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BOARDS > SESAP ABD > Flashcards

SESAP ABD Flashcards

1
Q

EGD - Ulcer
Predictors of rebleed
what is the greatest risk?

A

Ulcer size > 2 cm, hypotn, fresh blood in stomach, active bleeding.
visible vessel is the highest risl

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2
Q

pSBO 2/2 adhesions -

what treatment decreases hospital LOS?

A

Gastrografin challenge.

It hastens operative decision making and earlier feeding if contrast gets to colon.

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3
Q

Liver Cysts -
Biliary Cystadenoma
Imaging?
Treatment?

A

Heterogenous septations, irregular papillary growth, thickened cystic walls
MRI - Hyperintensitity on T2
NO daughter cysts.

Enucleation v. non-anatomic resection. Have malignant potential

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4
Q

Liver Cysts -
Simple Cyst
Imaging?
Treatment?

A

Thin walled, no septations.

Aspiration v. unroofing dependeing on size

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5
Q 
Liver Cysts -
Hyatid Cyst
Infection? 
Imaging?
Treatment?
A

PARASITE - Echinococcus
Humans eat contaminated food and are intermediary hosts. germinal layer that is fluid filled, central/south america (Dog -sheep -dog)
MRI - thick walled, CALCIFIED cysts with DAUGHTER CELLS
Diagnosis - ELISA OR INDIRECT HEMAGLUTINATION TEST
PAIR - puncture, aspiration, inject sclering agents, re-aspiration + albendezole/mebendezole

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6
Q

SMA Syndrome

A 
Acquired. Rapid weight loss
Dx: Narrowed aortomesenteric angle - <25 degrees
Rx:
1. hydrate
2. refeeding - carefully. 
3. D-j
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7
Q

Annular Pancreas

A

Congenital. Ventral bud tethered to duodenum to functionally obstruct duodenum
Dx: Double bubble
Rx: D-D

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8
Q

Entamoeba histolytica
Dx
Tx

A

SE Asia, frica
Dx - abx in serum - need serology
indirect hemagglutination, enzyme-linked immunosorbent assay, indirect immunofluorescence, and the latex agglutination technique.

Flagyl. perc drainage if abscess large > 10 cm

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9
Q

What is the ROME 3 Criteria used for?

A

functional gallbladder and sphincter of oddi dysfunction

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10
Q

Criteria of ROME 3 - biliary dyskinesia?

A

HIDA fraction 35-40%
episodes > 30 min
episodes of differentintervals
Crescendo pain not relieved by BM, postural changes, antacids.

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11
Q

meckels

when to resect

A

approximately 2% of the general population. malignancy in up to 17%, but most report rates of less than 5%.
Simple diverticulectomy is an acceptable treatment if there is no inflammation or palpable abnormality.
Given any inflammation, perforation, or palpable abnormality, segmental resection is the preferred treatment.

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12
Q

early dumping

A

within 1 hour after eating
fluid shifts with release of gastrointestinal hormones are triggered by the rapid transit of food into the small intestine, resulting in diarrhea and vasomotor symptoms.

reduce the amount of food consumed and delay fluid intake until at least 30 minutes after each meal

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13
Q

late dumping

A

1 to 3 hours after a carbohydrate load and causes a hyperinsulinemic response and subsequent hypoglycemia.

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14
Q 
Barcelona Clinic Liver Cancer
 Staging/Treatment
Healthy 56yM
Hep C
BR 1.5
Solitary 7 cm HCC in Segment 3

What do you do?
Prognosis?

A

Hepatic Resection
This is Early stage tumor, no aggressive features, patient is healthy with good liver function

> 5 years

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15
Q

Barcelona Clinic Liver Cancer
Staging/Treatment

EARLY versus VERY EARLY stage
Definition

A

Very early -
<2 cm single lesion
preserved liver function

Early -
Single lesion or 3 that are < 3 cm.
preserved liver function

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16
Q

Barcelona Clinic Liver Cancer
Staging/Treatment

EARLY versus VERY EARLY stage
What do you do?

A

Early -
Ablation if the patient is not a transplant candidate. > 5 YEAR survival prognosis
Not a transplant candidate -
Portal pressure/BR –>
if normal - resect
if high - with other diseases - ablate, if high without other diseases - transplant

Very Early -
solitary lesions - same as early.
up to 3 nodules - if you have associated diseases - ablate, if you are healthy - transplant

17
Q

Barcelona Clinic Liver Cancer
Staging/Treatment

75 year old M
CKD, Stable angina
good healthy liver
HCC - main lesion 2.7 cm in Segment 5 with two other smaller lesions

What next?

A

Early stage - Three lesions < 3 cm with comorbidities and good liver –> ablate.

If this patient had no other comorbidities –> consider transplant

18
Q

Barcelona Clinic Liver Cancer
Staging/Treatment

Intermediate

What next?

A

Chemoembolization

Multinodular, somewhat preserved liver function.

If you have disease over multiple segments not amenable to a resection
you are not amenable to a surgical management plan –> chemoembolize!

2-5 years

19
Q

Barcelona Clinic Liver Cancer
Staging/Treatment

Advanced disease

What next?

A

Portal hypertension, extra-hepatic disease.
No options for local targeted therapies.
Need systemic therapy for > 1 year survival.
Sorafenib

20
Q

Who is most likely to get post-splenectomy sepsis? When?

A

Malignancy 4 fold increase when compared to trauma.

Likely early after (3 years)

21
Q

Two indications for galbladder polyps and surgery?

A
  1. > 10 mm
  2. Symptoms!
    Also people older than 50 years and with sessile polyps…should get Gallbag out.

Serial US if you don’t remove!

22
Q

Adrenal incidentalomas -

when to operate?

A
  1. functioning lesion
  2. Radiographically concerning for malignancy
    > 6 cm
    >10 HU
    <60 % washout
23
Q

ITP

Rx

A
  1. First line - Steroids and IVIg
  2. Second line - Thrombopoeitin R agonists - Eltrombopag
  3. Rituximab - MAb targetting CD20 on B-cells. Not studied in those patients without splenectomy
  4. SPLENECTOMY!
24
Q

Chronic Pancreatitis - surveillance

A

Risk for pancreatic neoplasm –> CT and EUS

25
Q

Hepatic Adenoma
radiologic features?
patient features?
what to do?

A
  1. HYPERINTENSE on CT.
  2. female, oral contraceptives
  3. stop hormonal therapy. monitor.
    may spontaneously bleed –> angio
    if growing in size, malignant features or > 5 cm –> resect
    males have higher malignancy rate –> resect
26
Q

pancreatic adenocarcinoma

overall treatment

A

surgery and chemotherapy.
Patient’s with resectable disease - surgery then adjuvant chemotherapy (gemcitabine and fluoruracil)
patient’s with borderline resctability - neoadjuvant chemo and surgery

BOARDS (17 decks)

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