GI surgery uworld Flashcards

1
Q

RUQ pain + weight loss + hx of ulcerative colitis + ct abdomen: dilated intrahepatic ducts and normal sized common bile duct + elevated CA-19-9 and CEA

A

ulcerative colitis + primary sclerosing cholangitis associated with cholangiocarcinoma**

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2
Q

elevated lipase + alk phos + u/s: multiple gallstones and a dilated common bile duct
next step
dx

A

ERCP**
dx: gallstone pancreatitis
if stone stays, can result in bile stasis, allowing bacteria to ascend from duodenum –> acute cholangitis (pentad: RUQ, JAUNDICE, FEVER, AMS, HYPOTENSION)

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3
Q

post op day 3 s/p CABG now has RUQ pain, elevated alk phos
dx?

A

acalculus cholecystitis

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4
Q

obstruction of the CYSTIC duct by a gallstone: gallbladder dissension, pericholecystic fluid, and thickened gallbladder wall and fever
next best step?

A

cholecystectomy within 72hrs

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5
Q

distended gallbladder with gas in the gallbladder wall and lumen
next step?
organisms + abx:
dx?

A

emergency cholecystectomy
gas forming bacteria: Clostridium + E COLI – give piperacillin-tazobactam
emphysematous cholecystitis

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6
Q

pt with hyperactive bowel sounds + dilated loops of small bowel and air in the intrahepatic bile ducts

A

mechanical bowel obstruction**
d/t gallstone ileus causing n/v and pneumobilia
vs emphysematous cholecystitis would not see the hyperactive bowel sounds

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7
Q

asymptomatic gallstones but has painful ureter stone that relieves pain once passed
next step?

A

NO TX
since asymptomatic gallstones

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8
Q

hollow organ contraction and outlet obstruction

A

severe abdominal pain after eating a fatty meal – biliary colic 2/2 gallstones

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9
Q

pt had percutaneous liver biopsy 5 DAYS AGO now has RUQ pain and melena

A

hemobilia
s/p liver biopsy usually 5 days later upper GI bleeding causing intraductal hematoma
self limited manage conservatively

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10
Q

ROUX en y gastric bypass - 1 week later has fever, abdominal pain, tachypnea, and tachycardia

A

anastomotic leak – do a CT abdominal scan**

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11
Q

pt undergoes distal partial gastrectomy (bypassing pyloric sphincter) now has nausea, weakness, palpitation, light headedness, diaphoresis
next step?

A

DUMPing syndrome
dietary modifications **

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12
Q

retrosternal pain, fever, crepitus in setting of protracted vomiting

A

esophageal perforation

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13
Q

chest trauma now chest tube placed – one day later has turbid green fluid right sided pleural effusion (with fluid having high content of amylase)
dx
next step
tx

A

esophageal perforation
WATER SOLUBLE ESOPHAGRAM
NPO, iv abx, ppi, emergency surgical consult

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14
Q

vatical algorithm

A
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15
Q

s/p several weeks after Nissen fundoplication for GERD with n/v/post prandial bloating, upper go series shows no obstruction
next step?

A

scintigraphic gastric emptying scan
(Measures the percentage of a standard meal left in the stomach after a certain number of hours) it is diagnostic of Gastroparesis in the absence of obstruction

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16
Q

retrocardiac air-fluid with sensation of food getting stuck in chest

A

gastric herniation into thoracic cavity – paraesophageal hernia
needs Nissen fundoplication surgical repair

vs

sliding hernia asymptomatic – no sx

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17
Q

mallory weiss tear

A

longitudinal mucosal tear sometimes at gastroesophageal junction

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18
Q

S/P roux-en y gastric bypass years later has abdominal bloating flatulence and diarrhea for three months

A

bacterial overgrowth
small intestinal bacterial overgrowth – SIBO

19
Q

how to dx Zener diverticulum

A

swallow study with CONTRAST ESOPHAGOGRAPHY

20
Q

GERD best diagnosis initial:
management:
when to do sx?

A

pH monitoring
*lifestyle modifications
antacids, H2 blockers, PPIs, sucralfate

then do endoscopy EGD *immediate if alarming symptoms

long standing symptoms not controlled with ^^
medical intractability
disease complications: ulcerations, stenosis
Nissen fundoplication

21
Q

barrets esophagus

A

metaplasia *** doesnt need sx

if they have dysplasia and barrels –> resection required (cant do nissens won’t take barrels away)

22
Q

dysphagia worse for liquids than solids
FUNCTIONAL obstruction (not anatomic)
dx
tx

A

achalasia (similar to hurschsprungs, functional obstruction d/t decrease in myenteric plexus)
dx: BARIUM SWALLOW +/- manometry
tx: endoscopic balloon dilation

23
Q

progressive dysphagia worse with solids, now liquids, lost weight

A

esophageal cancer
Squamous cell carcinoma : smoking and drinking
adenocarcinoma: long standing GERD

dx: BARIUM SWALLOW (always noninvasive first) then EGD and biopsy
CT scan to assess operability

tx: surgical resection, palliative care

24
Q

older pt with anorexia, weight loss, vague epigastric pain, early satiety, occasional hematemesis
dx

A

gastric adenocarcinoma
dx: UPPER GI STUDY SERIES *******
then endoscopy with biopsy
then CT to assess operability

25
Q

older pt with anorexia, weight loss, vague epigastric pain, early satiety, occasional hematemesis
gastric lymphoma
dx
tx

A

dx: UPPER GI SERIES
then endoscopy with biopsy
THEN CT TO ASSESS STAGING EXTENT OF DISEASE
tx: chemo or radiation, surgery f risk of perforation
treat h pylori

26
Q

bowel obstruction management

A

NPO
NG suction tube
IV fluids

then surgery if that doesnt help ^
if develops fever, leukocytosis, abdominal tenderness rebound –> strangulation complete obstruction, ischemic, gangrene, perforated

27
Q

diarrhea, flushing of face, wheezing, right sided heart valvular damage

A

Carcinoid syndrome
seen in appendix** or small bowel - w/ metastasis to liver
dx: 24hr urinary HIAA
ct scan to assess metastasis and plan resection

*if you have the symptoms, its already metastasized to liver since cant break down the products

28
Q

appendicitis symptoms
dx:

A

CT scan
doesnt matter if clinically diagnosis

29
Q

familial adenomatous polyposis

A

thousands of polyps, check at age 10, complete removal of colon at age 20
gardner syndrome

30
Q

Hereditary Nonpolyposis colorectal cancer

A

ovarian endometrial and gastric cancers
remove most of the colon
in females: remove hysterectomy oophorectomy as well

31
Q

sigmoid volvulus mangement

A

xray: air fluid levels in small bowel
tx: rigid proctosigmoidoscopy with rectal tube
elective surgery in recurrent cases

32
Q

age 10-25, pain from minimum injury, sunburst pattern, invasion of adjacent soft tissues

A

osteogenic sarcoma

33
Q

age -15, grows in diaphysis of long bones, extreme pain, increased ESR, onion skinning

A

Ewing sarcoma
do a biopsy to confirm

34
Q

clavicle fracture, distal 1/3

A

closed reduction, with external manipulation
sling or immobilize with figure 8 bandage

Open reduction and internal fixation
if severely displaced or angulated bones

35
Q

arm is adducted and rotated outwards
numbness over the deltoid

A

anterior shoulder dislocation
axillary nerve causes numbness in deltoid

36
Q

s/p electrical burn or seizure
arm is adducted and internally* rotated

A

posterior shoulder dislocation

37
Q

fall on outstretched hand, “dinner fork” appearance

A

colles fracture: dorsally displaced and angulated fracture of distal radius
tx: closed reduction and long arm cast

38
Q

diaphysial fracture of proximal ulna with anterior dislocation of radial head
d/t direct blow to ulna

A

monteggia fracture
tx ORIF

39
Q

FRACTUre of distal radius of dorsal dislocation of distal radioulnar join

A

galeazzi fracture
tx ORIF

40
Q

scaphoid fracture “snuffbox region” will nOT see anything on xray

A

dx: xray negative, repeat in 3 weeks
tx: displaced and angulated : ORIF
non displaced: thumb spica cast

41
Q

shortened and externally rotated femur

A

hip fracture
pin the head and neck together if no diplacement
if displaced: high risk of avascular necrosis –> hemiarthroplasty

42
Q

shortened and externally rotated : intertrochanteric fracture

A

less likely avascular necrosis than hip fracture
Orif
put them on anticoagulants : low molecular weight heparin

43
Q

femoral shaft fracture tx

A

intramedullary rod fixation