute illness due to points of weakness in near blood supplyFree perforation- infection into peritoneal cavity, may abscess95% in sigmoid colon sue to increased pressure

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2
Q

Diverticular disease- Sx

A
  • LLQ pain- Constipation- Bloating- Subjective fever- Tachy, abd tenderness, leukocytosis- Maroon or bright red hematochezia in > 50
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3
Q

Diverticular disease- Dx

A

CT scan

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4
Q

Diverticular disease- Tx

A
  • Mild- abx- Elective colonoscopy after 4-6 weeks- Operation- Free perforation (sigmoid resection) or abscess (percutaneous drainage)
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5
Q

Appendicitis- Eti

A
  • Blockage in lining of appendix leading to infection
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6
Q

Appendicitis- Sx

A
  • RLQ tenderness with guarding- Malaise followed by periumbilical pain, localizes to RLQ followed by fever- McBurney point- Anorexia, nausea, vomiting
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7
Q

Appendicitis- Dx

A
  • US or CT scan
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8
Q

Appendicitis- Tx

A
  • Operation to remove - Abx- Cephalosporin
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9
Q

Hernia- Eti

A
  • Abnormal protrusion of an organ through abd cavity
  • Can be reducible, incarcerated or strangulated (loss of blood supply)
  • Higher risk in men- Right side more common
  • Femoral more common in women
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10
Q

Hernia- Sx

A
  • Bulge, pain of ache

- Protrusion in canal on exam

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11
Q

Hernia-Tx

A
  • Reduce the sac and repair the defect-

Can watch and wait but doesn’t get better on own

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12
Q

Hernia- Dx

A
  • Diagnostic tests unnecessary- Clinical exam
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13
Q

Ruptured spleen- Eti

A
  • Direct blow or trauma to abd- Mono, AIDS, malaria, leukemia, sickle cell
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14
Q

Ruptured spleen- Sx

A
  • Pain and tenderness radiating to left neck or shoulder (Kehr’s sign)- LUQ at 9th-10th rib- Shock, falling hematocrit
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15
Q

Ruptured spleen- Dx

A
  • Ultrasound- multi view- CT in stable pts
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16
Q

Ruptured spleen- Tx

A

Emergent splenectomy

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17
Q

Perforated bowel- Eti

A

Appedicitis, diverticulits- Blunt trauma- ASA or NSAID OD

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18
Q

Perforated bowel- Sx

A
  • Sudden explosive onset of severe mid to lower abd pain- Shock- Rigid, tender abd
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19
Q

Perforated bowel- Dx

A
  • Abd XR
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20
Q

Perforated bowel- Tx

A
  • Crystalloid fluids- Abx- Remove infected material- Repair
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21
Q

Peritonitis- Eti

A

Perforation of abd wall- D/t trauma, diverticulits, pancreatitis
- E. coli , klebsiella

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22
Q

Peritonitis- Sx

A
  • Abrupt pain, distension, fever- Diminished bowel sounds- Rebound tenderness
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23
Q

Peritonitis- Dx

A
  • Examine fluid- High WBC count

- Albumin

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24
Q

Peritonitis- Tx

A
  • Exploration, debridement and drainage
  • Abx x 14 days
  • Cefotaime or beta lactam
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25
Q

Bowel obstruction- Sx

A
  • Constipation or obstipation
  • Distention and tenderness
  • Abd pain- N/V
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26
Q

Bowel obstruction- Dx

A
  • CT with contrast
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27
Q

Bowel obstruction- Tx

A
  • Resection and decompression
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28
Q

Colon CA- Eti

A
  • Screen at age 50 q 10 yrs- Yearly fecal occult- Adenocarcinoma most common
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29
Q

Colon CA- Sx

A
  • Blood in feces- Weakness and anemia- Change in bowel habits- Dyspepsia
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30
Q

Colon CA- Dx

A
  • Colonoscopy and biopsy of polyps
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31
Q

Colon CA- Tx

A
  • Resection of lesion and lymph - CEA levels pre and post op- Colonoscopy at 6 mo, 12 mo, 3 yrs, 5 yrs
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32
Q

Volvulus- Eti

A
  • Rotation of bowel loops around fixed point- Ischemia, gangrene- Sigmoid most common
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33
Q

Volvulus- Sx

A
  • Colicky abd pain- Spasms- Distension, tympany- High pitched bowel sounds
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34
Q

Volvulus- Dx

A
  • XR: loss of haustra, kidney bean appearance- Bird beak sign, loop distension
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35
Q

Volvulus- Tx

A
  • Decompression with sigmoidoscopy- Fluid resuscitation
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36
Q

Umbilical hernia- Eti

A
  • W>M
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37
Q

Umbilical hernia- Sx

A
  • Increased size- Sharp pain with coughing or sneezing
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38
Q

Umbilical hernia- Dx

A

Clinical

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39
Q

Umbilical hernia- Tx

A
  • Repair to avoid incarceration- Mesh
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40
Q

Inguinal hernia- Eti

A
  • M>W- Indirect > direct
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41
Q

Inguinal hernia- Sx

A
  • Bulge and pain in inguinal canal- Aching
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42
Q

Femoral hernia- Eti

A
  • Prone to incarceration/ strangulation- W>M- Descend through femoral canal beneath inguinal ligament- Difficult to reduce
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43
Q

Femoral hernia- Sx

A
  • Asymptomatic until incarcerated - Small bulge in medial thigh- Colicky abd pain
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44
Q

Femoral hernia- Tx

A
  • Open laparoscopy
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45
Q

Incisional hernia- Eti

A
  • Complication of laparotomy- COPD, steroids, wt, smoking
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46
Q

Incisional hernia- Sx

A
  • Bulging, pain, ache at incision site- Protrusion and obstruction at surgical site
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47
Q

Incisional hernia- Tx

A
  • Recurrence is common- Mesh repair
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48
Q

Acute abdomen- Causes

A
  • Appendicitis
  • Obstriction
  • Perfed ulcer
  • Diverticulits
  • Acute cholecystitis
  • Acute pancreatitis
  • Renal colic
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49
Q

Acute Abd- Eval

A
  • Hx: Location, localization
    Character of pain
  • CXR best tool to eval
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50
Q

Achalasia- Eti

A
  • Absence of esophageal peristalsis
  • Hypertensive LES- failure to relax
  • Neuron disease
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51
Q

Achalasia- Sx

A
  • Dysphagia with solids and liquids

- Regurgitation of solid food

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52
Q

Achalasia- Dx

A
  • Manometry = gold standard

- Endoscopy

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53
Q

Achalasia- Tx

A
  • Laparoscopic Heller myotomy

- EGD w/ balloon dilation, botox injections

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54
Q

Esophageal varicies- Eti

A
  • Enlarged veins in esophagus d/t portal HTN

- Azygos vein

55
Q

Esophageal varicies- Sx

A
  • Hematemesis
  • Melena
  • Hematochezia
  • Hx of liver dz
56
Q

Esophageal varicies- Dx

A
  • EGD
57
Q

Esophageal varicies- Tx

A
  • Fluid resuscitation
  • EGD banding, sclerotherapy
  • TIPS
  • Octreotide drip
58
Q

Zenker diverticulum- Eti

A
  • Pharengeoesophageal diverticula
  • Killian triangle
  • D/t lack of coordination b/t pharyngeal contraction and opening of UES
59
Q

Zenker diverticulum- Sx

A
  • Halitosis
  • Dysphagia
  • Regurgitation, aspiration
  • Heartburn
60
Q

Zenker diverticulum- Dx

A

Barium swallow

61
Q

Zenker diverticulum- Tx

A
  • Cricopharyngeal myotomy

- Diverticulectomy

62
Q

Esophageal carcinoma- Eti

A
  • Adenocarcinoma MC USA
  • Squamous cell MC- world
  • Men, smokers, ETOH, barretts
63
Q

Esophageal carcinoma- Sx

A
  • Dysphagia
  • Wt loss
  • Hoarseness, back pain
64
Q

Esophageal carcinoma- Dx

A
  • Upper GI, GD for bx
65
Q

Esophageal carcinoma- Tx

A
  • Esophagectomy- stage 1 & 2

- + chemo , rad > stage 3

66
Q

Barrett esophagus- Eti

A
  • Columnar epi in esophageal mucosa

- D/t reflux

67
Q

Barrett esophagus- Sx

A
  • Long hx of GERD
68
Q

Barrett esophagus- Dx

A
  • Endoscopy- salmon pink epithelium

- Bx

69
Q

Barrett esophagus- Tx

A
  • High dose PPIs, endoscopic surveillance

- Esophagectomy in high grade dysplasia

70
Q

Caustic injury of esophagus- Eti

A
  • Ingestion of acid or alkali
  • Alkali- liquification necrosis
  • Acid worst- coagulation necrosis
71
Q

Caustic injury of esophagus- Sx

A
  • Inflammatory edema of lips, mouth, mucosa
  • CHest pain and drooling
  • Severe pain with swallowing
72
Q

Caustic injury of esophagus- Dx

A
  • EGD
  • Burn staging
  • CXR in all pts- perforation
73
Q

Caustic injury of esophagus- Tx

A
  • Fluids & Abx

- Resection of esophagus, jejunostomy feeding tube

74
Q

Schatzki ring- Eti

A

GERD

75
Q

Hiatal hernia- Eti

A

GE jxn and stomach into the thorax

76
Q

Hiatal hernia- Sx

A
  • Asymptomatic- poorly controlled reflux

- Dysphagia

77
Q

Hiatal hernia- Tx

A
  • PPIs, H2 blockers

- Nissen fundoplication

78
Q

Perforation of esophagus- Eti

A
  • Boerhaaves- full thickness rupture of distal d/t repeated forceful voting
  • Mallory weiss: Longitudianal lacerations
79
Q

Perforation of esophagus- Sx

A
  • Boerhaave: retrosternal chest pain, Pneumomediasteinum

- Mallory weiss- hematemesis after ETOH binge

80
Q

Perforation of esophagus- Dx

A
  • B: Chest CT

- M: Egd

81
Q

Perforation of esophagus- Tx

A
  • B: Surg

- M: Supportive

82
Q

Retroperitoneal abscess- Eti

A
  • Infxn from adjacent structures (GI tract)
  • E. coli, bacteroides
  • Psoas abscess
83
Q

Retroperitoneal abscess- Sx

A
  • Fever, abd, flank pain

- Acute illness

84
Q

Retroperitoneal abscess- Dx

A

CT- gas bubbles, confined to compartments

85
Q

Retroperitoneal abscess- Tx

A
  • Percutaneous drainage

- Abx

86
Q

Intraabdominal abscess-Tx

A
  • Percutaneous drainage and abx

- Surgal removal of affect organ

87
Q

Ascites- Eti

A
  • Chronic liver dz
88
Q

Ascites- Tx

A
  • Determine if SBP (WBC ct)
  • Albumin > 1
  • Paracentesis
  • Furosemide + spironolactoen
89
Q

Cholecystitis- Eti

A
  • E. coli infxn of gallbladder d/t stone obstruction
90
Q

Cholecystitis- Sx

A
  • Episodic RUQ pain, precip by food
  • Fever, N/V
  • Palpable GB
    • murphy
91
Q

Cholecystitis- Dx

A

US

92
Q

Cholecystitis- Tx

A
  • Cephalosporin + metronidazle

- Cholecystectomy

93
Q

Choledocholithiasis- Eti

A

Stones stuck in bile duct

- Fat, female, fourty

94
Q

Choledocholithiasis- Sx

A
  • Biliary colic (RUQ pain, abrupt onset, lasts 30 min)

- Jaundice

95
Q

Choledocholithiasis- Dx, Tx

A
  • US

- ERCP

96
Q

Cholangitis- Eti

A
  • Infxn on biliary tree

- Gram -

97
Q

Cholangitis- Sx

A
  • Fever, chills
  • RUQ pain
  • Jaundice
  • +/- shock and AMS
98
Q

Cholangitis- Dx, Tx

A

US

- Abx and surg

99
Q

Liver CA- Eti

A
  • METS MC cause

- HCC

100
Q

Liver CA- Sx

A
  • Elevated LFTs
  • CEA, AFP
  • Hepatomegaly
101
Q

Liver CA- Dx

A
  • US
102
Q

Liver CA- Tx

A

Transplant

103
Q

Hepatic trauma- Sx

A
  • Hypovolemic shock
  • HypoTN, low urinary output
  • Low CVP
104
Q

Hepatic trauma- Dx

A
  • Abdominal sonography

- CT if heme stable

105
Q

Hepatic trauma- Tx

A
  • Heme stability

- Surg exploration, arterial occlusion, hematoma drainage

106
Q

Short bowel syndrome- Eti/ sx

A
  • Diarrhea and malabsorption from extensive bowel resection

-

107
Q

Short bowel syndrome- Tx

A
  • TPN initially

- Many small meals chronically

108
Q

Blind loop syndrome- Eti

A
  • Bacterial overgrowth in small bowel
109
Q

Blind loop syndrome- Sx

A
  • Steatorrhea, diarrhea
  • Abd pain
  • Vit deficiency, B12
110
Q

Blind loop syndrome- Tx

A

Abx

111
Q

Mesenteric ischemia- Eti

A
  • Emboli or acute thrombus

- Intestinal ischemia

112
Q

Mesenteric ischemia- Sx

A
  • Pain out of proportion
  • Vomiting, diarrhea
  • hx of A-fib, heart dz
113
Q

Mesenteric ischemia- Dx, Tx

A
  • Arteriogram
  • Revascularization
  • Resection of necrotic tissue
114
Q

Colon polyps- Eti

A

Tubular adenoma MC

115
Q

Colon polyps- Sx

A
  • Bleeding
  • Change in bowel habits
  • Mucous per rectum
116
Q

Colon polyps- Dx, Tx

A
  • Colonoscopy
  • Polyp removal
  • Bowel and node resection
117
Q

Perirectal abscess- Eti

A

Crypt in dentate line

- Infection and spread

118
Q

Perirectal abscess- Sx

A
  • Rectal pain, pus
  • Fever
  • Perianal mass
119
Q

Perirectal abscess- Dx, Tx

A
  • DRE: mass with fluctuant

- Drainage!

120
Q

ANorectal fistula- Eti

A
  • D/t infection or chrons disease
121
Q

ANorectal fistula- Sx

A
  • Perianal drainage
  • Recurrent abscess
  • Diaper rash
122
Q

ANorectal fistula- Dx, Tx

A
  • DRE, protoscope

- Tx: Open tract, wound care

123
Q

Lower GI bleed- Eti

A
  • Diverticulosis MC
124
Q

Lower GI bleed- Sx

A

BRBPR

125
Q

Lower GI bleed- Dx

A

Colonoscopy

126
Q

Pilonidal cyst- Eti

A
  • Gland infxn over sacrum

- Men, chronic, recurrent

127
Q

Pilonidal cyst- Sx

A
  • Abscess and drainage

- Pain and swelling

128
Q

Pilonidal cyst- Tx

A

I and D

- Cystectomy

129
Q

Splenectomy- Indications

A
  • Hypersplenism caused by malignancy
  • Sickle cell
  • ITP, TTP
  • Thalassemias, autoimmune anemia
130
Q

Ranson criteria

A
  • Age > 55
  • WBC > 16,000
  • Glc > 200
  • AST > 250
  • LDH > 350
131
Q

Ranson > 48 H

A
  • Base deficit > 4
  • BUN increase > 5
  • Fluid sequestration
  • Serum Ca
  • Hct decrease
  • PO2
132
Q

Pancreatic CA- Eti

A
  • Adenoma in pancreas
  • Smoking = 3x risk
  • Head MC
133
Q

Pancreatic CA- Sx

A
  • Painless jaundice
  • Pruritis in skin
  • acholic stools
  • Dark urine
134
Q

Pancreatic CA- Dx

A

CA 19-9

2 Gen surg (9 decks)

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