Odds and Ends Flashcards
Approximately ___% of patients with upper GI hemorrhage have continued or rebleeding episodes. The mortality has remained the same over the past 20 years.
20%
LMW heparin is (more/less) effective than fractionated heparin in the prevention of DVT in high-risk individuals.
more
Why might an elevated INR in the posttraumatic setting not really have a protective effect for patients in terms of thromboembolism development?
It might just indicate coagulopathy induced by massive injury
Compare neuroblastoma vs Wilms tumor with regards to:
neuroblastoma: look sick, calcified, younger age group (<2), presurgical chemo, irregularly hyperechoic, extrarenal mass, crosses midline, elevated VMA and HMA, vascular encasement
Wilms: can look healthy, age 3-4, no calcification, marginated, evenly echogenic, intrarenal mass, does not cross midline
What are the stages of CRC and what are the treatments?
Stage 0: cancers have not grown beyond the inner lining of the colon, surgery to take out the cancer is all that is needed (polypectomy, or resection if tumor large)
Stage 1: These cancers have grown through several layers of the colon, but they have not spread outside the colon wall itself (or into the nearby lymph nodes). Partial colectomy — surgery to remove the section of colon that has cancer and nearby lymph nodes is tx
Stage 2: cancers have grown through the wall of the colon and may extend into nearby tissue. They have not yet spread to the lymph nodes; surgery with or without neoadjuvant chemotx (5-FU and leucovorin)
Stage 3: n this stage, the cancer has spread to nearby lymph nodes, but it has not yet spread to other parts of the body. Surgery (partial colectomy) followed by adjuvant chemo is the standard treatment for this stage. Either the FOLFOX (5-FU, leucovorin, and oxaliplatin) or CapeOx (capecitabine and oxaliplatin) regimens are used most often. Possible radiation therapy
STage 4: The cancer has spread from the colon to distant organs and tissues. Chemo is typically given as well, before and/or after surgery. In some cases, hepatic artery infusion may be used if the cancer has spread to the liver.; palliative surgery
What imaging is used to document acute osteomyelitis?
Radionuclide
Risk-benefit analysis has demonstrated that surgery benefits ouweigh the risks when colectomy is performed after what number bout of diverticulitis?
fourth bout
Squamous cell carcinoma of the esophagus is highly sensitive to
radiation therapy
When is primary esophageal repair in esophageal perforation?
If the perf is less than 24 hours in duration
If the patient is in good physiologic condition, surgical repair is used regardless of duration of perf
Though biliary colic is most commonly produced by the mechanical obstruction of gallbladder drainage by a gallstone, in a small subset of patients, it can be unrelated to gallstones. This condition is called:
bilary dyskinesia (gallbaldder ejection fraction
Gallbladder dysfunction in patients with biliary dyskinesia can be visualized with
a HIDA scan following CCK administration
Hyperparathyroidism is associated with which electrolyte abnormalities?
high calcium/calcinuria, low serum phosphate, high serum chloride, low serum bicarb
(PTH decreases bicarb reabsorption, chloride compensates)
OPSS is more liekly to occur in (children/adults) and in patients who had splenectomies for (trauma/primary hematological disorders).
Children; primary hematological disorders
Which patient group with ITP responds the best to splenectomy?
Those who responded to corticosteroid therapy
What is the most common liver mass?
hemangioma
Which measurement of depth is better at staging melanoma: breslow or clark?
Breslow
For a melanoma wiht depth between 2 and 4 mm, what are adequate margins?
2-3 cm
What is the only way to diagnose biliary atresia?
Operative exploration and intraoperative cholangiogram. However, it is not uncommon for patients with biliary hypoplasia (Alagille syndrome, which may include bile duct paucity or absence) to have no excretion of tracer into the duodenum on HIDA scan
What is Alagille syndrome?
bile duct paucity or absence; AD inheritance. Other signs of Alagille syndrome include congenital heart problems (ToF), an unusual butterfly shape of one or more of the bones of the spinal column that can be seen in an x-ray, certain eye defects, and narrowed pulmonary arteries that can contribute to increased pressure on the right heart valves.
In patients with biliary kinesia after 120 days, ___________ is rarely indicated.
Kasai portoeneterostomy (transplant instead)
A ductogram showing a well-filled duct except for a solitary lobulated filling defect is more consistent with _________
intraductal papilloma
What are type 5 gastric ulcers?
associated with chronic NSAID or aspirin use (can occur throughout the stomach)
T/F: The presence of ascites is a contraindication to Whipple surgery.
True. Ascites likely indicates poor hepatic reserve or disseminated cancer.
70% of pancreatic cancers are located where in the pancreas?
the head of the pancreas
The normal small bowel length is approximately 300-500 cm.
An individual with 90-180cm (1/3 normal intestinal length) may develop __________.
Individuals with less than 60 cm may require:
90-180: transient diarrhea and malabsoprtion
What are the most common causes of short bowel syndrome?
Crohn disease and mesenteric infarction in adults
NEC and midgut volvulus in infants
The acute phase of short bowel syndrome (up to months) rquires TPN. Early adaptation phase (up to 1 year postop) focuses on what?
Late adaptation (>1 year) focuses on surgical management, including bowel-lengthening procedures and potentially small bowel transplantation.
Early adaptation (months to 1 year post op) = enteral support inc as tolerated, glutamine supplementation, octreotide for control of GI losses, trophic growth factors if avaliable
What is the management of early small bowel obstruction (within 30 days) following abdominal surgery?
usually caused by early adhesions or persistent inflammation; frequently resolves with NG decompression and supportive care
Although both androgen insensitvity and XY gonadal dysgenesis have a propensity to become malignant, __________ has the greater risk.
gonadal dysgenesis
A supraclavicular node indicating metastasis in both intraabdominal or testicular cancer is called
Virchnow node (drainage along thoracic duct; usually on LEFT side – 9/10 times)
Why are 3 mL of crystalloids infused for every 1 mL of blood lost?
Because only 1/3 of isotonic crystalloid remains in the intravascular space, even at equilibrium
Which periampullary tumor is most common?
pancreatic adenocarcinoma
Why might pleural effusion be a contraindication to operative treatment?
If it has malignant cells in it, it indicates the tumor has extended into the pleural space
Name a contraindicaiton for a renal transplant:
urinary obstruction (will likely damage the transplanted kidney) HIV is no longer an absolute contraindication, provided patient is receiving HAART and has CD4>200
The finding of a nontender mass after a fall should indicate a core biopsy because…
a NONTENDER mass is inconsistent with soft tissue injury
Soft tissue sarcoma commonly metastasizes where?
lungs
GiSTS larger than 3cm in diameter should be treated with what adjuvant therapy?
imatinib
T/F: Following loss of hte short bowel, the colon can absorb short-chain fatty acids.
True! However, it combines with oxalate….predisposing to calcium oxalate stones in the kidney :(
What is the most common cause of appendicitis in children? In adults?
children: lymphoid hyperplasia
adults: fecalith
_____ poisoning can present as typhlitis (inflammation of the cecum)
Lead
This type of hernia is characteristic in older ladies:
femoral hernia
While usually you want to operate within 4-6 hours in cases of SBO, in these etiologies you can “ride it out:”
Crohn’s and radiation enteritis (due to inflammation of bowel, not to vascular compromise); give steroids
How can pancreatic cancer go to Sister Mary node in the umbilicus?
Cells from pancreatic cancer may migrate along hepatoduodenal ligament (Portal vein). The umbilical vein (which is in the falciform ligament) used to drain into the left portal vein in gestation; remnants may remain so node ends up in umbilicus. Umbilical vein used to carry oxygenated blood from palcenta to fetus.
What are risk factors for gallstone formation?
female, fat, forty, OCP use, rapid weight loss ( during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly), terminal ileal disease, cirrhosis (insufficient levels of bile reach the gallbladder), hemolytic disease
A cholangiocarcinoma present more as a (stricture/mass) on cholangiogram
stricture
What is the portal triad?
hepatic duct, hepatic portal vein, hepatic artery
Does portal hypertension result from increased flow or increased resistance to flow?
Both! Cirrhosis/architectural changes/stellate cell contractions increase resistance to flow; leading to production of vasodilators
What is the difference between Child Pugh score and MELD?
child pugh: encephalopathy, ascites, PT, bilirubin, albumin
MELD: INR, bilirubin, creatinine
Treatment of hepatic encephalopathy?
Neomycin or rifampin: both decrease ammonia production by bacteria
Lactulose: draws the ammonia products in and diarrhea out
SBP is defined as paracentesis of abdomen showing ___ PMN/mm3
> 250 PMN/mm3
T/F: In patients with hypersplenism 2/2 cirrhosis, a splenectomy can be beneficial.
FALSE. We don’t do anything about this hypersplenism
Risk factors for hepatic adenoma:
OCP, anabolic steroids, glycogen storage disease
What lesion is seen characteristically as a “central scar” on CT with central fibrosis?
FNH
What imaging can help distinguish hepatic adenoma from FNH?
Nuclear technetium scan.
While adenoma wont take up the tracer because it doesn’t have Kupffer cells (macrophages of liver) to take it up, FNH will
What serum marker is elevated in 50-80% of HCC?
AFP
Cholangiocarcinoma is associated with elevation in what serum marker?
CA19-9
Also elevated in gallbladder adenocarcinoma and pancreatic adenocarcinoma
What is the Casoni skin test?
A hypersensitivity test used to detect fluid from hydatid cysts (secondary to Echinococcus)
A main cyst visualized in the liver with several daughter cysts should make you think of:
hydatid cysts (echinococcus; treat with -azoles)
