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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
Bowel obstruction- Sx
- Constipation or obstipation - Distention and tenderness - Abd pain- N/V
26
Bowel obstruction- Dx
- CT with contrast
27
Bowel obstruction- Tx
- Resection and decompression
28
Colon CA- Eti
- Screen at age 50 q 10 yrs- Yearly fecal occult- Adenocarcinoma most common
29
Colon CA- Sx
- Blood in feces- Weakness and anemia- Change in bowel habits- Dyspepsia
30
Colon CA- Dx
- Colonoscopy and biopsy of polyps
31
Colon CA- Tx
- Resection of lesion and lymph - CEA levels pre and post op- Colonoscopy at 6 mo, 12 mo, 3 yrs, 5 yrs
32
Volvulus- Eti
- Rotation of bowel loops around fixed point- Ischemia, gangrene- Sigmoid most common
33
Volvulus- Sx
- Colicky abd pain- Spasms- Distension, tympany- High pitched bowel sounds
34
Volvulus- Dx
- XR: loss of haustra, kidney bean appearance- Bird beak sign, loop distension
35
Volvulus- Tx
- Decompression with sigmoidoscopy- Fluid resuscitation
36
Umbilical hernia- Eti
- W>M
37
Umbilical hernia- Sx
- Increased size- Sharp pain with coughing or sneezing
38
Umbilical hernia- Dx
Clinical
39
Umbilical hernia- Tx
- Repair to avoid incarceration- Mesh
40
Inguinal hernia- Eti
- M>W- Indirect > direct
41
Inguinal hernia- Sx
- Bulge and pain in inguinal canal- Aching
42
Femoral hernia- Eti
- Prone to incarceration/ strangulation- W>M- Descend through femoral canal beneath inguinal ligament- Difficult to reduce
43
Femoral hernia- Sx
- Asymptomatic until incarcerated - Small bulge in medial thigh- Colicky abd pain
44
Femoral hernia- Tx
- Open laparoscopy
45
Incisional hernia- Eti
- Complication of laparotomy- COPD, steroids, wt, smoking
46
Incisional hernia- Sx
- Bulging, pain, ache at incision site- Protrusion and obstruction at surgical site
47
Incisional hernia- Tx
- Recurrence is common- Mesh repair
48
Acute abdomen- Causes
- Appendicitis - Obstriction - Perfed ulcer - Diverticulits - Acute cholecystitis - Acute pancreatitis - Renal colic
49
Acute Abd- Eval
- Hx: Location, localization Character of pain - CXR best tool to eval
50
Achalasia- Eti
- Absence of esophageal peristalsis - Hypertensive LES- failure to relax - Neuron disease
51
Achalasia- Sx
- Dysphagia with solids and liquids | - Regurgitation of solid food
52
Achalasia- Dx
- Manometry = gold standard | - Endoscopy
53
Achalasia- Tx
- Laparoscopic Heller myotomy | - EGD w/ balloon dilation, botox injections
54
Esophageal varicies- Eti
- Enlarged veins in esophagus d/t portal HTN | - Azygos vein
55
Esophageal varicies- Sx
- Hematemesis - Melena - Hematochezia - Hx of liver dz
56
Esophageal varicies- Dx
- EGD
57
Esophageal varicies- Tx
- Fluid resuscitation - EGD banding, sclerotherapy - TIPS - Octreotide drip
58
Zenker diverticulum- Eti
- Pharengeoesophageal diverticula - Killian triangle - D/t lack of coordination b/t pharyngeal contraction and opening of UES
59
Zenker diverticulum- Sx
- Halitosis - Dysphagia - Regurgitation, aspiration - Heartburn
60
Zenker diverticulum- Dx
Barium swallow
61
Zenker diverticulum- Tx
- Cricopharyngeal myotomy | - Diverticulectomy
62
Esophageal carcinoma- Eti
- Adenocarcinoma MC USA - Squamous cell MC- world - Men, smokers, ETOH, barretts
63
Esophageal carcinoma- Sx
- Dysphagia - Wt loss - Hoarseness, back pain
64
Esophageal carcinoma- Dx
- Upper GI, GD for bx
65
Esophageal carcinoma- Tx
- Esophagectomy- stage 1 & 2 | - + chemo , rad > stage 3
66
Barrett esophagus- Eti
- Columnar epi in esophageal mucosa | - D/t reflux
67
Barrett esophagus- Sx
- Long hx of GERD
68
Barrett esophagus- Dx
- Endoscopy- salmon pink epithelium | - Bx
69
Barrett esophagus- Tx
- High dose PPIs, endoscopic surveillance | - Esophagectomy in high grade dysplasia
70
Caustic injury of esophagus- Eti
- Ingestion of acid or alkali - Alkali- liquification necrosis - Acid worst- coagulation necrosis
71
Caustic injury of esophagus- Sx
- Inflammatory edema of lips, mouth, mucosa - CHest pain and drooling - Severe pain with swallowing
72
Caustic injury of esophagus- Dx
- EGD - Burn staging - CXR in all pts- perforation
73
Caustic injury of esophagus- Tx
- Fluids & Abx | - Resection of esophagus, jejunostomy feeding tube
74
Schatzki ring- Eti
GERD
75
Hiatal hernia- Eti
GE jxn and stomach into the thorax
76
Hiatal hernia- Sx
- Asymptomatic- poorly controlled reflux | - Dysphagia
77
Hiatal hernia- Tx
- PPIs, H2 blockers | - Nissen fundoplication
78
Perforation of esophagus- Eti
- Boerhaaves- full thickness rupture of distal d/t repeated forceful voting - Mallory weiss: Longitudianal lacerations
79
Perforation of esophagus- Sx
- Boerhaave: retrosternal chest pain, Pneumomediasteinum | - Mallory weiss- hematemesis after ETOH binge
80
Perforation of esophagus- Dx
- B: Chest CT | - M: Egd
81
Perforation of esophagus- Tx
- B: Surg | - M: Supportive
82
Retroperitoneal abscess- Eti
- Infxn from adjacent structures (GI tract) - E. coli, bacteroides - Psoas abscess
83
Retroperitoneal abscess- Sx
- Fever, abd, flank pain | - Acute illness
84
Retroperitoneal abscess- Dx
CT- gas bubbles, confined to compartments
85
Retroperitoneal abscess- Tx
- Percutaneous drainage | - Abx
86
Intraabdominal abscess-Tx
- Percutaneous drainage and abx | - Surgal removal of affect organ
87
Ascites- Eti
- Chronic liver dz
88
Ascites- Tx
- Determine if SBP (WBC ct) - Albumin > 1 - Paracentesis - Furosemide + spironolactoen
89
Cholecystitis- Eti
- E. coli infxn of gallbladder d/t stone obstruction
90
Cholecystitis- Sx
- Episodic RUQ pain, precip by food - Fever, N/V - Palpable GB - + murphy
91
Cholecystitis- Dx
US
92
Cholecystitis- Tx
- Cephalosporin + metronidazle | - Cholecystectomy
93
Choledocholithiasis- Eti
Stones stuck in bile duct | - Fat, female, fourty
94
Choledocholithiasis- Sx
- Biliary colic (RUQ pain, abrupt onset, lasts 30 min) | - Jaundice
95
Choledocholithiasis- Dx, Tx
- US | - ERCP
96
Cholangitis- Eti
- Infxn on biliary tree | - Gram -
97
Cholangitis- Sx
- Fever, chills - RUQ pain - Jaundice - +/- shock and AMS
98
Cholangitis- Dx, Tx
US | - Abx and surg
99
Liver CA- Eti
- METS MC cause | - HCC
100
Liver CA- Sx
- Elevated LFTs - CEA, AFP - Hepatomegaly
101
Liver CA- Dx
- US
102
Liver CA- Tx
Transplant
103
Hepatic trauma- Sx
- Hypovolemic shock - HypoTN, low urinary output - Low CVP
104
Hepatic trauma- Dx
- Abdominal sonography | - CT if heme stable
105
Hepatic trauma- Tx
- Heme stability | - Surg exploration, arterial occlusion, hematoma drainage
106
Short bowel syndrome- Eti/ sx
- Diarrhea and malabsorption from extensive bowel resection | -
107
Short bowel syndrome- Tx
- TPN initially | - Many small meals chronically
108
Blind loop syndrome- Eti
- Bacterial overgrowth in small bowel
109
Blind loop syndrome- Sx
- Steatorrhea, diarrhea - Abd pain - Vit deficiency, B12
110
Blind loop syndrome- Tx
Abx
111
Mesenteric ischemia- Eti
- Emboli or acute thrombus | - Intestinal ischemia
112
Mesenteric ischemia- Sx
- Pain out of proportion - Vomiting, diarrhea - hx of A-fib, heart dz
113
Mesenteric ischemia- Dx, Tx
- Arteriogram - Revascularization - Resection of necrotic tissue
114
Colon polyps- Eti
Tubular adenoma MC
115
Colon polyps- Sx
- Bleeding - Change in bowel habits - Mucous per rectum
116
Colon polyps- Dx, Tx
- Colonoscopy - Polyp removal - Bowel and node resection
117
Perirectal abscess- Eti
Crypt in dentate line | - Infection and spread
118
Perirectal abscess- Sx
- Rectal pain, pus - Fever - Perianal mass
119
Perirectal abscess- Dx, Tx
- DRE: mass with fluctuant | - Drainage!
120
ANorectal fistula- Eti
- D/t infection or chrons disease
121
ANorectal fistula- Sx
- Perianal drainage - Recurrent abscess - Diaper rash
122
ANorectal fistula- Dx, Tx
- DRE, protoscope | - Tx: Open tract, wound care
123
Lower GI bleed- Eti
- Diverticulosis MC
124
Lower GI bleed- Sx
BRBPR
125
Lower GI bleed- Dx
Colonoscopy
126
Pilonidal cyst- Eti
- Gland infxn over sacrum | - Men, chronic, recurrent
127
Pilonidal cyst- Sx
- Abscess and drainage | - Pain and swelling
128
Pilonidal cyst- Tx
I and D | - Cystectomy
129
Splenectomy- Indications
- Hypersplenism caused by malignancy - Sickle cell - ITP, TTP - Thalassemias, autoimmune anemia
130
Ranson criteria
- Age > 55 - WBC > 16,000 - Glc > 200 - AST > 250 - LDH > 350
131
Ranson > 48 H
- Base deficit > 4 - BUN increase > 5 - Fluid sequestration - Serum Ca - Hct decrease - PO2
132
Pancreatic CA- Eti
- Adenoma in pancreas - Smoking = 3x risk - Head MC
133
Pancreatic CA- Sx
- Painless jaundice - Pruritis in skin - acholic stools - Dark urine
134
Pancreatic CA- Dx
CA 19-9

2 Gen surg (9 decks)

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