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GI2 > How'll App > Flashcards

How'll App Flashcards

1
Q

fluid maintenance rate of elderly

why?

A

25 mL/Kg

older pts are unlikely to tolerate the robust fluid

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2
Q

fluid maintenance regimen for young?

A

4 ml/kg for the first 10 kg

2 ml/kg for the second 10kg

1 ml/kg for every kg remaining

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3
Q

blood sugar goal for surgical patients

why?

A

180-200 mg/dL

can’t risk hypoglycemia- when body is stressed it has slight elevations of glucose that will normalize shortly after surgery

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4
Q

why would you think of an obstruction in a surgical patient

A

starts to complain of n/v, obstipation and constipation, distention

large surgical history (suggestive of adhesions)

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5
Q

test to determine if pt has obstruction?

A

CT of abdomen

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6
Q

how do you treat obstruction (N/V)

A

NG tube

esp Salem Slump

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7
Q

Abdominal pain and urgency to void, but with challenges in initiating and completing micturation

A

DISTENDED BLADDER

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8
Q

tx of distended bladder

A

foley Cath

urology consult

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9
Q

low urine output but normal bladder scan

A

pre-renal (hypovolemia)

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10
Q

5 W of post op fever

A 
Wind (atelectasis, PNA) 
Water (UTI, iV line) 
Wound (infxn, abscess)
Walking (DVT, PE)
Wonder drug (B-lactam abx)
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11
Q

Signs of likely infection: (6)

A

Fever occurring > 48hrs post-op

Pre-operative trauma

An initial temperature elevation above: 38.6°C (>101.5°F)

Leukocytosis greater than 10,000/L

Post-op BUN of 15 mg/dL+

Poor protoplasm

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12
Q

PE of post op fever

A

1 check the wound/surgical site

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13
Q

the MC pancreatic carcinoma?

A

Adenocarcinoma

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14
Q

Where is the MC location of pancreatic carcinoma?

A

Head of the pancreas, followed by body and then the tail.

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15
Q

What are some genetic variants/risks associated with pancreatic carcinoma?

A

First degree relative,

BRCA gene, HNP-CC, FAP

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16
Q

social hx risk factors of pancreatic CA

A

Smoking, Drinking and DM

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17
Q

What is the palpable mass of the RUQ called?

A

Courvoisier Sign

palpable gall bladder

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18
Q

pancreatitis and jauncie

A

painless obstructive jaundice due to mass in head of pancreas causing biliary obstruction

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19
Q

pruritus and pancreatic CA

A

common in pts due to biliary obstruction

Benadryl will not help (not histamine issue)

ERCP stent placement to expand duct

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20
Q

virchow’s node

A

Palpable cervical node,

most prominently in the medial end of the supraclavicular aspect

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21
Q

blumer’s shelf

A

presence of metastatic mass in the rectal pouch

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22
Q

sr. Mary joseph’s nodule

A

Periumbilical subcutaneous nodule

highly suggestive of metastatic disease

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23
Q

what study should be done to evaluate a pancreatic mass?

A

Abdominal CT with contrast

MRCP would also work

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24
Q

lab marker for pancreatic CA

A

CA 19-9

> 100 highly specific for malignancy

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25
Q

surgical procedure done to manage pancreatic CA?

What stage is most appropriate?

A

Whipple

stage 1-2

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26
Q

post - op MI work up

A

CXR
Cardiac Enzymes

also if symptoms are GI related then CT abdomen and Pelvis w/contrast to ensure it is ok

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27
Q

wound vac

A

pulls fluid from the wound to reduce swelling and help clean wound to remove bacteria

**promotes granulation tissue development ***

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28
Q

how many days before you can take out a suture:

on head

A

4-5 days

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29
Q

how many days before you can take out a suture:

UE/LE

A

5-7 days

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30
Q

how many days before you can take out a suture:

Torso

A

7-10 days

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31
Q

keloid

A

3-12 months after injury and extend beyond

tx with kenalog (surgical correction

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32
Q

where is MC spot for keloid

A

earlobe, deltoid, presternal and upper back lesions

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33
Q

kenalog

A

tx of choice fir keloid

steroid reaction causing skin atrophy

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34
Q

hematoma effect on wound

A

distort wound edges and impinge on vital structures

blood will leak thru suture

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35
Q

seroma

A

Fluid, other than pus or blood, which collects at the operative site, delaying healing and increasing the risk of infection.

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36
Q

issue with seroma of groin?

A

left to resolve on own w/surveillance bc increased risk of infection with aspiration

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37
Q

three phases of wound healing

A

inflammatory
proliferative
maturation

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38
Q

first cell to enter a wound?

A

platelet

contact with damaged collagen causes degranulation and release of growth factors to attract cells to wound

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39
Q

What cell predominates in the inflammatory phase?

A

neutrophils

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40
Q

what effect do PMNs have on wound healing and recovery

A

PMN’s do not heal the wound and persist presence will delay wound healing

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41
Q

Oxygen free radicals are produced by

A

macrophages

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42
Q

If the wound is deprived of the following blood cell, delayed wound healing and poor tissue strength should be effected?

A. Platelets
B. Macrophages
C. Neutrophils
D. Lymphocytes

A

Macrophages

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43
Q

This cell predominates in the proliferative phase of wound healing, and what is it’s role?

A

Fibroblast: synthesizes and secretes collagen, for wound deposition

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44
Q

GI is a challenge in wound healing why?

A

heavy bacterial burden

inability to provide adequate “rest” of the system

pH changes in HI

early and marked lysis of collagen

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45
Q

GI healing complication when NOT enough healing occurs

A

dehiscence, leaks, fistulas

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46
Q

GI healing complication when TOO MUCH healing occurs

A

strictures/stenosis of lumen (adhesions)

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47
Q

Why does cartilage suffer so greatly following wounding?

A

It is avascular, must depend on diffusion for adequate nutrient and oxygen supply;

no inflammatory response.

48
Q

contaminated wound

A

15% infx rate,

spillage from the GI, GU, and pulm system. + trumatic wounds w/soil

49
Q

clean contaminated

A

8% infx rate, including Gi, GU or Pulm system w/o spillage of contents

50
Q

dirty

A

35% infx rate, at side of existing abscess and infx

51
Q

clean wound

A

3% infx rate, no break in sterile field

52
Q

abrasion

A

superficial epithelial loss

no closure just cleaning, tx with petroleum gauze

53
Q

puncture wound tx

A

deep tissue injury assessment, valuation for foreign bodies and ongoing infection

tetanus management

54
Q

avulsion

A

shearing force and part of wound doesn’t have underlying fat and muscle

closure by anchoring to underlying tissue and finding edges

55
Q

vermillion border

A

line up sutures here

found across hair or eyebrow

better cosmetic results

56
Q

Primary Wound Closure

A

approximating the epithelial wound edges with suture, staples or adhesive immediately after cleaning and debridement.

done right away

57
Q

Secondary Wound Closure

A

The wound is allowed to close by granulation tissue proliferation followed by contraction and epithelialization from the edge of the wound

58
Q

Tertiary Wound Closure

A

after a delay of days to a week, the edges of the wound are debrided and closed like a primary closure.

59
Q

neuroendocrine pancreatic CA

A

arises out of endocrine tissue of pancreas

typically benign but CAN be malignant

secrete peptides (insulin, glucagon, gastrin, VIP)

60
Q

Insulinoma + tx

A

pt presents with recurrent hypoglycemia (insulin) or hyperglycemia (glucagon)

tx with surgical resection

61
Q

Gastrinoma

A

large amounts of gastrin produced, increased gastric acid production = refractory PUD

gastrin > 150

62
Q

ZES tumor found where?

A

pancreas or duodenum

63
Q

how do you confirmZES

A

fasting secretin test

gastrin levels increased .200

64
Q

VIPoma syndrome

A

WDHA

Watery Diarrhea
Hypokalemia
Achlorhydria

65
Q

TXA

A

interferes with hyperfibrinolysis (excessive clot formation in truama)

CRASH -2 = ok to give if <3 hrs post injury

66
Q

necrotizing fasciitis

A

ecchymosis, hemorrhagic bullae, cellulitis, crepitation

pain out of proportion to exam

67
Q

necrotizing fasciitis tx

A

aggressive surgical debridement

broad spectrum abx

hyperbaric O2

68
Q

lab assessment of hyponatremia + tx

A

FeNa

correction slowly (< 10 mEq/L in 24hrs)

69
Q

hyperkalemia EKG

A

Peaked T, flat P, shortened QT,

muscle weakness, respiratory paralysis

70
Q

hyperkalemia tx

A

Medications: - Calcium, D50, Insulin-

Loop Diuretric, Albuterol, and Dialysis

71
Q

hypokalemia s/s

A

Flat T’s, depressed ST, prolonged PR interval and widened QRS.

fatigue, weakness, paresthesias and an Ileus

72
Q

tx of hypokalemia

A

K supplementation

IV or PO (both have bad side effects)

73
Q

isotonic fluid order that can reduce these electrolyte derangements in the immediate post-operative period?

A

D5W 1/2 NS + 20mEq KCL @ 75cc/hr

74
Q

wound dehiscence

A

rupture of total or partial layers of surgical wound

75
Q

systemic factors causing dehiscence

A

DM, renal failure, obesity,

immunosuppression, low albumin, CA, sepsis

76
Q

when does dehiscence MC occur?

A

5-8 days post op

77
Q

how is dehiscence described?

A

sudden ripping or tearing sensation

78
Q

local factors causing dehiscence

A

inadequate closure
increased intraabdominal pressure
deficient wound

79
Q

how is hepatic CA diagnosed?

A

ONLY one that doesn’t need Bx

contrast CT scanning

repeat u/s in 3 months

80
Q

risk factors for HCC

A

Hepatitis B and C,
Hemochromatosis
Cirrhosis

EtOH/Tobacco, NASH, Alpha1Antitrypsin

81
Q

factors that are considered protective against HCC?

A

statin use, white meat/fish, omega 3 fatty acid consumption

82
Q

how are high risk patients for HCC screened?

A

RUQ U/s and AFP

83
Q

what GI CA known to present with fever

A

Hepatocellular and Cholangiocarcinoma

84
Q

four neoplastic syndromes in hepatocelluar carcinoma?

A
  1. Hypoglycemia,
  2. Erythrocytosis,
  3. Hypercalcemia,
  4. Diarrhea
85
Q

the four common sites of metastatic spread in hepatocellular carcinoma?

A
  1. bone,
  2. adrenal glands,
  3. lymph nodes (intra-abdominal)
  4. lung
86
Q

Prognostic tool for hepatocellular carcinoma

A

Child-Pugh Classification

87
Q

Child-Pugh Score 7-9

A

B Moderate

88
Q

Child-Pugh Score 5-6

A

A Mild

89
Q

Child-Pugh Score 10-15

A

C Severe

90
Q

Child-Pugh Score who gets resection?

A

Child-Pugh A and B

91
Q

Child-Pugh Score who gets chemo?

A

NONE

chemo resistant

92
Q

Child-Pugh Score who gets transplant?

A

Child-Pugh c

93
Q

When the liver is found to have metastatic disease of cancer, but the liver is not believed the primary site- what two areas are believed the source?

A

Lung and Breast

94
Q

MC bacteria for PNA

A

GNR

95
Q

considering tx for post op PNA, what do you want to cover for?

A

polymicrobial infection

96
Q

how do you tx hypoxia?

A

increased FiO2

97
Q

how do you tx hypercapnia?

A

increase minute ventilation

98
Q

oliguria

A

UOP < 30 cc/hr or less than 400 mL/day

99
Q

condition marked by compression of the common hepatic duct by an impacted stone in the gallbladder neck?

A

Mirizzi Syndrome

100
Q

Gallbladder CA typically diagnosed?

A

late stage, intraoperatively

Ideal would be u/s! But unfortunately, not going to happen until late

101
Q

how do you cure gall bladder CA?

A

surgical management can be curative

BUT not often done due to late stage presentation

102
Q

What are the agents that are often used for PCA?

A

Morphine,
Dilaudid,
Fentanyl
Meperidine

103
Q

PCA last drug of choice?

A

Meperidine

avoid in elderly, renal failure, or concurrent MAO inhibitor tx

104
Q

PCA drug of choice

A

morphine

105
Q

What is one vital sign measure that is a limitation for pain management when admitted?

A

RR <12

106
Q

Dilaudid

onset of action + duration of action (IM)

A

onset: 20-30 min

lasts for 4-6 hrs

107
Q

Dilaudid

onset of action + duration of action (IV)

A

onset: 5 min
Last: 2-4 hrs

108
Q

Fentanyl

onset of action + duration of action (IM)

A

onset: 8 min
last: 1-2 hrs

109
Q

Fentanyl

onset of action + duration of action (IV)

A

onset: <1 min
lasts: 0.5-1 hr

110
Q

MOA for Narcotics?

A

Binding the receptors in the CNS, increasing pain threshold altering pain reception, inhibits ascending pain pathways

111
Q

Side effects of Narcotics?

A

Respiratory and CNS depression, as well as Constipation

112
Q

How do you want to address constipation w/outpt opioids?

A

Colace

113
Q

what must be accomplished prior to pt being discharged

A

Urinated

Get out of bed

Tolerate small amount of oral intake

114
Q

MOA + Dose

Promethazine (Phernergan)

A

H2 blocker and mesolimbic dopinergic

12.5-25 mg

115
Q

MOA + Dose

Metoclopramide (Reglan)

A

Blocks dopamine receptors and dependent serotonin receptors

10 mg

116
Q

MOA + Dose

Ondansetron (Zofran)

A

Blocks serotonin, working in vagal nerve an central chemoreceptors

4-8 mg

GI2 (6 decks)

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