Osler Flashcards
Reasons for colectomy
Appendiceal cancer
Colonic carcinoid
Colonic gastrointestinal stomal tumors (GIST)
Metastatic tumor
RF for colon cancer
AA Ashkenazi Jews Obesity Physical inactivity High red meat diet Diet high in fat and low in fiber Smoking Heavy alcohol use DM Increased age Personal hx of colorectal CA or polyps IBD FHx Having an inherited syndrome Radiation therapy from other CAs FAP: mutation in APC gene HNPCC: mutation in MLH1 or MSH2 gene Peutz-Jehgers: STK11 gene (hyperpigmentation around hands and lips, hamartomas)
Colon cancer PE findings
R-sided: occult blood loss, anemia
L-sided: obstruction and macrobleeding
Rectal: bleeding, obstruction, alternating diarrhea and constipation
Preop colon cancer eval
Colonoscopy
Maybe CT
CEA blood test
If rectal: adjuvant 5FU
Volvulus s/sx
Acute/chronic abd pain Distention Vomiting Obstipation Diminished appetite
Workup for volvulus
X-ray: bent inner tube sign
CT best test
Initial treatment of sigmoid volvulus
IV resuscitation by detorsion of sigmoid via rigid proctoscopy
Followup tx of sigmoid volvulus
After endoscopic detorsion, pt should undergo resection of the sigmoid colon
When should an elective colectomy be considered for diverticulitis?
After an episode of complicated diverticulitis and/or recurrent uncomplicated diverticulitis
Sx of diverticulitis
Change in BM Anorexia Nausea Fever/chills Urinary urgency
Labs for diverticulitis
Will see leukocytosis
Imaging for diverticulitis
CT scan abdomen
Barium enema
Don’t do colonoscopy while inflamed
What STI is a risk factor for colon cancer?
Anal HPV
Colonoscopy screening for high-risk pts
HNCPP FAP Gardners UC and Chron's Screen in teens IBD: Annually after 10 yrs of dx -Consider prophylactic colectomy for high risk pt
Colonoscopy screening recommendation for intermediate risk
Personal hx or strong family hx
Colonscopy at 40 and then q3-5 yrs
Colonscopy screening recommendation for mild risk
Age, diet, physical activity, obesity, smoking, no family hx
Beginning at age 50 have colonscopy q 10 yrs, or yearly fecal occult blood test or flexible sigmoidoscopy q5 yrs
Sx of appendicitis
Abdominal pain- classically begins diffusely in the umbilical region then localized to the RLQ
Anorexia
N/V following abdominal pain
Signs of appendicitis
Maximal tenderness over McBurney point- 2/3 between umbilicus and ASIS
-Rebound tenderness, guarding, decreased bowel sounds, +/- fever
Rovsing’s sign: Deep palpation in LLQ causes rebound referred pain in RLQ
Psoas: RLQ pain which right hip is flexed
Obturator: pain in RLQ when flexed right thigh is internally rotated when pt is supine
Labs/rads of appendicitis
Leukocytosis on CBC
CT scan w/o contrast
U/S
GI sx of hemorrhoids
Nausea
Vomiting
Abdominal pain
Irregular/discolored/bloody stools
Labs for hemorrhoids
Hemoccult
CBC (signs of infection or anemia d/t bleeding)
Coags to check for coagulopathy
Imaging for hemorrhoids
Colonscopy
Anoscopy (anal speculum- mandatory for viewing internal hemorrhoids)
Flexible sigmoidoscopy (to evaluate for proximal dz such as rectal prolapse)
Enteroscopy
Indications for hemorrhoid surgery
Conservative or nonsurgical tx fails
Presence of concomitant anorectal conditions
Pt preference
Grade III or IV hemorrhoids with severe sx
Hx of groin hernia
Pt presents with pain and swelling in groin
Pain may radiate into scrotum
May be intermittent or continuous
May get worse after extended periods of standing and improve with rest
Ask for sx of bowel obstruction (n/v, abd distention, abd pain, constipation)
PE of groin hernia
Examine supine and standing and with and without Valsalva
Women should be considered for surgical exploration and repair even if PE is negative
Complete PE includes full abdominal exam
Imaging for hernia
Ultrasound or CT may only be helpful for atypical presentations
U/s for exclusion of testicular changes
Labs for hernia
No labs are diagnostic of hernia
Possible leukocytosis and elevated lactate with intestinal ischemmia
When to consider surgery for hernias
The hernia is painful and adversely affects the ADLs (Note a hernia may be painful for a few weeks after its development, but often becomes symptomless thereafter)
The hernia is large (5-10 cm)
It is a femoral hernia (all)
RFs for breast cancer
Prior radiation Birth control IUD FHx of breast CA Early menarche Late menopause Nullipara before age 30 Inactivity Overweight or obese after menopause Dense breast tissue
When should genetic testing for breast CA be done?
Those who have family members with breast, ovarian, tubal, or peritoneal cancer
PE of breast cancer
LAD
Breast: lumps, tenderness, erythema, skin changes, axillary LN, nipple retraction, palpable mass
MS: UE edema
Labs/diagnostics for breast CA
Breast u/s Diagnostic mammography Tissue bx with core needle sample, hormone receptor status Sentinel LN bx MRI breasts with IV contrast CBC CMP UA Urine pregnancy
Reasons to get a hysterectomy
Complicated endometriosis
Adenomyosis
Endometrial carcinoma
Cervical malignancies
When to be suspicious for endometriosis
Pelvic pain
Infertility
Dysmenorrhea
But may be asx
Labs/diagnostics for cervical CA
Cone bx of cervix to determine cervical involvement
PET to check for mets to lung, liver, and bone
CT to stage
CXR
Labs/diagnostics for reproductive CAs
Trans vaginal u/s
CA-125
B-hCG
Lab studies related to hysterectomy
CBC Pap Endometrial sampling U/s Blood type and cross
Imaging related to hysterectomy
ECG CT MRI Cystoscopy Barium enema IVP Blood chemistry Tumor markers
Indications for cholecystectomy
Acute cholecystitis Biliary colic Gallbladder CA Gallstone pancreatitis Choledocholithiasis
