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Surgery > Midpoint surgery > Flashcards

Midpoint surgery Flashcards

1
Q

clinical presentation-Crohns

A 
age
chronic worsening abdominal pain
non-bloody diarrhea
malnutrition/weight loss
barium enema findings
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2
Q

characteristics-Crohns

A

transmural inflammation
skip lesions
granulomas
distribution in GI from mouth to anus

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3
Q

radiographic features-Crohns

A

thumb printing
string sign
ulcers/fistulas/fissures

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4
Q

indications for surgery-Crohns

A 
intestinal obstruction
symptomatic fistulas or disabling perineal disease
GI perforation/abscess
intestinal hemorrhage
intestinal carcinoma
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5
Q

clinical presentation-Ulcerative Colitis

A

frequent diarrheal stools
defecation urgency
tenesmus

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6
Q

characteristics-Ulcerative colitis

A

limited distribution (colon, rectum)
superficial
no granulomas
rectal involvement 100% of the time

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7
Q

radiographic features-ulcerative colitis

A

loss of haustra
pseudopolyposis
lead pipe appearance

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8
Q

indications for surgery-ulcerative colitis

A 
toxic megacolon
intestinal obstruction
hemorrhage 
perforation
colorectal carcinomas
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9
Q

etiology-pancreatitis

A 
gallstones
ethanol
trauma
hypercalcemia
hyperlipidemia
drugs
tumor, anatomic abnormalities
infection
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10
Q

importance of ranson criteria

A

determines prognosis and severity (>3 to ICU, >7 dead)

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11
Q

at admission-Ranson

A 
age>55
WBC>16k
Glucose>200
LDH>350
SGOT>250
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12
Q

at 48 hrs

A 
Hct >10 pt decrease
BUN>5 increase
calcium <8
PO2<60
base excess>4
estimated fluid sequestration >6kmL
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13
Q

complications pancreatitis

A 
pseudocyst
pancreatic ascites
hemorrhage
necrosis/infection/abscess
respiratory failure/ARDS/MSOF
splenic vein thrombosis
GI tract obstruction
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14
Q

initial management-pancreatitis

A

IV hydration
NPO/NGT
analgesia
foley

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15
Q

physical findings bowel obstruction

A 
abdominal distention
tenderness to palpation with possible guarding 
high pitched bowel sounds
rule out hernia
empty rectal vault
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16
Q

etiologies bowel obstruction

A

adhesions from prior surgery
hernia, inguinal, abdominal wall
carcinomas
colonic volvulus

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17
Q

associated lab abnormalities bowel obstruction

A 
elevated WBC
hemoconcentraiton
hyponatremia
hypokalemia
elevated BUN, creatinine, and urine specific gravity
18
Q

radiographic studies bowel obstruction

A

flat and upright abdomen
chest x-ray
CT scan/contrast studies

19
Q

appropriate fluid for resuscitation bowel obstruction

A

normal saline

lactated ringers

20
Q

complications of bowel obstruction

A

strangulation with intestinal necrosis

perforation

21
Q

evaluation for breast cancer

A

history
mammography
FNA
open biopsy

22
Q

treatment options for breast carcinoma

A

segmental mastectomy with axillary node dissection and radiation
modified radical mastectomy
radical mastectomy
simple mastectomy

23
Q

axillary node dissection

A

precise pathological staging

24
Q

TMN staging

A

determines prognosis and need for adjunctive therapy
size of lesion
axillary lymph node status
distant mets

25
Q

physical exam findings indicating poor prognosis for breast cancer

A 
edema of skin of breast
skin ulceration
tumor fixed to chest wall 
massive axillary lymph node enlargement
supraclavicular lymph node
satellite skin nodules 
arm edema
inflammatory carcinoma
size
26
Q

DCIS

A

ductal carinoma in situ

treatment options include lumpectomy with radiation and simple mastectomy

27
Q

upper GI bleed

A

occurs from oropharynx to ligament of Treitz

28
Q

causes of uper GI bleeding

A 
gastritis
duodenal ulcers
gastric ulcers
mallory weiss
esophagitis
hemobilia
varices 
tumor
29
Q

differential diagnosis of epigastric pain

A 
peptic ulcer
GERD
gastritis
cholelithiasis
ischemic heart disease
pancreatitis
30
Q

diagnostic procedure GI bleeding

A

EGD (sensitivity, specificity, biopsy can be obtained)

contrast study

31
Q

medical therapy GI bleeding

A

PPI, H2 blockers, sucralfate, non-prescription antacids, lifestyle modifications

32
Q

complications of duodenal ulcer disease

A

bleeding
perforation
gastric outlet obstruction
intractability

33
Q

signs and symptoms of perforated peptic ulcer

A

sudden onset of severe abdominal pain
abdominal rigidity
absent bowel sounds

34
Q

diagnosis of perforated peptic ulcer

A

upright CXR/CT scan

35
Q

organ systems in preop eval

A

cardiac
pulmonary
renal

36
Q

cardiac history preop

A

past MI, age of MI, prior ACB, cardiac meds, chest pain, history of rheumatic fever, arrhythmias, CHF, murmur, and hypertension

37
Q

pulmonary history preop

A

smoking, asthma, obesity, chronic bronchitis, COPD, occupational lung disease, cough, wheeze, exertional dyspnea

38
Q

metabolic/endocrine abnormalities

A

DM, thyroid disease, liver dysfunction, adrenal insufficiency and malnutrition

39
Q

renal history preop

A

hypertension, leg edema, stones, DM

40
Q

bleeding tendency

A

anti-coagulants, aspirin, chronic alcohol use and sever malnutrition

Surgery (6 decks)

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