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Surgery Pre Test > GI Tract, Liver, Pancreas > Flashcards

GI Tract, Liver, Pancreas Flashcards

0
Q

What is the most appropriate elective operation for a patient with ulcerative colitis?

A

Total proctocolectomy with ileal pouch anal anastomosis and diverting ileostomy

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1
Q

What is the safest and most effective treatment for achalasia?

A

Esophagomyotomy– The operation of choice is a modified laparoscopic Heller myotomy.

Surgery results and improvement in more than 90% of patients, compared with 70% of patients treated by forceful dilatations

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2
Q

Treatment of choice for noninfected pancreatic pseudocyst

A

Internal drainage

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3
Q

Treatment of choice for infected pancreatic pseudocyst

A

External drainage – percutaneous catheter drainage with antibiotics

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4
Q

Most frequent serious complication of and colostomies

A

Parastomal herniation – commonly occurs when the stoma is placed lateral to The rectus muscle

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5
Q

Best study to evaluate for a pancreatic mass?

A

Helical contrast enhanced CT

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6
Q

Treatment for acute variceal bleed?

A

– Isotonic crystalloids followed by transfusion of blood
– Elevated prothrombin times should be corrected with fresh frozen plasma
–Octreotide or vasopressin to decrease splanchnic bloodflow
–Balloon tamponade

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7
Q

Treatment for persistent gastric ulcer unresponsive to medical therapy. What is the next best step in management?

A

– Distal gastrectomy with gastroduodenostomy
Or with gastrojejunostomy to definitively rule out a malignancy

This is a partial gastrectomy with vagotomy

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8
Q

Method to document the eradication of H. pylori infection?

A

Carbon labeled urea breath test

Sensitivity and specificity greater than 95%

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9
Q

Type of polyps seen in peutz jeghers syndrome

A

Hamartomas – no malignant potential

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10
Q

What are the indications for surgical intervention for diverticular disease?

A

– Hemorrhage secondary to diverticulosis
– Recurrent episodes of diverticulitis
– Intractability to medical therapy
– Complicated diverticulitis

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11
Q

Treatment for diverticular abscess

A

– Percutaneous drainage

–Sigmoid resection with primary anastomosis

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12
Q

Treatment for perforated diverticulitis?

A

Hartman procedure – sigmoid resection with end colostomy and rectal stump or

Sigmoid resection, anastamosis, diverting loop ileostomy

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13
Q

How do you diagnose biliary dyskinesia? What is the treatment?

A

A gallbladder ejection fraction of less than 35% at 20 minutes is diagnostic

Treatment is cholecystectomy

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14
Q

48-year-old with right lower quadrant pain that develops a playing tennis. Progresses with low-grade fever, leukocytosis, anorexia nausea. Ultrasound shows mass and abdominal wall. Most likely diagnosis?

A

Hematoma of the rectus sheath

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15
Q

Treatment for amoebic liver abscesses?

A

Metronidazole monotherapy

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16
Q

Treatment for pyogenic liver abscesses?

A

Percutaneous catheter drainage and antibiotics against gram-negative and anaerobic organisms

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17
Q

Best way to determine the proper treatment for his sliding hiatal hernia?

A

Flexible endoscopy

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18
Q

72-year-old man with hematochezia, fever, abdominal pain. What is it? Management.

A

Ischemic colitis

Expectant management – IV fluids, bowel rest, supportive care

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19
Q

Definitive treatment for hepatic adenoma?

A

Resection
Lesions greater than 4 cm in size of an increased risk of rupture with hemorrhage
Hepatic adenomas also have a risk of malignant transformation to well-differentiated hepatocellular carcinoma

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20
Q

Treatment for focal nodular hyperplasia?

A

Resection only if lesion is symptomatic.

FNH cannot be distinguished from hepatic adenoma on CT scan, nuclear medicine scan may demonstrate hot lesion for FNH or cold lesion for hepatic adenoma

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21
Q

Treatment for iatrogenic injury of the common bile duct resulting in stricture?

A

End to side choledochojejunostomy (Roux-en-y) performed over a stent. Primary repair of the common bile duct may result in recurrent structure

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22
Q

When is polypectomy adequate treatment when malignant cells are identified in colonic polyp, and invasive component is identified?

A

(1) no vascular or lymphatic invasion is present
(2) there is an adequate negative margin – 2 mm
(3) cancer is not poorly differentiated

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23
Q

Where do most gastrinoma’s occur?

A

90% are located within the gastrinoma triangle – the three corners are defined by the junction of the second and third portions of the duodenum, junction of the neck and body of the pancreas, junction of the cystic and common bile duct

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24
Q

Treatment for epidermoid cancers of the anal canal

A

Combined external radiation with synchronous chemotherapy (fluorouracil and mitomycin) also known as the Nigro protocol

25
Q

Differential for distended bowel?

A

Tumor, foreign body, colitis, cecal or sigmoid volvulus

26
Q

Best diagnostic test for sigmoid volvulus?

A

Sigmoidoscopy

27
Q

75-year-old woman with abdominal radiograph demonstrating air filled kidney bean shaped structure in the left upper quadrant. What is it? Management.

A

Cecal volvulus

Right hemicolectomy

28
Q

45-year-old right upper quadrant pain and fever. CT shows large calcified cystic mass in the right lobe of liver. Echinococcus is suggested by the CT findings. Management.

A

Total pericystectomy

Agents such as .5% silver nitrate or hypertonic saline are introduced into the cyst at the time of surgery

29
Q

What is the most common nonobstetric surgical disease of the abdomen during pregnancy?

A

Appendicitis

30
Q

Which type of hernia is more dangerous? Sliding hernia or paraesophageal?

A

Paraesophageal – Substantial risk for both strangulation and obstruction

Surgical repair required!

31
Q

Management of Ogilvie’s syndrome?

A

Discontinue anticholinergics, narcotics, medications that contribute to ileus.

Strict bowel rest with IV hydration and correction of electrolytes

Persistent distention or a dilated cecum greater than 10 cm, cautious endoscopic colonic decompression can be performed or sympatholytic agent such as neostigmine

32
Q

First-line treatment for major hemobilia

A

Transarterial embolization

33
Q

Risks associated with a paraesophageal hernia?

A

Bleeding, ulceration, construction, the cross of the stomach wall, perforation

34
Q

Which type of pancreatic tumors are deemed unresectable?

A

T4 lesions – extension beyond the pancreatic capsule and into the retroperitoneum, involvement of neural or nodal structures surrounding the origin of the celiac axis or superior mesenteric artery, extension into the hepatoduodenal ligament

35
Q

Most common cause of small intestinal bleeding in patients under 30?

A

Meckel diverticulum

36
Q

What is a stress ulcer?

A

Acute gastric or duodenal erosive lesions that occur following shock, sepsis, major surgery, trauma, or burns

– Characteristics – multiple show lesions with discrete areas of erythema along with focal hemorrhage in the fundus
Involve the body and fundus and spare the antrum

37
Q

Most common location of common benign gastric ulcers

A

lesser curvature and antrum

38
Q

Treatment for high risk critically ill patients with multisystemic disease and cholecystitis?

A

Tube cholecystostomy

39
Q

What is a dieulafoy lesion?

A

abnormally large submucosal artery that protrudes through a small, solitary mucosal defect, located 6 cm distal to the GE junction.

40
Q

Tx for dieulafoy lesion

A

Upper endoscopy with injection sclerotherapy, electrocoagulation or heater probe.

If surgery is required, gastrotomy and simple ligation or wedge resection.

41
Q

When is risk of malignancy low in carcinoid tumor?

A

When tumors are < 2 cm. Malignant potential increases when size > 2cm and metastasis to liver occurs causing carcinoid syndrome.

42
Q

Management of patient with asymptomatic hemangioma

A

Safely observed

risk of rupture and severe hemorrhage is extremely low

43
Q

Definitive treatment for patients with UC

A

total proctocolectomy with either end ileostomy or ileoanal J-pouch anastomosis.

44
Q

Indications for operation in UC

A

High grade dysplasia or carcinoma
Toxic megacolin
Massive colonic bleeding
Intractability to medical therapy

45
Q

Tx for 60 year old woman with recurrent SCC of the anus after chemoradiation?

A

Abdominoperineal resection with formation of a permanent end colostomy.

46
Q

Surgical tx for toxic megacolon

A

subtotal colectomy with end ileostomy

47
Q

Treatment for distal rectal cancers involving the sphincters or that are too close to obtain an adequate margin (2cm)

A

Abdominoperineal resection (APR)

48
Q

Treatment for proximal and midrectal cancers

A

Low anterior resection (LAR)

49
Q

33 y/o with chron disease develops fever, abdominal pain and marked dilation of the large bowel. What is it? Management.

A

Toxic megacolon

Subtotal colectomy with end ileostomy

50
Q

Treatment for diffuse esophageal spasm?

A

Long myotomy guided by manometric evidence

51
Q

20-year-old man admitted to hospital with acute onset left-sided chest pain. What is it? Management.

A

Spontaneous pneumothorax resulting from rupture of subpleural blebs.
Thoracotomy with bleb excision pleural ablation

52
Q

50 year old has severe vomiting and retching spell punctuated by sharp substernal pain. Four hours later CXR shows left descending aorta is outlined by air density. What is it? Management.

A

The presence of air in the mediastinum after an episode of vomiting and retching is virtually pathognomonic for spontaneous rupture of the esophagus - Borehaave syndrome

-Contrast esophagram: Barium for suspected thoracic perforation and gastrografin for suspected abdominal perforation

Thoracotomy, Repair, and drainage for leaks that are less than 24 hours old

53
Q

Treatment for chylothorax

A

Low-fat, medium chain triglycerides diet reduces the flow of chyle.
Repeated thoracentesis or tube thoracostomy drainage

54
Q

Strategies to prevent spinal cord ischemia during operation on thoracic aorta aneurysms

A

Aggressive reattachment of segmental intercostal and lumbar arteries, minimizing cross-clamp time, hypothermia, moderate systemic heparinization, left heart bypass, cerebrospinal fluid drainage using a lumbar drain

55
Q

Indications for CABG

A

– Patients with angina
– Asymptomatic patients with ischemia on cardiac stress test
– Multivessel disease
–Treatment of choice in diabetic patients

56
Q

treatment for thoracic outlet syndrome

A

Physical rehabilitation

57
Q

Indications for pulmonary metastectomy?

A

-Controlling the primary lesion
– No evidence of extra thoracic disease
– Ability to tolerate pulmonary resection including possible sing-along ventilation
– Predicted ability to complete resection
– Lack of a more effective systemic therapy

May be performed for sarcomas, melanomas, germ cell tumors, carcinomas including colon, renal cellit’ll sell, endometrial, head and neck

58
Q

What is the treatment for chylothorax after drainage of chest cavity, bed rest, TPN fails?

A

If drainage of chyle continues to be greater than 500 mL per day, operative ligation of thoracic duct should be performed

Ligated from diaphragm to C6

59
Q

Primary therapy for a bronchial carcinoid?

A

Operatively resection – lobectomy or lesser section as long as tumors excised
Mediastinal lymph node sampling or dissection

60
Q

Thoracic aortic aneurysm can because by this disease

A

syphillis

Surgery Pre Test (12 decks)

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