GIT and Abdominal Wall Flashcards by Zoe Fernandez

Blood supply of the cervical esophagus

Inferior thyroid artery

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True or false: Physiologic gastric reflux most often occurs in the awake and upright position

True

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Most common cause of defective LES

Inadequate intraabdominal length

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Hallmark of Barretts Esophagus

Goblet cells

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The preoperative test most heavily correlated with the ability to tolerate an esophagectomy is

FEV1

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Most common site of esophageal rupture

Left, above GEJ

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Most accurate test for Zollinger-Ellison Syndrome

Secretin stimulation test

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Preoperative imaging study of choice for gastrinoma

Octreotide scan

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Standard treatment for GIST

Wedge resection

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Subtype of gastric carcinoid associated with type A chronic atrophic gastritis and is usually BENIGN

Type I

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Subtype of gastric carcinoid that is SPORADIC, not associated with hypergastrinemia, and has the worst prognosis

Type III

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Subtype of gastric carcinoid associated with MEN 1 and ZES

Type II

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“Watermelon stomach”, characterized by dilated mucosal blood vessels in the antrum that often contain thrombi, is also known as

Gastric antral vascular ectasia (GAVE)

Note: It is associated with elderly women, chronic GI loss, chronic liver disease, auto-immune connective tissue disorder

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Treatment for GAVE

antrectomy

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Treatment for dumping syndrome after failure of an anti-dumping diet

Octreotide

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Menetrier disease is associated with protein losing gastropathy and ____chlorydia

hypochlorydia

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How much fluid normally enters the small intestine daily?

8 L

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Factors that inhibit spontaneous fistula closure

“FRIENDS”

Mnemonic: FRIENDS
Foreign body
Radiation 
Infection/inflammation of fistula origin
Epithelialization of fistula tract
Neoplasm of fistula origin
Distal obstruction of the intestine
Short tract <2cm

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Most common primary small bowel malignancy

Adenocarcinoma of the duodenum

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Short bowel syndrome is defined as a small intestine length of less than _____.

200 cm

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In an emergency setting, the best place to put a colostomy is _____ (above/below) the beltline, in the rectus abdominis muscle, _______ (near/away from) the costal margin

Above the beltline
Away from the costal margin

In emergencies, a high-lying site is preferred

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First line therapy for inflammatory bowel disease in the outpatient setting

Salicylates

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Treatment for diverticulitis in an immunocompromised patient

Colectomy

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Stage III diverticulitis is associated with _______ peritonitis, while stage IV is associated with _______ peritonitis

Stage III - purulent peritonitis

Stage IV - fecal peritonitis

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Most common fistulas that develop in complicated diverticulitis

Colovesical fistulas

Gold standard for detecting liver lesions

Intraoperative ultrasound

Clinically significant portal HPN is defined as hepatic vein pressure gradient of >____ mmHg

10 mmHg

Most common solid benign mass of the liver

Hemangiomas

Most common benign hepatic lesion

Simple cyst

Milan criteria for liver transplant in HCC: One tumor less than ____ cm or Three tumors less than _____ cm No evidence of gross intravascular or extrahepatic spread

One tumor less than 5 cm | Three tumors less than 3 cm

The only FDA-approved chemotherapeutic agent for HCC

Sorafenib

Most common presentation of a biliary injury in the early post-operative period:

Elevated transaminases

Most common presenting symptom of somastatinoma

Cholelithiasis

Treatment of gastrinoma in the duodenal wall

Full thickness resection

The only therapy proven to prevent chronic pancreatitis progression

Pancreatic duct decompression

Which splenic ligament is avascular?

Gastrosplenic

Most common physical finding in hairy cell leukemia

Massive splenomegaly

Most common etiology of splenic cysts worldwide

Parasitic infection | Most commonly Echinococcal

Gold standard for management of splenic abscesses

Splenectomy

Most common indication for splenectomy

Trauma

Most common elective indication for splenectomy

ITP

Most common complication following open splenectomy

Left lower lobe atelectasis

Anterior abdominal wall above the umbilicus drains into the ______ nodes

Axillary nodes

Most umbilical hernias are present in 10% of all newborns (usually preterm infants) and spontaneously close by ____ years of age

5 years

Primary treatment for retroperitoneal fibrosis

Corticosteroids

Borders of the triangle of doom

Medial: ductus deferens Lateral: gonadal vessels Posterior: peritoneal edge

Borders of the triangle of pain

Lateral: reflected peritoneum Medial: gonadal vessels Inferolateral: iliopubic tract

Most common cause of urinary retention after hernia repair

General anesthesia

Meralgia paresthetica occurs due to damage to:

Lateral femoral cutaneous nerve

Management of an adrenal incidentaloma with no other abnormal blood chem and urinary findings

Repeat CT and chemical tests annually

Syndrome associated with persistent enlargement of an ACTH- secreting pituitary fossa rumor Symptoms: hyperpigmentation, visual field loss, headaches, extraocular muscle palsies

Nelson syndrome

Undescended testes are repaired by ____ years old

2 years old

Screening for prostate CA starts at age:

Most sensitive test for ureteral injury

Retrograde pyelogram

Most common level of cervical radiculopathy from cervical disc herniation is:

C6-C7

First line empiric treatment for spontaneous bacterial peritonitis

Cefotaxime

Portal venous pressure of >____ mmHg is needed for varices to form and bleed

12 mmHg

Most accurate method of determining portal HPN

Hepatic venography

Syndrome with massive chronic splenomegaly leading to destruction of RBCs

Banti’s syndrome

Most common symptom of hemangioma and is the usual indication for resection:

Pain

Focal nodular hyperplasia of the liver has [some/no] potential for malignancy?

No potential for malignancy

85% of variations in the hepatic pedicle are found in this circular area in the hepatocystic triangle

Moosman Area

Blood supply of bile duct (2)

Gastroduodenal artery | Right hepatic artery

Prophylactic cholecystectomy is indicated for the following:

Hemoglobinopathies Heriditary spherocytosis and thalassemia at the time of splenectomy Transplant recipients (cardiac and lung)

Sclerosing cholangitis most commonly affects which part of the duct?

Hepatic duct bifurcation

Most common type of bile duct carcinoma: (specific)

Nodular adenocarcinona

Most common initial presentation of bile duct CA:

Painless jaundice

Hepatic cells that provide the primary defense against lipopolysaccharide

Kuppfer cells

Most common congenital anomaly of the pancreas

Pancreas divisum

Best procedure for a pancreatic pseudocyst

Internal drainage (cystogastrostomy)

Most common site of perforation in the colon

Cecum

Give the lengths (in cm) of the ascending colon until the sigmoid colon

13 cm - 38 cm - 25 cm - 25-38cm

Narrowest portion of the colon; most prone to obstruction

Sigmoid colon

Standard initial therapy for acute sigmoid volvulus

Rigid proctosigmoidoscopy

Treatment of Hinchey Stage III and IV of Diverticulitis

Hartmann procedure, or diverting colostomy plus percutaneous drainage for unstable patients

Treament of Hinchey Stage II of Diverticulitis (Diverticulitis with a distant abscess)

Percutaneous drainage or resection

This cause of LGIB is due to a chronic intermittent obstruction of submucosal veins and tends to cause slow but recurrent episodes of bleeding

Angiodysplasia

RBC scintigraphy can detect bleeding rates as little as __ mL/min

0.1 mL/min

Most common hamartomatous syndrome

Juvenile polyposis syndrome

True or False: Patients with Peutz-Jeghers syndrome have an increased risk of malignant gastrointestinal neoplasms

True

Preferred initial screening tool for colorectal CA

Flexible sigmoidoscopy

Most consistent rectal valve

Middle valve (Kohlrausch valve)

Landmark used to identify location of appendix

Anterior taenia

Surgical treatment for Hirschprung’s disease:

Duhamel, Swenson, Soave

Most common symptom of anal carcinoma

Anal bleeding

Which appendiceal sign is this: migration of pain from umbilicus to right iliac region:

Kocher sign

Radioopaque fecalith in RLQ is nearly always associated with _________ appendicitis

Gangrenous

Highest rate of perforated appendicitis is among the:

Elderly

Treatment of appendiceal adenocarcinoma

Right hemicolectomy

Congenital type of SMA syndrome is called:

Wilke’s syndrome

Gold standard to differentiate partial from complete SBO

Small bowel series/enteroclysis

Worst prognosis among small bowel neoplasms

Jejunal/ileal adenocarcinomas

Most common GI mets of metastatic melanoma

Small bowel

Treatment for asymptomatic Meckel Diverticulum in children

Diverticulectomy + appendectomy

MC cause of AMI

Arterial embolus

Surgical treatment for Pyloric Stenosis

Fredet-Ramstedt pyloromyotomy

Surgical treatment for meconium ileus

Ileostomy with mucus fistula, with ileostomy takedown after 2-3 weeks

First step in management of intussusception

Air contrast enema

Anomaly most commonly associated in infants with gastroschisis:

Intestinal atresia

Most common arrhythmia during laparoscopy

Sinus bradycardia

Definition of splenomegaly and massive splenomegaly

Splenomegaly- greater than 500g or 15 cm | Massive splenomegaly - 1000g or 22 cm

Most common primary esophageal disorder

Nutcracker esophagus

Most common presenting symptom of esophageal CA

Dysphasia

Most common ulcer complication

Bleeding

First line surgical treatment for: Gastric ulcer bleed Duodenal ulcer bleed

Gastric ulcer bleed: oversew and biopsy | Duodenal ulcer bleed: oversew only

Treatment for gastric ulcer perforation (first line surgical therapy)

Biopsy and patch

First line surgical treatment for duodenal ulcer perforation

Patch

Treatment for recurrent duodenal ulcer after oversewing

Oversew, V+D

Treatment for recurrent gastric ulcer bleed after initial oversew and biopsy

Oversew, biopsy, V+D

Most common gastric ulcer type

Type I (Antral lesser curvature)

Treatment for late dumping syndrome

Alpha glucosidase inhibitors

Treatment for early dumping

Octreotide

Obstructions in efferent loop syndrome are usually due to:

Internal herniation of distal intestine behind the efferent limb

Management for GIST that is resectable

Wedge resection with negative margins (no lymphadenectomy)