Pestana General Surgery Flashcards
A patient presents with burning retrosternal pain that arises when bending over or lying down at night. The pain is relieved by antacids? How should this patient be monitored? What complication and tests if the patient has had longstanding symptoms?
GERD. Monitor by pH monitoring.
Barrett esophagus with endoscopy and biopsies.
Dysplastic changes of the esophagus are treated with?
Nissen fundoplication and radiofrequency ablation.
A women presents with chrushing pain when swallowing that is worse for liquids than solids. She now drinks fluids upright? Tests and treatments (2)?
Achalasia. X rays (megaesophagus), barium swallow then Manometry (diagnostic). Balloon dilation or Heller myomoty.
A black man with a history of smoking and drinking presents with dysphagia. He notes it started with meat, and now he struggles to swallow liquids. He admits recent significant weight loss? Tests and Treatment?
Squamous Cell Carcinoma of the esophagus. Barium swallow then endoscopy. CT Scan and palliative surgery.
An overweight man with longstanding history of GERD presents with progressive dysphagia and significant weight loss? Tests and Treatment?
Adenocarcinoma of the esophagus. Barium swallow then endoscopy. CT Scan and palliative surgery.
Alcoholic with hematemesis after forceful vomiting? Tests and Treatment?
Mallory Weiss tear (tearing of sub/mucosa of esophagus). Endoscopy and cauterization or epinephrine.
Patient presents with severe retching, vomiting, and hematemesis. Develops sudden wrenching epigastric/low sternal pain with fever and leukocytosis? Tests and Treatment?
Boerhaave syndrome (tearing of muscular layer of esophagus). Gastrofarrin swallow, followed by barium swallow if negative. Repair surgically.
What is the most common cause of esophageal perforation? What is the diagnostic clinical sign? Common symptoms?Tests and treatment?
Instrumental perforation during endoscopy. Subcutaneous emphysema in the neck. Acute substernal pain. Xray gastrografin contrast study.
Treatment of gastric adenocarcinoma? Gastric lymphoma? MALTOMA?
Surgery. Chemoradiation. Eradication of H. Pylori
An elderly patient presents with early satiety, weight loss, and anorexia? Tests and Treatment?
Gastric Adenocarcinoma. Endoscopy and biopsies. Surgical repair.
Patient with PSH of abdominal surgery presents with colicky pain, vomiting, abdominal distension, and no passage of gas or feces? Tests (signs)? Treatment?
Obstruction (adhesions). X ray - distended small bowel loops with air fluid level.
NPO, NG, IV fluids. Surgical removal.
Patient with obstruction develops fever, leukocytosis, pain, rebounding and gaurding? Complications? Treatment?
Strangulation. Sepsis. Emergency surgery.
Patient presents with diarrhea, facial flushing, wheezing, distended JVP? Test and treatment
Carcinoid tumor (small bowel metastasis to liver - most commonly appendix). CT scan. Surgical removal.
Patient complains of anorexia and mild periumbilical pain that suddenly migrates to the right lower quadrant. The pain is now sharp and severe. Tests? Treatment?
Appendicitis.
Physical exam: tenderness, gaurding, and rebound. Fever.
CBC: Leukocytosis, left shit.
CT scan - ESPECIALLY W/OUT classic symptoms.
Emergency appendicitis.
An elderly patient presents with bloody stool (4+) - melena. CBC indicates hypochromic anemia? Tests and treatment?
Right colon cancer. Colonscopy with biopsy. Right hemicolectomy.
An elderly patient presents with thin, blood coated stool and constipation? Tests and Treatment? How does treatment change for large lesions?
Left colon cancer. Flexible proctosigmoidscopic study. Full colonoscopy to assess additional lesions, CT scan for operability. Neoadjuvant chemoradiation before surgical excision if large lesion.
Colonic polyps that are premalignant (4)?
Familial polyposis, familial multiple inflammatory polyps, villous adenoma, adenomatous polyp
Colonic polyps that are not premalignant (4)?
Juvenile polyps (highly vascular- remove), Peutz Jeghers, isolated inflammatory, hyperplastic (most common)
Indications for surgical treatment of Chronic UC? Procedure?
20+ years of disease, increased steroid doses, toxic megacolon. Removal of affected colon WITH ALL of the mucosa.
A patient hospitalized for a UTI develops profuse, watery, diarrhea, with fever and leukocytosis? Test? Treatment?
Pseudomembranous enterocolitis (C. Diff). Toxin in the stool. Stop antibiotics, give Metronidazole or Vancomycin.
Internal vs. External Hemorrhoids. Presentation? Treatment?
I: Painless bleeding. Rubber band ligation.
E: Pain. Surgical removal.
A young woman presents with recent constipation and cc of severe pain on defecation with blood coated stools? Treatment?
Anal fissure. Stool softeners and calcium channel blockers.
A man in his 20’s with PMH of anal ulcers that do not resolve after surgery? Which surgical prodcedure should be preformed?
Chrohn’s disease. NO surgery for Chrohn’s of the anus.
A man presents with fever, constipation, and looks very uncomfortable, unable to even sit in the chair? Treatment?
Ischiorectal abcess. Incision and drainage.
A man with PMH of ischiorectal abcess presents with fecal soiling and perineal discomfort? Treatment?
Fistula-in-ano (from previous drainage). Fistulotomy.
An HIV+ man presents with a dungating mass growing out of the anus and metastatic inguinal nodes? Treatment?
Squamous cell carcinoma of the anus. Chemoradiation.
What is the anatomical border between the Upper GI and Lower GI
Ligament of treitz - junction between duodenum and jejunum.
Young patients bleed from the upper or lower GI predominately ?
Upper GI
A patient vomits blood. Upper or lower GI bleed? Tests?
Upper GI. Upper GI endoscopy
A patient presents with melena. Upper or lower GI bleed? Tests?
Upper GI. Upper GI endoscopy
A patient presents with red blood per rectum. Upper or lower GI bleed? Tests?
Unknown. Do NG tube, upper GI endoscopy, lower GI endoscopy.
A patient presents with active bright red bleeding per rectum. NG tube, upper GI endoscopy, and anoscopy are negative for blood? Which test can’t be used during active bleeding? Tests for fast, medium, and slow bleeders?
Lower GI bleed. Can’t use colonoscopy during active bleeding. Fast = CT angiogram. Medium = tagged red cell study. Slow = wait until bleeding stops and do colonoscopy.
Rule of 2’s for Meckel diverticulum (5)?
2% population, 2 ft proximal to ileocecal valve, 2 inches long, 2 years old, 2:1 M:F.
A young child presents with bleeding per rectum? Tests?
Meckel diverticulum. Technetium scan.
How to treat massive upper GI bleeds?
Angiographic embolization.
Patient presents with sudden, constant, very severe generalized abdominal pain. On PE, patient exhibits tenderness, gaurding, and rebounding, and no bowel sounds? Confirmatory test and sign? Treatment?
Perforated peptic ulcer. Upright xrays (free air under the diaphragm). Emergency surgery.
What are the unique combination of symptoms exhibited in an ischemic bowel?
Severe abdominal pain and blood in the lumen.
A man with cirrhosis and history of ascites presents with gaurding, tenderness, rebounding, fever, and mild leukocytosis? Tests? Treatment?
Primary peritonitis. Culture of ascitic fluid. Antibiotics.
A middle aged patent presents with peritoneal irritation in his left lower quadrant, fever and leukocytosis? Tests? Treatment?
Acute diverticulitis. CT Scan. NPO, IV fluids, antibiotics- surgery if those don’t work - Left Hemicolectomy with ostomy and Hartmann pouch.
An elderly patient who lives in a nursing home presents with severe abdominal distension, constipation, absent bowel sounds, and no passage of gas/feces? Tests and signs? Treatment?
Volvulus of the sigmoid (can often be in Cecum). X rays - air fluid levels, distended colon “inner tube”, on barium enema “parrot’s beak”. Proctosigmoidoscopy, leave rectal tube.
A cardiac patient with recent history of MI presents with an acute abdomen, severe pain, and blood per rectum. Eventually he becomes confused and looks SHOCKY? Tests? Treatment?
Mesenteric ischemia of the SMA. Arteriogram. Embolectomy.
A cirrhotic man develops right upper quadrant pain and weight loss? Tests? Treatment?
Hepatoma. A-fetoprotein in blood, CT scan. Resection.
Is primary or metastatic liver cancer more common? How is metastatic liver cancer detected?
Metastatic 20:1. CT scan.