MISC Flashcards
Describe Bilroth anatomy
Discuss location and etiology of aberrant hepatic arterial anatomy
Replaced left hepatic artery off of the left gastric. Found under the lesser omentum.
Replaced Right hepatic artery off the SMA. Found in the lateral aspect of porta hepatis.
Thoracic outlet order
Subclavian vein > anterior scalene > subblavian artery > brachial plexus
Alpha 1
Vasoconstriction
Alpha 2
Vasoconstriction
Beta 1
Increases heart rate and contractility
Beta 2
Bronchodilation and vasodilation
Norepinephrine
Alpha 1 > alpha 2 > beta 1
Epinephrine
Low dose Beta
High dose Alpha
Dopamine
Dopamine (renal vasodilation) > Beta (HR and contractility) > alpha (vasoconstrictor)
Dobutamine
Beta 1 > Beta 2
Useful in cardiogenic shock
Phenylephrine (neosynephrine)
Alpha 1
Isoproterenol
Beta 1 and Beta 2
Insulinoma
Most common, Whipple’s triad: fasting hypoglycemia, Sx of hypoglycemia (palpitations, tachycardia, diaphoresis), and relief w/ glucose.
Dx increast in C peptide and pro-insulin.
Tx enucleate (<2cm), formal resection (>2cm)
Gastrinoma
Most common w/ MEN1. Found in gastrinoma triangle: CBD, neck of pancreas and third portion of duodenum.
Sx: refractory or complicated peptic ulcer disease
Dx; secretin stimualtion test gastrin will increase. Octreotide scan to localize
Tx: <2cm enucleation, >2cm formal resection
Glucagonoma
Most are malignant. Distal pancreas
Sx: diabetes, stomatitis, dermatitis (rash-necrolytic migratory erythema)
Dx: fasting glucagon lv
VIPoma
Most are malignant. Distal pancreas.
Sx: watery diarrhea, hypokelemia (from diarrhea), and achlorhydria
Somatostatinoma
Most are malignant. Head of pancreas.
Sx: diabetes, gallstones, steatorrhea
Dx: fasting somatostatin lv
BIRADS
0: incomplete
1: negative
2: benign
3: probably benign. Short interval f/u
4: suspicious. Bx
5: highly suggestive of malignancy. Bx
6: Bx proven malignancy
Ranson criteria
GALAW & CHOBBS
Glucose, Age, LDH, AST and WBC;
Calcium, Hematocrit, Oxygen, BUN, Base, Sequestration
