GI Tract Misc Flashcards
Risk of overwhelming postsplenectomy sepsis after splenectomy in childhood is highest when the spleen is removed for what reason?
Best prognosis for splenectomy if after what indication?
Malignancy: more than 4 times the risk compared to trauma
Best prognosis: splenectomy for trauna
mesh significantly reduces the risk of hernia recurrence for hernias larger than how many cm?
In 2 recent meta-analyses, what kind of mesh placement had the highest probability of being the best treatment to prevent recurrenc? Onlay, inlay, sublay, underlay?
Which has lower rate of recurrence? Biologic or synthetic?
> 4cm
Sublay has the best result.
Onlay: on top of the anterior rectus sheath
Inlay: under the anterior rectus sheath, connecting the rectus muscles
Sublay: right under the rectus muscles
Underlay: under the posterior sheath
Synthetic has lower recurrence rate
For what size hepatic adenoma is it reasonable to first stop OCP and watch? Over what size should you just cut it out?
What’s about hepatic adenoma in males?
<5cm reasonable to stop OCP and watch. > 5cm just cut it out.
Hepatic adenoma of any size in males -> cut it out because of higher chance of malignancy
acellular dermal matrix is best for what scenario?
Entral hernia repair with ECF takedown
Young-ish pt. 30’s, rlq pain. CT shows a mass in the rlq. Bx shows spindle cell. What’s the diagnosis?
What is the recurrence rate at 5 vs 10 yrs?
Does frozen section matter?
Sarcoma.
At 5 yrs: 25-30%
At 10 yrs: 35-60%
Histologic grade and size matters a lot. Frozen little value in determining margins
Difference in recurrence rates between laparoscopic ventral hernia repairs (LVHR) and open ventral hernia repair?
There is no difference according to 4 meta-analysis
Difference in complication rate between open hasson vs varess needle?
No difference
Can you still place a synthetic mesh after inadvertant enterotomy? What about enterocutaneius fistula?
You can actually.
Not in enterocutaneius fistula
What’s the difference in infection rate in laparoscopic vs. open ventral hernia repair?
Lap repair actually has lower infection rate
but the recurrence rate is the same. go figure
For GB cancer after CCY
[T/F] staging laparoscopy is recommended before laparotomy for a potentially curative resection
Lymphadenectomy should include nodes where?
What’s the deal with interaortocaval nodes?
Resection of common bile duct is recommended if cancer is found where?
True. Laparoscopy is recommended.
Nodes should include: portahepatis, gastrohepatic ligament, retrodiodenal
Interaortocaval nodes -> metastatic if positive. Unresectable.
If cancer is found at the cystic duct margin
What are the mortality rates for child A vs B vs C
A: 10%
B: 30%
C: 80%
Who should get liver cancer screening?
Modality of choice?
What to do when you find a lesion based on size?
Hep c with compensated cirrhosis.
Hep b even without evidence of cirrhosis
Ultrasound
<1 cm: repeat US ~4mo. To see if it’s growing
>1 cm: 4-phase dynamic CT
Cirrhotic with HCC, tumor rupture.
Does rupture worsen long term survival?
How is the survival of transarterial embolization vs urgent resection?
[T/F] Once tumor ruptures, it is not amenable to curative resection
Apparently it doesn’t worse. Long term survival
TAE has lower mortality than urgent resection
Can still do curative rxn
What’s the lifetime risk of developing an umbilical hernia for cirrhotic patients who have ascites?
40% because of increased intra-abdominal pressure
3 most important factors for GIST prognosis
1) size >5 cm
2) >5 mitoses per 50 high power field
3) location outside the stomach
Hemorrhoid complication. “Mucosal eversion” what procedure causes this?
Whitehead hemorrhoidectomy
Circumferential excisional hemorrhoidectomy.
Mucosal eversion is where the rectal/anal mucosa is hanging out outside at the skin
Anal canal squamous cell cancer. When can you just cut it out and not do nigro protocol?
<1cm T1 lesion not involving the sphincters. Still do radiation
You’re in a case for an appy. Appendix is 2cm dilated, no inflammation. Swollen, well circumscribed tip that contains a focal lesion. Do you do an appy or r hemi?
Appy. Most of the time low grade mucinous neoplasm. If invasive adeno then go back and do right hemi
If >2cm or involves the base, do a right hemi right away
For PD catheters, what is the most common reason for conversion to HD?
Infection. Mechanical failure is the second most common cause
[T/F] laparoscopic PD catheters have lower exit site infection rate compared to open
What about removal rate?
False. Lap has lower catheter removal rate but infection rate is the same
For PD catheters, what can reduce the incidence of catheter mechanical dysfunction?
Rectus sheath tunneling
Quality indicator for colonoscopy:
- withdrawal time
- adenoma detection rate of at least
- incidence of perforation less than
- incidence of polypectomy bleeding less than
- rate of cecal intubation and photo documentation at least
- withdrawal time 6min
- adenoma detection rate of at least 25% (Thisrateisdefinedas thepercentageof patients age 50 and older undergoing screeningcolonoscopy, who have one or more precancerous polypsdetected) so if you scope 4 ppl you should be finding adenomas in one of the four
- incidence of perforation less than 1 in 1000
- incidence of polypectomy bleeding less than 1%
- rate of cecal intubation and photo documentation at least 90%
During your operation for a carcinoid you do a liver lesion biopsy and the pt becomes hypotensive, unresponsive to pressors. What do you do next?
Give high dose octreotide. Serotonin, histamine, bradykinin can be vasoactive
What is the expected length of survival for stage IV colon cancer with peritoneal carcinomatosis? What is it with chemo/Hipec?
6 mo. Without therapy
22 months with chemo
Paeudomyxoma peritoneii
Most common overall symptom
Second most common symptom in men vs women
MC overall: increasing abdominal girth
Second MC in men: inguinal hernia
Second MC in women: pelvic mass
What is the randomized controlled trial data on lap vs. open splenectomy?
How about case series data?
There is no randomized controlled trial data for lap vs open splenectomy
Almost all case series argue that lap spleen is better
Pt in your office with ITP. what things indicate treating with steroids vs observing?
Any pt with plt <20,000
Or, plt <30,000 with active sports or dangerous lifestyle
Or if bleeding then treat with steroids
If platelet >= 30,000
No symptoms
No active lifestyle can watch
When is splenectomy indicated for ITP?
Should you give platelets pre-op?
If platelets <30,000 after 3 months of maximal therapy
Yes, give platelets pre-op to raise count at least >50,000
What is Hill esophagogastropexy? When and how do you do it?
When someone who has had a gastric wedge and doesn’t have enough stomach to wrap around, you do this
Take the lesser curvature and plicate it around the right side of the esophagus and the median arcuate ligament
You have to do intraopetative manometry
What to do for duodenal polyps <1cm vs >1cm?
<1cm: endoscopic polypectomy
>1cm: transduodenal polypectomy or segmental resection
Truelearn says < 2cm: endoscopic
> 2cm: transduodenal polypectomy
Three types of vagotomy
For each, cuts which nerve? Effect on pylorus/drainage procedure?
Truncal: main trunks of the vagus nerve. Denervates pylorus. Needs drainage procedure
Selective: anterior and posterior latarjet nerves. Denervates pylorus. Needs drainage procedure
Highly-selective: nerve fibers innervating parietal cells. No need for drainage
For peds umbilical hernia defect greater than what cm needs mesh?
3cm
Most common location of small bowel adenoma?
Duodenum
Risk of malignancy in small bowel villous adenoma?
Up to 40%
Risk of fetal loss for perforated and non perforated appendicitis in pregnancy?
Non perforated? ~5%
Perforated? 25%
For esophageal cancer, what is the most accurate imaging tool for locoregional lymph node involvement?
PET scan (68% accuracy)
Endoscopic ultrasound (66%). It’s more SENSITIVE
Most common cause of lower gi bleed in pts under 65 vs over 65?
Under 65: diverticulosis
Over 65: angiodysplasia
How many nodes does esophageal cancer need?
Colorectal?
Stomach?
15
12
16
1, 2, 3 most common locations for accessory spleen
#1: hilum #2: tail of the pancreas #3: greater omentum
Effect of pneumoperitoneum to end tidal CO2?
Increases end tidal CO2
If varess needle is in the correct place, what should the pressure and flow be?
P <8mm
Flow 1L/min
How can pneumoperitoneum cause bradycardia?
Stretching the peritoneum too quickly can cause vagal mediated bradycardia
Gallstone ileus. Proximal enterotomy, milk the stone from distal? Or distal enterotomy, milk the stone from proximal?
Proximal enterotomy. Milk from distal to proximal
Gastric band problem. gives you an xr. Horizontal vs vertical band. Diagnosis and treatment?
Horizontal band: slipped band
Vertical band: erosion. Needs OR
Esophageal spasm after gastric band. What’s the problem?
Band too tight. Not slipped or erosion