Pestana: general surg Flashcards
diagnosing motility disorder of esophagus
- barium swallow
2. definitive: manometry
treatment for achalasia
balloon dilatation- endoscopy
achalsia has dysphagia worse for liquids or solids
liquids
achalsia on x ray
megaesophagus
diagnostic for boerhaave syndrome
contrast swallow (gastrografin first, barium if negative)
most common reason for esophageal perforation
instrumental perf
gastric adenocarcinoma presentation
elderly
anorexia, weight loss,
epigastric distress, early satiety
treatment of gastric adenocarcinoma vs gastric lymphoma
adeno: surgery
lymphoma: Chemo/RT (surgery if perf risk)
SBO presentation
colicky pain, vomiting, distension
no gas or feces
high pitched bowel sounds
treatment of SBO
NPO, NG suction, IV fluids
if doesn’t spontaneously resolve within 24 hrs (for complete) or few days (if partial)–> surgery
strangulated obstruction presentation
compromised blood supply–> fever, WBCs, peritoneal signs, sepsis
carcinoid syndrome in small intestine seen with mets to where?
liver
other symptoms of carcinoid syndrome
diarrhea, flushing, wheezing
right sided heart damage
diagnosing carcinoid syn
24 hr urinary 5-HIAA
cancer of left vs right colon presentations
right: iron def anemia
left: bloody bm’s
are polyps that are juvenille or peutz-jeghers premalignant?
no
most common antibiotic to cause c dif
cephalosporins
clinda was the first described
cause of anal fissure
tight sphincter
treatment for anal fissure
CCBs botox nitroglycerin forceful dilatation stool softeners
75% of GI bleeding comes from where
upper GI tract
red blood per rectum indicates bleeding from…
anywhere in the GI tract!
diagnostic steps when patient is actively bleeding from rectum
pass NG tube and aspirate gastric contents
if bleeding–> upper GI bleed
if white–> do endoscopy to see if duodenum is a source
if green–>lower GI
lower GI bleeding workup
- anoscopy: r/o hemorrhoids
- if bleeding rate:
> 2 ml/min: angiogram
<0.5 mL/min: wait and do c-scope
0.5
massive upper GI bleed in the stressed, multiple trauma, or complicated post-op patent is probably from…
stress ulcers
stress ulcers diagnosis confirmation and therapy
diagnostic: endoscopy
treatment: angiographic embolization
diagnosis to confirm acute abdominal pain by perf
x ray: free air under diaphragm
most common example of perforation to cause abdominal pain
peptic ulcer
what is this: x-ray of air fluid levels in small bowel, disteneded colon, huge air-filled loop in RUQ rhat tapers down toward LLQ with shape of “parrot’s beak”
volvolus of sigmoid
volvolus of sigmoid occurs in which population
elderly
treating volvolus of sigmoid
proctosigmoidoscopic
rectal tuble left in
recurrent–> sigmoidectomy
presentatiion of mesenteric ischemia
elderly
acute abdomen + afib/recent MI (clot breaks off into superior mesenteric artery)
specific blood marker for primary hepatoma
alpha fetoprotein
whats more common: mets to liver or primary liver cancer?
mets to liver (20:1)
pyogenic liver abscess seen as complication of
biliary dz- acute asc. cholangitis
amebic abscess of liver affects which population
mexican men
diagnosis and treatmnet of pyogenic liver abscess vs. amebic abscess
pyogenic:
Diagnose: US
Treat: percutaneous drainage
amobeic:
diagnose: serology
treat: metronidazole
hemolytic jaundice is unconjugated or conjugated bilirubin?
unconjugated
labs of hepatocellular jaundice
very high AST/ALT
modest high Alk phosph
high unconjugated and conjugated bili
courvoiser-terrier sign
seen in malignant obstructive jaundice
thin-walled distended gallbladder seen
ERCP
invasive, need anesthesia
visualizes biliary and pancreatic ducts
also therapeutic: can do sphincterotomies, retrieve stones, drain pus, make stents, biopsy tumors, etc.
MRCP
non-invasive, patient awake
only diagnostic of biliary and pancreatic
which cancer: obstructive jaundice with anemia and positive blood in stools?
ampullary cancer
presentation of biliary colic vs cholecystitis
colic: temporary (10-30 minutes), no periotoneal signs
cholecystitis: constant; fever, WBCs, peritoneal signs
acute ascending cholangitis presentation
deadly! sonte reached common duct–> obstruction/inf.
104-105 degree fevers, sepsis
treatment of acute ascending cholangitis
IV antibiotics and emergency decompression of common duct- ERCP or percutaneous transhepatic cholangiogram
eventually cholecystectomy
treatment of acute edematous pancreatitis (gallstones, alcoholics)
few days of pancreatic rest- NPO, NG suction, IVF
labs in acute hemorrhagic pancreatitis
starts as edematous (elevated amylase, lipase)
low hematocrit!
elevated: WBCs, glucose, BUN
Low calcium
metabolic acidosis, low arterial PO2
how is acute hemorrhagic pancreatitis deadly?
leads to mutiple pancreatic abscesses
which antibiotics for acute hemorrhagic pancreatitis abscesses
carbapanems
quinolones
metronidazole
pancreatic psuedocyst sequelae of…
5 weeks after acute pancreatitis or pancreatic trauma
treatment of pancreatic pseudocyst depending on size/time
under 6 cm/<6 weeks: observe
over 6 cm/>6 cm: drainage
what are the two exceptions for hernias that dont need to be surgically repaired?
umbilical hernias in kids 2-5 (close by themselves)
esophageal sliding hiatal hernias
medullary cancers of thyroid come from which cells
C cells - make calcitonin
therapy for follicular neoplasm of thyroid
total thyoidectomy
treatment for hyperthyroidism
radioactive iodine
what should you check for if hyperparathyroidism found?
bone mets
dexamethasone test results meaning and workup
suppression at low dose–> r/o cushing’s
no suppression–> 24 hr urine free cortisol measurement
–> if elevated: high dose dex test
suppression at high dose: pitutiary microadenoma
no suppression –> adrenal adenoma or paraneoplastic sy
insulin and c peptide high or low in diabetics vs insulinomas?
diabetics: insulin high, low c-peptide
insulinomas: both high
nesidioblastosis
hypersecretion of insulin in new born
pancreatectomy required
glucagonoma symptoms
severe migratory necrolytic dermatitis
anemia
glossitis
stomatitis
treatment of glucagonoma
resection is curative
somatostain and stretozocin will help with metastatic/inoperable
primary hyperaldosteronism symtoms
hypokalemia
hypertensive- but renin low
hypernatremia, metabolic alkalosis
hyperaldosteronism caused by hyperplasia vs adenoma
hyperplasia:
- responds to postural changes (more aldosterone when upright than lying down)
- treated medically
adenoma:
- no postural response
- surgical resection
diagnosing coarctation of aorta
spiral CT diagnostic
CXR: scalloped ribs
renovascular HTN seen in two groups
women with fibromuscular dysplasia
old men with arteriosclerotic occlusive dz
