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AMBOSS (BA) > GI-Surgery > Flashcards

GI-Surgery Flashcards

1
Q

Headache, vomiting, focal neurologic deficit : Indication? Next step in Management?

A
  • Increased ICP

- MRI of the brain

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2
Q

Elderly, intermittent hematochezia, anemia, fever, LLQ pain,

A

Diverticulitis ( common in sigmoid colon, associated with constipation)

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3
Q

Oil cysts on mammography after chest trauma. Next step in management (NSIM)?

A

Reassurance- It is pathognomonic for fat necrosis of the breast. Biopsy confirmation:foam cells and multinucleate giant cells

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4
Q

Drugs that decrease intestinal motility (2 listed)

A

amlodipine, chlorpromazine

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5
Q

abd distention and marked dilation of the colon and cecum on imaging indicates? possible causes?

A

acute megacolon; complication of interventional procedures and/or SE of medications that decrease motility

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6
Q

Acute N/V, bloating, absent bowel sound, and uniform gas pattern in small bowel, colon and rectum without air-fluid level on x-ray is

A

paralytic ileum

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7
Q

Connects the lesser curvature of the stomach with liver and must be cut in surgery to access for removal of pancreatic tumor

A

gastrohepatic ligament

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8
Q

Tx for refractory ascites that has not responded to diuretics? consider complication?

A

large-volume paracentesis, albumin level (electrolyte abnormalities)

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9
Q

Sign of mechanical obstruction and X-ray with accumulation of gas in the biliary system (Pneumobilia) and dilated bowel with air-fluid levels is?

A

Cholecystoentreic fistula

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10
Q

Salmon-colored fluid from incisional wound after open abd surgery? NSIM?

A

wound dehiscence; secure wound with tape & abd binding and OR

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11
Q

fever, abd pain, changes in mental status, ascites fluid with >250 polymorphonuclear leukocytes/mm3 is

A

Spontaneous Bacterial peritonitis (SBP)

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12
Q

Tarry stool, BP 90/50, HR 110, on naproxen, Dx? NSIM?

A

Upper GI bleeding, EGD

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13
Q

4YO, acute intermittent umbilical abd pain, , draws up his knees to the chest when in pain, Hgb 10.6, abd US with concentric rings of bowel in transverse section, Dx? Pathological lead point?

A

Intussusception, Meckel’s diverticulum (older than 3 think lead point)

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14
Q

5YO, abd pain, hyperactive bowel sounds, US normal, Dx? NSIM?

A

constipation, give polyethyelene glycol

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15
Q

10YO, Vomiting, RLQ pain without guarding, normal BS, Leukocyte count 12,800. Dx? Imaging?

A

Acute appendicitis; abd ultrasound for children

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16
Q

36, fatigue for 4 month, generalized itching, ALK 480, AMA antibody +, ANA +, abd US gallbladder sludge, Dx? NSIM?

A

Primary biliary cholangitis (PBC), Ursodeoxycholic acid ( 1st line therapy)

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17
Q

26, fatigue for 6 months, diarrhea for 5 weeks with occasional bloody, ESR 80, Dx? NSIM?

A

Inflammatory bowel disease; colonoscopy (used for IBD, colorectal cancer screening and diagnosing)

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18
Q

On colonoscopy; inflamed, reddened mucosa, bleeding on contact with then endoscope, and fibrin-covered ulcers. Dx?

A

Ulcerative colitis

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19
Q

66F, profuse watery diarrhea with streaks of blood, UTI 3 weeks ago, 14 day course of ciprofloxacin, N/V, leukocytosis. Dx? Abd xray will show?

A

Toxic megacolon-complication of pseudomembranous colitis, abdXray- dilation of the colon with loss of haustration

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20
Q

treatment for intussusception

A

Air enema or hydrostatic enema

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21
Q

treatment for nonmetastastatic pancreatic head carcinoma

A

Whipple procedure- Pancreaticoduodenectomy

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22
Q

32m, Crohn’s disease with small bowel resection for midgut volvulus at birth, laparotomy with two discrete strictures in the mid-ileum. NSIM? Two things pt at risk for?

A

Strictureplasty of individual strictures; risk for short bowel syndrome (prior SB reception hx) & adhesions/fistulas (crohn’s disease hx)

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23
Q

56F, difficulty swallowing solid and now liquid, wt loss, smoker, Esophageal manometry monitoring shows lower esophageal sphincter fails to relax. Dx? NSIM?

A

Achalasia; Gastroesophageal endoscopy. It can present as distal esophageal cancer also achalasia predisposes to cancer

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24
Q

Surgical procedure for GERD

A

Myotomy of LES with fundoplication

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25
Q

Screening test for C-diff ( 3)

A
  • Enzyme immunoassay (EIA) for glutamate dehydrogenase antigen ( GDH);
  • PCR testing;
  • bacterial culture;
  • Fecal lactoferrin (Not specific enough to confirm diagnosis)
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26
Q

Testing for malabsorption

A

stool acidity test

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27
Q

Testing for Inflammatory bowel disease (IBD)

A

Fecal lactoferrin

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28
Q

unstable pt with severe retrosternal pain radiating to the back and left shoulder, nonbillious vomiting, hx of daily beer, crepitus over the thorax. Dx?Appropriate test? and what if pt is stable ?

A
  • Boerhaave syndrome
  • CT scan of the chest (unstable)
  • Contrast esophagram with gastrografin (NO barium)
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29
Q

Pt close proximity with animals, RUQ abd pain, N/V, eosinophilia, Liver cysts on US. Dx? Tx? SE?

A

Hydatid cyst disease (echinococcosis): albendazole SE Leukopenia (CBC q2weeks during therapy)

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30
Q

Hypoechoic heterogenous lesion at the caudal border of liver with surrounding hyperemia. RUQ pain, fever, elevated LFT, leukocytosis. Dx? NSIM

A

Pyogenic liver abscess; percutaneous draining (if less than 3cm and pt stable tx with abx only)

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31
Q

secondary prophylaxis to prevent variceal bleeding is ? using?

A

Variceal ligation: using Endoscopic variceal ligation (EVL) q 1-2 weeks until the variceal have been obliterated then 3-6 months endoscoping exam

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32
Q

Tx of acute variceal hemorrhage but not for secondary prophylxis due to drug tolerance (down regulation of receptors)

A

Octreotide (splanchnic vasoconstriction)

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33
Q

32M, hx HTN & ulcerative colitis , generalized fatigue and severe pruritus, abd US focal bile duct dilation, elevated conjugated bilirubin & ALK pha. DX?

A

Primary sclerosing cholangitis

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34
Q

32F, hx HTN & ulcerative colitis , generalized fatigue and severe pruritus, abd US focal bile duct dilation, elevated conjugated bilirubin & ALK pha + antimitochondrial antibodies. DX?

A

Primary biliary cholangitis (PBC)

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35
Q

CP radiating to the back, Tachy, Tachypnea, crepitus over the chest, endoscopic procedure one day ago. Dx?

A

esophageal perforation

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36
Q

What is the most likely cause of postop hemorrhage within 24hr after surgery in pt with normal coagulation parameter?

A

Insufficient mechanical hemostasis due to slipped suture or tie

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37
Q

fever, malaise, tender abd, raised amylase, lipase following an episode of acute pancreatitis, abd US with complex cystic fluid collection with irregular walls and septations in pancrease. Dx?

A

Pancreatic abscess

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38
Q

fever, malaise, tender abd, raised amylase, lipase following an episode of acute pancreatitis, abd US anechoic or hypoechoic, smooth, round structure. Dx

A

Pancreatic pseudocyst

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39
Q

22F, Chronic abd pain, bloody diarrhea, wt loss, procititis, + p-ANCA. Dx? Colonoscopy will show?

A

Ulcerative colitis; confluent inflammation of the colonic mucosa with edema, linear ulcers and loss of vascular pattern

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40
Q

upper abd pain, achy and crackling with every heartbeat associated with lucency of the mediastinum is called? diagnosis? How to diagnose?

A

Mediastinal emphysema (Hamman’s sign); iatrogenic esophageal perforation (after upper endoscopy); contrast esophagography with gastrografin

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41
Q

new born, with Polydromnios before birth, cyanotic attack that does not improve with crying suggests?

A

developmental anomaly, esophageal atresia

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42
Q

1st line therapy to treat initial episode of C-diff infection

A
  • Oral fidaxomicin or oral Vancomycin
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43
Q

Why LR and not NS?

A

LR reduces the risk of SIRS and large quantities of NS can cause non-anion gap hypercholoremic acidosis

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44
Q

54M, Abd distension with shifting dullness, cloudy ascitic fluid, serum-ascites albumin gradient (SAAG) < 1.1 and Triglycerine count >200, non-pitting pedal edema is

A

Lymphedema (Chylous ascties) caused by Lymphoma

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45
Q

68M, increased in the frequency of bowel movement and occasional bloody stools, smoker, digital rectal exam shows a large internal hemorrhoid, stool + for occult blood, NSIM?

A

colonoscopy

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46
Q

what disease could cause chronic, progressive changes in bowel habits and hematochezia in an elderly man with a history of smoking?

A

Colorectal cancer

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47
Q

What lab test helps determine the severity of pancreatitis quickly?

A

Hematocrit (severity), Lipase is good for diagnosis but correlated poorly with disease severity

48
Q

Tx for acute diverticulitis complicated by a large abscess (>3cm) is

A

CT-guided percutaneous drainage

49
Q

Young boy with painless lower GI bleeding, DX? NSIM?

A

Meckel Diverticulum, Technetium-99m pertechnetate scan

50
Q

1st-line treatment for an obstructing Schatzki ring/esophageal ring is

A

mechanical dilation using bougie or ballon dilators

51
Q

Dysphagia, esophageal obstruction, ring like appearance of obstruction with normal mucosa on biopsy is

A

Schatzki ring

52
Q

Achlohydria, overgrowth of nitrite-producing bacteria, and reflux of bile through the gastrojeunal anastomosis after partial gastrectomy will have risk for

A

gastric cancer

53
Q

name for absent of HCL in gastric is called

A

achlorhydria

54
Q

secretory diarrhea, episodic cutaneous flushing, abd pain, heart valve dysfunction, and wheezing

A

Carcinoid syndrome due to excess serotonin recreation from Carcinoid tumor

55
Q

Young woman on oral contraceptive pill with 3cm hepatic mass. Dx? NSIM?

A

hepatic adenomas, reimagined in 6 month after stoping oral contraceptives (OCPs)

56
Q

Ingestion Scerotherapy is used for tx of

A

rectal prolapse

57
Q

Tx of anogenital warts (condylomata acuminate)

A

Local cytostatic 5-fluorouracil therapy

58
Q

Tx of choice for pt with anal SSC cancer is

A

Radiochemotherapy, shown to be superior to surgery

59
Q

Elderly, hx of multiple medical conditions, with abd pain and distention. Imaging colonic dilation with haustral preservation in absence of an obstructing lesion is

A

acute colonic pseudo-obstruction (oglivie syndrome)

60
Q

Disease of GI characterized by impairment of the autonomic nervous system

A

Oglivie syndrome

61
Q

How do you treat Oglivie syndrome

A

Neostigmine therapy- causes increase in acetylcholine to stimulate bowel peristalsis

62
Q

Viscous, dark green substance draining after 12hrs abd surgery, Dx? NSIM?

A

enterocutanous fistula, Total parenteral nutrition and stony pouch

63
Q

Risk factors of cholecystitis

A 
Female
Fat
Forty
Fair-skinned
Family history
Fertile (Multiparity)
64
Q

Tx of acute Acalculous cholecystitis

A
  1. IV fluid
  2. Broad-spectrum antibiotics (piperacilin-tazobactam)
  3. Cholecystostomy
65
Q

Bulimic pt with retrosternal pain and leakage of contrast from lower esophagus after serval episode of vomiting. No sepsis, pneumothorax, pleural effusion or mediastinal emphysema, leak contained to the mediastinum. Dx? Tx?

A

Boerhaave syndrome, IV ampicillin therapy .

Surgical repair only if therapy fails or sever tear

66
Q

17M, Progressive high fever, leukocytosis, add pain and abd fluid collection seen on CT in right pelvis, Dx? NSIM?

A

appendices abscess, Continue conservative management (bowel rest, IV fluids, and abx) and schedule appendectomy in 6-8 weeks

67
Q

Elevated cholestatic parameters and a dilated common bile duct without evidence of stones in the biliary system after cholecystectomy. Dx? Tx?

A 
Postcholecystectomy syndrome( residual gallstones within biliary tree or sphincter of oddi dysfunction) 
- ERCP with sphincterotomy
68
Q

Down syndrome new born with bilious vomiting, abd distention, explosive stool release upon rectal exam, late passage of meconium.Dx? NSIM?

A

Hirschsprung’s disease; Rectal suction biopsy ( 2cm proximal to the dectate line)

69
Q

Recommended procedure for pt with hematochezia and hemodynamic instability despite resuscitation efforts

A

Angiography

70
Q

Mutation in mismatch repair genes(MLH1, MSH2)- Lynch syndrome risk of developing 3 different cancers

A
  • Colorectal
  • Gastric
  • Endometrial (might require Hysterectomy and bilateral salpingo-oophorectomy
71
Q

Newborn with abd distention, multiple episodes of billow vomiting, and dilated large bowel loop, delayed passage of meconium, absent of air in the rectum, and narrow sigmoid colon with dilated colon segment on x-ray suggest

A

Hirschsprung’s disease

72
Q

Defective migration of neural crest cells

A

Hirschsprung’s disease

73
Q

Gastric outlet obstruction (GOO) caused by ACUTE peptic ulcer disease causes vomiting from

A

inflammation-induced edema

tissue deformation of the gastroduodenal junction

74
Q

Gastric outlet obstruction (GOO) caused by Chronic peptic ulcer disease related to H.Pylori-induced chronic gastritis & chronic NSAID use causes vomiting due to

A

scarring and tissue remodeling

75
Q

Changes in Na, pH, K, Cl from vomiting from pyloric stenosis in the early stages of dehydration

A

Na (hyponatremia), pH(normal in early stage due to respiratory and kidney compensation), K ( Normal), Cl (normal)

76
Q

Triple bubble sign in a new born with bilious vomiting

A

Jejunal atresia

77
Q

Double bubble sign in a new born with bilious vomiting

A

Duodenal atresia

78
Q

What would be the best approach to evaluate abdominal injuries in a hemodynamically unstable patient with inconclusive FAST test?

A

Diagnostic peritoneal lavage (DPL)

79
Q

Abd X-ray on a new born low birth weight with pneumatosis intersitnalis (gas within the wall of the intestine) is indicative of? NSIM?

A

Necrotizing enterocolitis; Exploratory laparotomy

80
Q

Indication for familial adenomatous polyposis (FAP) is

A

proctocolectomy with ileana anastomosis

81
Q

A smooth, bony hard, and nontender mass in the midline of the hard palate is

A

torus palatines-benign bone tumor

82
Q

Crepitus in the abd wall and thickened gallbladder with gas

A

emphysematous cholecystitis

83
Q

US with bile duct wall thickening and focal strictures and dilations of the interahepatic and extra hepatic bile ducts

A

Primary Sclerosing Cholangitis (PSC)

84
Q

neonate with acute-onset bilious vomiting, mildly distended abd, no gas in the small intestine on x-ray, Dx? NSIM?

A

Intestinal malrotation with midgut volvulus (misplaced ligament of Treitz and duodenojejunal auction on the right of the mid-line)
Upper GI contrast series

85
Q

Obvious signs of malrotations are

A

misplaced ligament of Treitz and duodenojejunal junction on the right of the mid-line

86
Q

Recommended treatment of chronic pancreatitis

A

pancreatic enzyme therapy

87
Q

Bloody diarrhea and cramps abd pain

A

Inflammatory Bowel disease

88
Q

Friable and inflamed mucosa that bleeds on colonoscopy Dx?, Tx?

A
  • ulcerative colitis;

- Mesalamine therapy (for mild UC), 5-aminosalicyclic acid derivatives (sulfasalazine and olsalazine)

89
Q

Therapy only for management of steroid-refractory UC in pt not willing to have surgery and who have contraindication for calcineurin inhibitors

A

infliximab therapy

90
Q

Therapy for Crohn’s disease

A

Infliximab

91
Q

A prognostic grading scale for cirrhosis (mortality)

A

Child-Pugh score /CTP score (Child-Turcotte-Pugh score)

on the bases of; bilirubin, albumin, PT and degree of cities and encephalopathy (Graded A-mild to C-severe)

92
Q

Higher CTP score on cirrhotic patient with ascites who need surgery, what you should be done to prevent surgical morbidity?

A

abd paracentesis

93
Q

abd pain and distention with obstipation, x-ray with coffee-bean sign indicates? NSIM?

A 
Sigmoid volvulus
endoscopic detorsion (via sigmoidoscopy)
94
Q

1st line of tx for gastroparesis

A

Metoclopramide (Reglan)

95
Q

Abd x-ray with cecal and right colon dilation, Dx? Tx?

A

colonic pseudo-obstruction, neostigmine therapy

96
Q

Congenital umbilical hernias close spontaneously by what age?

A

5

97
Q

Pt with cholecystitis needs what therapy before lap cholecystectomy?

A

Antibiotic therapy- Piperacillin-tazbactam IV (Zosyn)

98
Q

Emergent open cholecystectomy is indicated for (2)

A

gangrenous cholecystitis or gallbladder empyema

99
Q

Trauma pt with paralytic ileum (tx opioids), ileum with bilateral flank pain, seatbelt sign, Grey Turner sign, obliteration of the psoas outline on x-ray and fluid-responsive hemodynamic changes make?

A

retroperitoneal hemorrhage

100
Q

Flank ecchymosis due to retroperitoneal bleeding dissecting through fascial planes is called

A

Grey Turner’s sign

101
Q

Five days after pancreaticoduodenectomy presenting with hyperchloremic normal anion gap metabolic acidosis needing testing of drain fluid for amylase is due to

A

Pancreatic fistula

102
Q

Tx for pancreatic fistula include

A

-conservational tx (Octreotide, TPN) or with stunting of the pancreatic duct

103
Q

Fever, jaundice, & RUQ abd pain is called

A

Charcot’s triad

104
Q

right upper abd pain on pregnant women who has vomiting, fever, leukocytosis and mild pyuria

A

Appendicitis- gravida uterus can displace the appendix to the RUQ. Pyuria if appendicitis is proximal to ureters

105
Q

Vomiting, abd pain, RUQ tenderness in pregnant women with high LFT, hemolysis and low plt. Dx?

A

HEELP syndrome

106
Q

Initial management of bleeding esophageal varies involves (4)

A
  • Fluid resuscitation
  • blood product to stabilize coagulation
  • octerotide
  • prophylactic abx
107
Q

When should Endoscopic band ligation be performed on a patient with esophageal varies

A

within 12 hrs of presentation, after medical treatment and prophylaxis

108
Q

4 weeks old infant with scleral icterus and play stools suggests

A

direct hyperbilirubinemia (biliary atresia)

109
Q

Immediately following birth child with jaundice, normal stool color is

A

indirect hyperbilirubinemia (Crigler-Najjar syndrome)

110
Q

Pregnant women with pruritus, elevated direct bilirubin levels, elevated bile acid indicates

A

intrahepatic cholestasis of pregnancy

111
Q

After 1 day of MVA abd pain, nausea and vomiting. X-ray with large gastric bubble with mild gastric distention. Dx? Tx?

A
  • Duodenal hematomas causing upper intestinal obstruction

- NG decompression and TPN

112
Q

Epigastric pain, N/V and history of multiple episodes of acute pancreatitis with walled off pancreatic fluid on CT, Dx? Tx?

A
  • Pancreatic pseudocyst

- CT-guided percutaneous drainage

113
Q

Pt of Asian descent with saccular or fusiform dilation of the biliary tree or as a dilated masses that communicate with the biliary tree is

A

Biliary cysts

114
Q

MVA 8hrs ago, HR 140, bp 80/50, CVP 19, JVD, abd is tense and distended;Dx? NSIM?

A
  • Abd compartment syndrome (from resuscitation)

- Reopen abd and cover with plastic

115
Q

Sudden compromises of blood flow to bowel causing necrosis and infection

A

Ischemic colitis (absent bowel sound , tenderness in palpation of all quadrant, x-ray with air-filled distended bowel)

116
Q

When direct and indirect hernias happen together, it is called

A

Pantaloon or Saddle bag hernia

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