PreTest Surgery: Gastrointestinal Tract, Liver, and Pancreas Flashcards
Describe the management of ITP based on platelet level and bleeding status.
- > 30,000: close observation and follow-up
- 15,000 - 30,000: steroids first, then IVIG as backup
- Acute bleeding: treat with platelets to above 50,000 and give steroids
Non-invasive appendiceal adenocarcinoma should be treated with ____________.
right hemicolectomy
What is the difference between a colectomy and a proctocolectomy?
Proctocolectomy involves the rectum
The definitive treatment for ulcerative colitis is _____________.
Proctocolectomy with ileal pouch-anal anastomosis and diverting ileostomy
The difference between aspiration and drainage is ____________.
that aspiration takes only a small part for diagnostic purposes while drainage is therapeutically emptying it
The most common complication of ileostomies is ______________.
parastomal hernia
A patient has obstructive jaundice but the RUQ US shows no gallstones. Next image?
CT
Without gallstones, the diagnosis is likely pancreatic cancer.
A patient has a gastric bypass and then complains of postprandial weakness and diarrhea. What’s happening?
Dumping syndrome
Normally, food slowly drips through the pylorus to the small intestine. In a patient with surgical damage to the pylorus, food can rapidly fill into the small intestine. It is often hyperosmolar, so the food pulls water from the body to the intestines, resulting in loss of intravascular volume.
What is a Billroth I and a Billroth II?
- Billroth I: gastroduodenostomy
* Billroth II: gastrojejunostomy
Gallstone ileus occurs due to a fistula between _____________.
the gallbladder and duodenum
In which cases is a colectomy indicated for diverticula?
Abscess, perforation, or diverticulitis refractory to medical management
The proper course is to medically treat (antibiotics, percutaneous drainage) and follow-up with colectomy.
CCK-HIDA is used to evaluate for _____________.
biliary dyskinesia, a syndrome in which the gallbladder is inflamed in the absence of inflammation or stones
Review the management of gallbladder polyps.
- < 1 cm: observation with repeat US
- ≥ 1 cm: cholecystectomy with frozen section, radical removal (portal lymphadenectomy with liver wedge resection) if positive
Sudden onset abdominal pain with fever, elevated WBCs, and mass in the abdominal wall on imaging is likely ______________.
rectus hematoma
Compare the treatment of amebic and bacterial liver abscesses.
- Amebic: medical first line, add more drugs second line, laparotomy if that fails
- Bacterial: percutaneous drainage
You need to get a ___________ to evaluate a sliding hernia.
endoscopy
Discuss mesenteric ischemia versus ischemic colitis.
• Mesenteric ischemia:
- Presents in vasculopaths with fever, hematochezia, elevated WBCs, and duskiness of splenic flexure on colonoscopy
- Treat with bowel rest and vascular management
•Ischemic colitis:
- Presents as sudden-onset hematochezia and fever in someone with a thromboembolic disorder (ahem, atrial fibrillation)
- Treat with thrombectomy
True or false: those with major colectomies typically have chronic diarrhea.
False
The reserve capacity of the colon is immense. A majority of it can be removed with little change in the quality of the stool and the nutritional health of the person.
Hepatic adenomas should be managed with _____________.
resection if they are greater than 4 cm; they carry a small risk of transitioning to HCC or hemorrhaging
How should focal nodular hyperplasia of the liver be treated?
Nothing
It is benign and carries no risk of malignant transformation.
A teenager has acute-onset RLQ pain, fever, and nausea. Upon surgical intervention you notice a normal appendix and a fibrinopurulent exudate on the terminal ileum. Diagnosis and management?
Crohn’s with appendectomy for prevention of future Crohn’s tissue
Iatrogenic bile duct strictures should be treated with _______________.
Roux-en-Y bypass
The most accurate assessment of the T stage of esophageal cancer is an ____________.
endoscopic ultrasound
Most gastrinomas form within _____________.
the triangle formed by the duodenum, pancreas, and bile duct
What are Ranson’s criteria?
They are a set of criteria used to prognosticate acute pancreatitis: •Admission: - Age - WBC - LDH - AST - Glucose •Next 48 hours: - Hct fall - BUN - Calcium - Base deficit
Describe the presentation of insulinoma.
- Persistent release of insulin causes hypoglycemia with subsequent release of epinephrine (and thus sweating, shaking, and anxiety)
- Revealed by high insulin during hypoglycemic state
How is anal cancer treated?
Radiation and chemotherapy
It metastasizes quickly. Studies of wide excision have revealed disappointing outcomes.
A man has acute abdominal pain. Abdominal x-ray reveals large air distention of the colon. What should be the next diagnostic step?
Sigmoidoscopy
The most likely cause of acute colonic distention is volvulus, which would be diagnosed by sigmoidoscopy. Contrast enema is also diagnostic but to be avoided if there are any signs of perforation.
Celiotomy should follow a positive sigmoidoscopy.
A woman presents with a kidney-shaped, air-filled object in her LUQ after an AAA repair. What is this and how should you treat?
Cecal volvulus and right hemicolectomy
Echinococcal cysts should be treated with _____________.
pericystic resection
Compare and contrast the two types of hiatal hernia.
•Sliding hiatal hernia:
- Both stomach and distal esophagus slide up and down
- Less worrisome. Surgical correction not necessary for all cases.
•Paraesophageal hiatal hernia:
- Distal esophagus remains in place but nearby stomach slides up through a hole in the diaphragm.
- More worrisome because larger hernia can disrupt lung expansion. Symptomatic (as in reflux or dysphagia
A patient hospitalized with pancreatic cancer develops abdominal distention. X-ray reveals dilated colon. What likely happened?
Opioid ileus
Discontinue all opiates and anticholinergics.
Another potential diagnosis is hypercalcemia of malignancy (which can cause constipation).
First-line treatment for major hemobilia is ____________.
transarterial embolization (same as for any major GI bleed)
Bleeding from the ileocecal valve (seen on colonoscopy) in a 25-year-old should be further assessed with ____________.
Tc scan
Bleeding from proximal to the ileocecal valve is likely a Meckel’s.
Describe the three tiers of management of carcinoid tumors of the appendix.
- < 1 cm: appendectomy
- 1 - 2 cm: depends on how close the tumor is to the colon
- > 2 cm: right hemicolectomy
Cystic dilations of the bile duct should be treated with _____________.
Roux-en-Y bypass
Describe the presentation of stress ulcers.
Multiple shallow ulcers in the fundus
Critically ill patients with multisystem disease who have acute cholecystitis should be treated with __________.
tube cholecystectomy (percutaneous drainage of the gallbladder)
Bleeding Dieulafoy lesions should be treated with _____________.
wedge resection
In which cases should a person get a right hemicolectomy for an appendiceal carcinoid tumor?
If it’s greater than 2 cm or near the base of the appendix.
Small ones that are distal can be treated with appendectomy.
Describe the management of gallbladder polyps.
Most gallbladder polyps are benign (90% are cholesterol pseudotumors). Features that correlate with increased risk of malignancy are age >50 and mass > 1 cm. If either of those features are met or if the person has obstruction, then remove the mass.
What is brittle diabetes?
A form of IDDM that occurs when the pancreas is taken out. There is no glucagon so hypoglycemia develops more easily.
The definitive treatment for UC is _______________.
total proctocolectomy with ileoanal pouch or ileostomy
The treatment for refractory anal cancer or rectal cancer is ______________.
abdomino-perineal resection
