LOOKED UP REVIEWS Flashcards
algorithm for gastrinoma workup: initial, labs values, imaging
initial:
fasting serum gastrin level 72 hours off PPIs
(not definitive diagnosis)
Baseline gastrin level nondiagnostic
All patient’s require secretary stimulation test to confirm:
Most widely used level 200
Recent recommendations 110-120
Imaging:
Somatostatin scintigraphy greater sensitivity than all conventional studies combined
EUS high-sensitivity for detection of pancreatic gastrinoma
Not good for duodenal gastrinoma (even intraop)
If cannot find gastrinoma:
Hepatic vein sampling with calcium stimulation
arcuate line of the abdomen, other names, relationships to rectus, internal oblique, transversus, external landmarks, epigastric vessels,
also called linea semicircularis or Douglas’ line
Horizontal lower limit of the posterior (lateral) layer of the rectus sheath
(Above you have two layers of fascia to close)
1/3 of the distance from the umbilicus to the pubic crest
where the inferior epigastric vessels perforate the rectus abdominis.
Inferior to the arcuate line, the internal oblique and transversus abdominis aponeuroses merge and pass superficial (i.e. anteriorly) to the rectus muscle.
The linea semilunaris
a curved tendinous line placed one on either side of the rectus abdominis boarding the lateral edges of the rectus muscle
Acinic cell carcinoma of the parotid treatment
malignant
“En bloc surgical resection”-does not include facial nerve if no invasion
superficial parotidectomy with radiation and mass confined to superficial parotid
total parotidectomy deep lobe involved
radiation used when: unclear margin- partial parotidectomy to spare facial nerve High-grade Neural invasion Invasion of surrounding structures Metastatic
small bowel lymphoma most common type and site
Most common non-Hodgkin’s:
diffuse
B cell
MALT lymphoma
most common site of non-Hodgkin’s:
Ileum-large immune component
in children younger than 10 years, lympomas are the most common intestinal neoplasm
most common GI site of lymphoma
stomach
Second most-small bowel
risk factors for small bowel lymphoma
celiac - Non-Hodgkin’s T-cell lymphoma
HIV-aggressive B-cell lymphoma
H. pylori-MALT
diagnosis small bowel lymphoma
CT scan
Tissue biopsy
treatment small bowel lymphoma, early stage, symptomatic, cell type tx is
local early stage:
surgical resection all gross disease prevents perforation/obstruction (Cam)
in the absence of symptoms:
may respond to chemotherapy without the need for surgery (Sab)!
B cell lymphomas:
more chemosensitive have high remission rates with or without surgery.
T cell lymphomas:
traditionally more resistant to therapy and will progress to symptoms of obstruction or perforation if not resected.
resection is indicated:
at any onset of symptoms regardless of type
because progression to life-threatening hemorrhage or perforation with worse prognosis
Advanced disseminated:
Surgery only for tissue biopsy and possibly pale eating complications
Chemotherapy-test for diffuse large cell
Anaplastic resistant to chemotherapy and
most common site of GIST tumor in small bowel
duodenum (2nd portion) to- this is from H. pylori risk factor in stomach/duodenum
careful, lymphomas most common ileum
diagnosis gist tumor and small bowel
NO biopsy
CT scan abdomen pelvis
Smooth well-circumscribed exophytic growth
Large tumor-central necrosis/hemorrhage
Treatment of GIST tumor small bowel
localized disease:
complete gross resection With intact capsule
en bloc resection of involved organs
Involved periampullary tumors:
May require Whipple
NO lymphadenectomy -
metatarsal metastasis to liver
marginal resectable tumors:
Neoadjuvant Imatinib
adjuvant for:
incomplete resection
Recurrent disease
Metastatic disease
von Willebrand disease mechanism
deficient von Willebrand factor
Cannot link platelets on collagen on endothelium
treatment of von Willebrand’s 1, 2, 3
II: Low circulating level DDAVP Conjugated estrogens von Willebrand factor Cryoprecipitate
II:
Qualitative - may not work to give DDAVP because of defective present von Willebrand factor
von Willebrand factor
Cryoprecipitate
III: Complete absence of production Associated with low factor a level severe bleeding - like hemophilia A. DDAVP will not work
unresectable pancreatic cancer
Vascular- circumferential encasement or invasion or inclusion of: Portal vein Superior mesenteric vein Superior mesenteric artery
exception may be made for venous structure- SMV, portal vein
advanced disease: Extension beyond pancreas capsule and the retroperitoneum Neural Nodes outside direct field of resection: Pubic access Superior mesenteric artery Hepatoduodenal ligament frank metastases: Liver Peritoneal
careful, pancreatic metastases to not undergo meniscectomy peek and shreek
blood products associated with TRALI and mechanism
RBC
Platelet
Plasma!
the DONOR antibodies of attach host leukocyte
Workup of a patient with suspected Cushing’s syndrome includes
24-hour urine cortisol, late evening salivary cortisol, ACTH level, high dose dexamethasone suppression test, MRI head, CT chest/abdomen/pelvis, inferior petrosal sinus sampling.
treatment of melanoma
in situ:
0.5-1 cm excision
less than 1 mm:
1 cm excision
1 and greater mm:
2 cm excision!
1-2 mm - 1 cm margin maybe acceptable if greater excision would cause significant morbidity
sentinel node: 1 millimeter or greater ulceration Regression Absence of clinical note
basal cell carcinoma margin
low risk: 4-5 mm less than 2 cm trunk/extremities Head and neck less than 1 cm Less than 6 mm- face, feet, hands
High-risk: 1 cm size greater than 6 mm Recurrent Immunocompromised Radiation field Sclerosing Micronodular Perineural invasion
squamous cell carcinoma skin margin
same his basal
low risk: 4-5 mm less than 2 cm trunk/extremities Head and neck less than 1 cm Less than 6 mm- face, feet, hands
High-risk: 1 cm Recurrent Immunocompromised Radiation field Sclerosing Micronodular Perineural invasion
also: Poorly differentiated Adenoid Adenosquamous Desmoplastic
most common skin cancer and
Basal cell
second most common skin cancer
squamous cell
Merkel cell carcinoma skin, risk factors, Workup, treatment
immunocompromise
polyomavirus
CT scan
Excision down to fascia or pericranium:
1.5-2 cm margin
sentinel node or no dissection
adjuvant radiation
chemotherapy for regional or distant metastases
