Obesity, hiatal hernia, anal disorders

Question 1

what are the BMI categories

Answer 1

Question 2

what is the criteria for morbid obesity

Answer 2

Question 3

what is the diagnostic criteria for metabolic syndrome

Answer 3

At least 3 of the following…
- Central (abdominal) obesity
- Low HDL
- Hypertension
- Hyperglycemia
- Hypertriglyceridemia

Question 4

who is a surgical candidate for weight loss surgeries

Answer 4

• BMI>40
• BMI>35 with 1+ obesity related condition
• BMI>30 with metabolic syndrome or severe DM

Question 5

what is the MC bariatric surgery

Answer 5

roux n y bypass surgery

Question 6

what is the general idea of the Roux-N-Y bypass surgery

Answer 6

decreased absorption and restrictive intake space.

a small gastric pouch is anastomosed to the small bowel

Question 7

what isthe general idea of a sleeve gastrectomy

Answer 7

Removal of greater curvature of the stomach, leading to a tubular stomach

Question 8

what are three common medical diagnoses associated with developing a hiatal hernia

Answer 8

• nonerosive GERD (1/4 of patients develope HH)
• severe erosive esophagitis (3/4)
• barretts esophagus (90%)

Question 9

what is the pathophysiologic cause of hiatal hernias

Answer 9

Caused by movement of the LES above the diaphragm

Question 10

what is the difference between a sliding esophageal hernia (type 1) and a paraesophageal hernia (type 2)

Answer 10

• sliding is widening of the hiatal tunnel causing the gastric cardia to herniate or “slide” upwards
• paraesophageal is laxity of gastric ligaments that normally prevent displacement of the stomach, this allows portions to be displaced above hiatal tunnel

95% are type 1

Question 11

what are the MC risk factors for hiatal hernias

Answer 11

• being >50
• obesity

Question 12

what is the presentation of a sliding hiatal hernia

Answer 12

increased frequency and severity of GERD symptoms!

Question 13

what is the presentation of a paraesophageal hiatal hernia

Answer 13

• less GERD s/s than sliding
• epigastric pain
• postprandial fullness
• NV

Question 14

what differentiates internal vs external hemorroids

Answer 14

• internal = above dentate line
• external = below dentate line

Question 15

what are causes of hemorroids

Answer 15

increased venous pressure 2/2:
* Constipation, low fiber diet
* Straining
* Pregnancy
* Obesity

Question 16

How do you stage an internal hemorroid

Answer 16

Question 17

what is the treatment for internal hemorroids

Answer 17

• stage 1&2: proper toileting, high fiber, laxatives
• stage 3/ mild 4: rubber band ligation (can do sclerotherapy)
• Stage severe 3 or 4: hemorroidectomy

Question 18

How do you treat external hemorroids

Answer 18

• Warm Sitz baths
• Topical ointments
• Evacuation of clot

Question 18

what is an anal fissure

Answer 18

tears/ulcerations around the anus

Question 19

what is the MC area for an anal fissure

Answer 19

posterior midline

if fissures aren’t here, consider Crohn, HIV/AIDs, TB, Anal carcinoma

Question 20

what is the treatment for anal fissuresq

Answer 20

Proper toileting
Sitz Baths
Fiber
Topical anesthetics
if chronic = surgery

Question 21

what is the presentation for a perianal abscess

Answer 21

Throbbing
Continuous perianal pain
erythema/fluctuance
swelling

Question 22

what is the treatment for a perianal abscess

Answer 22

I&D
Antibiotics only to people who are septic (cipro+metro OR augmentin)

Question 22

what is the presentation of a perianal fistula

Answer 22

• purulent discharge
• pain
• itching

Question 23

what is the treatment of perianal fistula

Answer 23

• Surgical excision or incision under anesthesia
• “Fistulotomy”