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Surgery > More Holliday > Flashcards

More Holliday Flashcards

1
Q

mid epigastric pain worse with eating, steroids, NSAIDS… think…
workup…
surgery if…

A

gastric ulcer

double-contrast barium swallow
EGD shows punched-out lesion w/ red margins, get Biopsy – tells H.Pylori, Malignant, Benign

Surgery if… lesion persists after 12 wks of treatment

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2
Q

most common gastric cancer

A

adenocarcinoma

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3
Q

where is gastric cancer most common

A

Japan

adenocarcinoma

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4
Q

Gastric Cancer mets to Ovaries eponymn

A

Krukenberg

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5
Q

Gastric Cancer mets to Left Supraclavicular Fossa lympn node eponymn

A

Virchow’s node

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6
Q

what is virchow’s node

A

GI cancer met to lymph node in Left Supraclavicular fossa

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7
Q

who gets gastric lymphoma

A

HIV pts

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8
Q

gastric cancer mets felt on DRE is called…

A

Blummer’s Shelf

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9
Q

what is Blummer’s Shelf

A

gastric cancer mets felt on DRE

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10
Q

gastric cancer mets to umbilical node is called…

A

Sister Mary Joseph

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11
Q

what is Sister Mary Joseph

A

gastric cancer mets to umbilical node

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12
Q

who gets gastric MALT lymphoma

A

pts w H.Pylori

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13
Q

eponymns assoc w Gastric Cancer GC

A

Krukenberg - GC mets to ovary

Virchow’s node - GC mets to L supraclavicular node

Blummer’s Shelf - GC mets felt on DRE

Sister Mary Joseph - GC mets to umbilical node

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14
Q

treat Gastric MALT Lymphoma

A

treat associated H.Pylori

-triple therapy… ppi, clarithromycin, amoxacillin

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15
Q

what are the cliff notes on mentrier’s disease

A

protein losing gastroenteropathy
(lose protein in GI tract)
also associated with enlarged rugae

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16
Q

gastric varices most often caused by…

A

splenic vein thrombosis

eg from pancreatitis

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17
Q

Dieulafoy’s is….

A

congenital superficial gastric? esophageal? vessel can cause hematemesis…. see other online meded flashcards

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18
Q

mid epigastric pain better with eating vs worse with eating

A

better with eating - duodenal ulcer

worse with eating - gastric ulcer

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19
Q

tests for h.pylori in peptic ulcer

A

stool or breath test

best is endoscopy with biopsy and CLO test… also best because can rule out cancer this way

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20
Q

how to assess effectiveness of H.Pylori treatment

A

stool or breath test

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21
Q

what to suspect if mid epigastric pain / ulcers do not improve with triple therapy?
best test?
tx?
what else to look for?

A

Zollinger Ellison syndrome (gastrinoma)

Secretin stim test (gastrin remains inappropriately high)

surgical resection - gastrinoma usually located in pancreas

look for MEN1 panc, pituitary, parathyroid tumors

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22
Q

patient lost a lot of weight, now has bilious vomiting and post-prandial pain

suspect. ..
treat. …

A

SMA syndrome aka Nutracker syndrome
-duodenum part 3 compressed between aorta and SMA, pain after eating when duodenum demands more blood

treat with Weight Restoration… can do surgery eg. Roux-Y… think you have to mobilize duodenum to do that…. or maybe just better with food bypassing duodenum less blood demand….

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23
Q

2 most common causes of pancreatitis

A

gallstones and alcohol

drinking and McDonalds

24
Q

define pseudocyst

A

a fluid-filled cavity resembling a cyst but lacking a wall or lining.

25
Q

most common cancer of pancreas

A

Adenocarcinoma

26
Q

Pancreatic cancer (adenocarcinoma) usually asymptomatic until advanced unless maybe….

A

cancer in Head of pancreas, causing Obstructive Biliary symptoms

aka Courvoisier’s sign - large non-tender gallbladder, itching and jaundice

27
Q

Large Non-tender Gallbladder, Itching, Jaundice think…

A

Courvoisier’s sign
pancreatic cancer of head of pancreas, fortunately causing symptoms early so maybe you can get it before widely metastasized

28
Q

eponymned signs associated with pancreatic cancer

A

Courvoisier’s sign

  • Large Non-tender Gallbladder, Itching, Jaundice think
  • pancreatic cancer of head of pancreas, fortunately causing symptoms early so maybe you can get it before widely metastasized

Trousseau’s sign - migratory thrombophlebitis

29
Q

what to you call migratory thrombophlebitis in setting of pancreatic cancer

A

Trousseau’s sign

30
Q

what is Trousseau’s sign in setting of pancreatic cancer

A

migratory thrombophlebitis

31
Q

when to Whipple pancreatic cancer

A 
no mets Outside Abdomen
no extension into SMA
no extension into Portal Vein
no Liver Mets
no Peritoneal Mets

basically, if caught early, pretty local

32
Q

Whipple’s triad

labs to get?

A

hypoglycemic symptoms - such as sweating, tremors, hunger, seizures

hypoglycemia - blood glucose low v45

symptoms resolve with glucose administration

Dx is INSULINOMA

Labs Insulin (high) and C-peptide (to rule out exogenous abuse)

33
Q

Glucagonoma

sx

A

hyperglycemia
diarrhea
weight loss

characteristic rash - necrolytic migratory erythema

34
Q

Somatistatinoma
sx
benign or malignant?

A

malabsorption - steatorrhea, etc, because pancreas malfunction (somatistatin decreases like all GI secretions…)

commonly malignant

35
Q

which is commonly malignant

insulinoma, glucagonoma, somatistatinoma, VIPoma

A

somatistatinoma is commonly malignant, the worst one to have

36
Q

VIPoma
sx
looks similar to…
tx…

A

watery diarrhea, flushing
(hypokalemia and dehydration from diarrhea)

sx similar to carcinoid syndrome

treat with octreotide

37
Q

differentiate between symptomatic gallstones and cholecystitis

A

fever and WBC with cholecystitis

38
Q

when do symptomatic gallstones get percutaneous cystostomy

A

when too unstable for cholecystectomy

39
Q

charcot’s triad

vs raynaud’s pentad

A

RUQ pain, fever, jaundice
-acute cholangitis

RUQ pain, fever, jaundice, shock (hypotension, AMS (confusion)
-ascending cholangitis

40
Q

choledocal cysts
demographic
type 1
type 4

A

peds

type 1 - most benign. fusiform dilation of CBD. Excise

type 4 - most severe. cysts all the way up into intrahepatic bile ducts. liver transplant

41
Q

risk factors for primary sclerosing cholangitis

treatment

A

UC ulcerative colitis
Liver Flukes
Thorotrast exposure (radiocontrast used in 1930’s-40’s)

surgery plus/minus radiation

42
Q

AST mildly elevated 2x ALT think…

A

alcohol hepatitis

43
Q

ALT greater than AST

both highly elevated into 1000s… think…

A

viral hepatitis

44
Q

AST and ALT elevated s/p hemorrhage, surgery, or sepsis… think…

A

shock liver

liver ischemia from hypotension

45
Q

when to band or sclerotherapy esophageal varices

A

as soon as they bleed once

46
Q

treat portal htn from cirrhosis

watch out for…
how to treat that…

A

SS and VP somatostatin and vasopressin
to upstream vasoconstrict and decrease portal flow and pressure

BBs beta blockers for the same reason, drop BP decrease portal pressure

Endoscopic Sclerotherapy or Banding of esophageal varices if they bleed once

TIPS relieves portal htn but risks ENCEPHALOPATHY from ammonia accumulation because not being processsed in liver

treat encephalopathy with LACTULOSE to poop out ammonia

47
Q

risk factors for hepatocellular carcinoma

A

chronic Hep B more so than Hep C

Cirrhosis for any reason

Aflatoxin (mycotoxin that contaminates corn, soybeans, peanuts)

Carbon Tetrachloride (used to be in fire extinguishers, refrigerants, cleaning agents)

48
Q

diagnose hepatocellular carcinoma

treat

A

CT/MRI
AFP often elevated as well (70%)

  • surgically remove soiltary mass
  • radiation or cryoablation for palliation if multiple masses
49
Q

woman on OCP, palpable abdominal mass w spontaneous rupture into hemorrhagic shock…

makes you think…
dx
tx

A

hepatic adenoma

Dx US or MRI

Discontinue OCPs (grows from estrogen).
Resect if large or desire pregnancy  (again, estrogen will make grow, so resect before pregnancy)
50
Q

most common benign liver tumor

pres
dx
tx

A

hepatic adenoma

woman on OCP, palpable abdominal mass w spontaneous rupture into hemorrhagic shock…

Dx US or MRI

Discontinue OCPs (grows from estrogen).
Resect if large or desire pregnancy  (again, estrogen will make grow, so resect before pregnancy)
51
Q

2nd most common benign liver tumor

tx

A

focal nodular hyperplasia
no tx

(hepatic adenoma the most common)

52
Q

most common bugs in abdominal bacertial abscess

A

e.coli
bacteroides
enterococcus

53
Q

RUQ pain, profuse sweating and rigors, palpable enlarged liver

….think….
dx….

A

entamoeba histolytica

metronidazole

54
Q

2 abscesses surgeons DON’T drain

A

lung abscess

amoebic liver abscess

55
Q

Mexico/South America, RUQ pain, large liver cysts on US…

think...
mode of transmission
lab findings
tx
watch out for
A

Enchinococcus

hydatic cyst paracyte from dog feces

eosinophilia, +Casoni skin test

albendazole and surgery to remove ENTIRE cyst

watch out for rupture causing anaphylaxis

56
Q

what to give post-splenectomy

A

Aspirin (thrombocytosis ^1mil aka 1,000 platelet count

prophylactic Penicillin
S.pneumo H.flu N.meningitis vaccines

57
Q

1:50:59

A

1:50:59

Surgery (22 decks)

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