Potpourri Flashcards
Disorder characterized by bacterial overgrowth of a segment of small intestine from a segment that is bypassed leading to diarrhea, steatorrhea, malnutrition, megaloblastic anemia (B12 deficiency)
blind loop syndrome
Diagnostic test for blind loop syndrome:
d-xylose test
Appearance of cystic pneumatosis intestinalis:
granular or foamy appearance that represents gas in the submucosa
Appearance of linear pneumatosis intestinalis:
consists of small bubbles within the muscular mucosa and subserosa to form a thin linear or curvilinear gas pattern outlining the wall of a segment of intestine
gold standard imaging modality to diagnosis intussusception
CT scan
Radiologic features of toxic megacolon:
cecal diameter >12cm or colonic dilation >6cm
Treatment of toxic megacolon:
total abdominal colectomy with end ileostomy
Output of a low output fistula:
<200cc/D
Output of intermediate output fistula:
200-500cc/D
Output of a high output fistula:
> 500cc/D
True or false. 4 day fixed course of IV abx isi as efficacious as longer duration treatment for intraabdominal abscess.
true
Medication that enhances GI recovery after colon surgery by antagonizing the peripheral effects of opioids on GI motility
alvimopan (Entereg)
when is operative management for a fistula indicated:
after failure of nonoperative management after a 6-8 week period
Risk factors for development of symptoms from a Meckel’s diverticulum:
male sex, age younger than 50, diverticulum length >2cm; presence of ectopic gastric tissue (strongest risk factor)
Complications of TPN and short gut syndrome:
metabolic bone disease, cholelithiasis, nephrolithiasis, liver disease, blood stream infections
yearly DEXA and routine LFTs indicated
99m technetium pertechnate scan for Meckels has an affinity for identification of____
gastric mucosa
antibiotic of choice for small bowel intestinal overgrowth
rifaximin
treatment of first uncomplicated episode of C. difficile:
oral metronidazole
treatment of recurrent C. difficile after receiving metronidazole:
oral vancomycin for 10 days
treatment of recurrent C. difficile after initial treatment with vancomycin:
pulse tapered oral vancomycin or oral fidaxomicin
treatment of multiple refractory C difficile episodes
fecal transplant
Treatment of Olgivies:
medical management initially and rule out mechanical obstruction
if unsuccessful, then neostigmine
if neostigmine unsuccessful, then colonic decompression
True or false. Incidentally discovered Meckels does not indicate need for resection.
true
True or false. Stomal necrosis that does not extend beyond/below the fascia still requires emergent intervention.
false
Most common complication of ileostomy reversal
SBO
Where is cholecystokinin produced?
I cells of duodenum and jejunum
What stimulates release of cholecystokinin?
fat, protein, and amino acid ingestion
What effects does cholecystokinin have?
increases antral and pyloric contraction, relaxes sphincter of Oddi, stimulates GB contraction, stimulates secretion of pancreatic enzymes
Condition associated with immunosuppression that is characterized by numerous polyps in the small and large intestine that consist of enlarged submucosal lymphoid follicles:
nodular lymphoid hyperplasia
Physiologic effects of using vasopressin to control GI bleed:
initiates arteriolar vasoconstriction and bowel wall contraction; side effects are MI, HTN, dysrhythmias, mesenteric thrombosis, simultaneous IV nitroglycerin is paramount to counteracting side effects
For GI bleeds,_____ has largely replaced vasopressin infusion due to its complications and rebleeding rate.
transcatheter embolization
Best test to confirm ischemic colitis:
endoscopy
Injury of less than ___ of the circumference of the large intestine can be repaired primarily.
50%
Preoperative albumin of less than ____ is a risk factor for anastomotic leak after colorectal surgery
<3.5g/dL
True or false. COPD can cause pneumatosis intestinalis.
true
Medications that can cause paralytic ileus:
opiates, antihistamines, alpha adrenergic agonists, anticholinergics
____ is the most common complication of stricturoplasty.
Hemorrhage
What is the colonoscopy screening regimen for a patient who has a 1st degree relative with an advanced adenoma, adenoma >1cm, or an adenoma with a villous component?
colonoscopy starting at age 40 or age of adenoma onset, whichever is first and then every 5-10 years if normal
screning regiment for average risk patient of colon cancer:
colonoscopy at age 50 and every 10 years after that if normal
True or false. External anal sphincter is under involuntary control
false
Where does the external anal sphincter receive innervation from ?
inferior rectal branches of the pudendal nerve and the perineal branches of the fourth sacral nerve (S4)
Primary fuel source of small bowel enterocytes
glutamine
Primary fuel source for colonocytes
short chain fatty acids
Medication that can help restore intestinal function and structural inegrity through intestinotrophic and proabsorptive effects and indicated in short bowel syndrome
teduglutide, a glucagon like peptide 2 analog
plain film findings of gallstone ileus:
air in biliary tree, calcified gallstone in RLQ, air fluid levels and small bowel distention
RCTs have shown that in patients undergoing colorectal surgery, _____ sheets decrease the risk of adhesion formation and reoperations for adhesive SBO.
hyaluronic acid sheets (seprafilm)
High ileostomy output is defined as:
> 1200mL/day
_____ is superior to vancomycin in treatment of recurrent C. difficile infections.
Fidoxamicin
True or false. Staple hemorrhoidectomy is associated with less pain, early return to work, less operative time than open hemorrhoidectomy.
true
What complications occur more commonly with stapled hemorrhoidectomy compared to open hemorrhoidectomy?
higher rates of tenesmus, higher rates of rectal prolapse, more early bleeding complications, pelvic sepsis complications are higher
What is SMA syndrome?
entrapment of the 3rd portion of the duodenum between the SMA and aorta (decreased angle) caused by loss of intraabdominal fat
2 most common antecedent events for SMA syndrome:
weight loss and corrective surgery for scoliosis
Symptoms of SMA syndrome:
weight loss, epigastric postprandial pain and satiety; high volume emesis of partially digested food
Findings of SMA syndrome on barium UGI:
abrupt cutoff of contrast at 3rd portion of duodenum relieved by proning or moving to right lateral decubitus
Treatment of SMA syndrome:
duodenojejunostomy
Most reliable way to detect C. difficile infection:
toxigenic stool culture
Rapid test for C. difficile with high negative predictive value:
PCR for C diiff
test that detects heme from humans and nonhuman sources:
fecal occult blood test
test that detects heme specifically from human colon:
fecal immunohistochemical test (FIT)
first step in evaluation of suspected Ogilvie syndrome:
rule out distal obstruction by gastrografin enema or CT with rectal contrast
Procedure of choice for anal incontinence with an identified/confirmed sphincter defect:
overlapping sphincteroplasty
True or false. A 4 day course of antibiotics for perforated appendicitis is as efficacious as a longer duration treatment when abscess is present.
true
What type(s) of medication are protective against radiation enteritis?
ACE inhibitors and statins
Three approaches to performing a parastomal hernia repair:
local repair, repair with prosethetic mesh, stoma relocation
True or false. An end ileostomy is more likely to develop a parastomal hernia than a loop ileostomy.
False. Loop ileostomy is more likely to develop a hernia because it requires a larger incision
Complications of chronic TPN and short bowel syndrome:
metabolic bone disease PN associated liver disease cholelithiaiss nephrolithiasis catheter related blood stream infections
Most common location of iatrogenic perforation from colonoscopy
sigmoid
What is a ripstein repair for rectal prolapse and what is the most common complication?
transabdominal proctopexy (with mesh affixed to presacral fascia); most common complication is constipation
Most common cause of lower GI bleeding in the cecum/right colon in the unites for patients over 65
angiodysplasia
Most common cause of lower GI bleeding in the left colon in patients of any age as well as overall in patients under 65
diverticulosis
True or false. In patients being considered for appendectomy, enteral contrast improves the accuracy of diagnosis compared with IV contrast alone.
false. there is no proven benefit in dx
What determines the surgical management for Meckel diverticulum?
presence or absence of palpable abnormality, inflammation, or perforation
in presence of inflammation, perforation, and palpable abnormality - perform segmental resection
in absense of these findings - simple diverticulectomy acceptable
True or false. Inversion of a Meckels diverticulum leaves the patient with a risk of malignancy
true
Visualization of what structures indicates adequate medial mobilization for a right hemicolectomy:
duodenum and pancreatic head
