Osler Flashcards

1
Q

Reasons for colectomy

A

Appendiceal cancer
Colonic carcinoid
Colonic gastrointestinal stomal tumors (GIST)
Metastatic tumor

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2
Q

RF for colon cancer

A
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)
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3
Q

Colon cancer PE findings

A

R-sided: occult blood loss, anemia
L-sided: obstruction and macrobleeding
Rectal: bleeding, obstruction, alternating diarrhea and constipation

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4
Q

Preop colon cancer eval

A

Colonoscopy
Maybe CT
CEA blood test
If rectal: adjuvant 5FU

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5
Q

Volvulus s/sx

A
Acute/chronic abd pain
Distention
Vomiting
Obstipation
Diminished appetite
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6
Q

Workup for volvulus

A

X-ray: bent inner tube sign

CT best test

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7
Q

Initial treatment of sigmoid volvulus

A

IV resuscitation by detorsion of sigmoid via rigid proctoscopy

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8
Q

Followup tx of sigmoid volvulus

A

After endoscopic detorsion, pt should undergo resection of the sigmoid colon

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9
Q

When should an elective colectomy be considered for diverticulitis?

A

After an episode of complicated diverticulitis and/or recurrent uncomplicated diverticulitis

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10
Q

Sx of diverticulitis

A
Change in BM
Anorexia
Nausea
Fever/chills
Urinary urgency
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11
Q

Labs for diverticulitis

A

Will see leukocytosis

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12
Q

Imaging for diverticulitis

A

CT scan abdomen
Barium enema
Don’t do colonoscopy while inflamed

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13
Q

What STI is a risk factor for colon cancer?

A

Anal HPV

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14
Q

Colonoscopy screening for high-risk pts

A
HNCPP
FAP
Gardners
UC and Chron's
Screen in teens
IBD: Annually after 10 yrs of dx
-Consider prophylactic colectomy for high risk pt
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15
Q

Colonoscopy screening recommendation for intermediate risk

A

Personal hx or strong family hx

Colonscopy at 40 and then q3-5 yrs

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16
Q

Colonscopy screening recommendation for mild risk

A

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

17
Q

Sx of appendicitis

A

Abdominal pain- classically begins diffusely in the umbilical region then localized to the RLQ
Anorexia
N/V following abdominal pain

18
Q

Signs of appendicitis

A

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

19
Q

Labs/rads of appendicitis

A

Leukocytosis on CBC
CT scan w/o contrast
U/S

20
Q

GI sx of hemorrhoids

A

Nausea
Vomiting
Abdominal pain
Irregular/discolored/bloody stools

21
Q

Labs for hemorrhoids

A

Hemoccult
CBC (signs of infection or anemia d/t bleeding)
Coags to check for coagulopathy

22
Q

Imaging for hemorrhoids

A

Colonscopy
Anoscopy (anal speculum- mandatory for viewing internal hemorrhoids)
Flexible sigmoidoscopy (to evaluate for proximal dz such as rectal prolapse)
Enteroscopy

23
Q

Indications for hemorrhoid surgery

A

Conservative or nonsurgical tx fails
Presence of concomitant anorectal conditions
Pt preference
Grade III or IV hemorrhoids with severe sx

24
Q

Hx of groin hernia

A

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)

25
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
26
Imaging for hernia
Ultrasound or CT may only be helpful for atypical presentations U/s for exclusion of testicular changes
27
Labs for hernia
No labs are diagnostic of hernia | Possible leukocytosis and elevated lactate with intestinal ischemmia
28
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)
29
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 ```
30
When should genetic testing for breast CA be done?
Those who have family members with breast, ovarian, tubal, or peritoneal cancer
31
PE of breast cancer
LAD Breast: lumps, tenderness, erythema, skin changes, axillary LN, nipple retraction, palpable mass MS: UE edema
32
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 ```
33
Reasons to get a hysterectomy
Complicated endometriosis Adenomyosis Endometrial carcinoma Cervical malignancies
34
When to be suspicious for endometriosis
Pelvic pain Infertility Dysmenorrhea But may be asx
35
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
36
Labs/diagnostics for reproductive CAs
Trans vaginal u/s CA-125 B-hCG
37
Lab studies related to hysterectomy
``` CBC Pap Endometrial sampling U/s Blood type and cross ```
38
Imaging related to hysterectomy
``` ECG CT MRI Cystoscopy Barium enema IVP Blood chemistry Tumor markers ```
39
Indications for cholecystectomy
``` Acute cholecystitis Biliary colic Gallbladder CA Gallstone pancreatitis Choledocholithiasis ```