SESAP ABD Flashcards
EGD - Ulcer
Predictors of rebleed
what is the greatest risk?
Ulcer size > 2 cm, hypotn, fresh blood in stomach, active bleeding.
visible vessel is the highest risl
pSBO 2/2 adhesions -
what treatment decreases hospital LOS?
Gastrografin challenge.
It hastens operative decision making and earlier feeding if contrast gets to colon.
Liver Cysts -
Biliary Cystadenoma
Imaging?
Treatment?
Heterogenous septations, irregular papillary growth, thickened cystic walls
MRI - Hyperintensitity on T2
NO daughter cysts.
Enucleation v. non-anatomic resection. Have malignant potential
Liver Cysts -
Simple Cyst
Imaging?
Treatment?
Thin walled, no septations.
Aspiration v. unroofing dependeing on size
Liver Cysts - Hyatid Cyst Infection? Imaging? Treatment?
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
SMA Syndrome
Acquired. Rapid weight loss Dx: Narrowed aortomesenteric angle - <25 degrees Rx: 1. hydrate 2. refeeding - carefully. 3. D-j
Annular Pancreas
Congenital. Ventral bud tethered to duodenum to functionally obstruct duodenum
Dx: Double bubble
Rx: D-D
Entamoeba histolytica
Dx
Tx
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
What is the ROME 3 Criteria used for?
functional gallbladder and sphincter of oddi dysfunction
Criteria of ROME 3 - biliary dyskinesia?
HIDA fraction 35-40%
episodes > 30 min
episodes of differentintervals
Crescendo pain not relieved by BM, postural changes, antacids.
meckels
when to resect
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.
early dumping
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
late dumping
1 to 3 hours after a carbohydrate load and causes a hyperinsulinemic response and subsequent hypoglycemia.
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?
Hepatic Resection
This is Early stage tumor, no aggressive features, patient is healthy with good liver function
> 5 years
Barcelona Clinic Liver Cancer
Staging/Treatment
EARLY versus VERY EARLY stage
Definition
Very early -
<2 cm single lesion
preserved liver function
Early -
Single lesion or 3 that are < 3 cm.
preserved liver function
Barcelona Clinic Liver Cancer
Staging/Treatment
EARLY versus VERY EARLY stage
What do you do?
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
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?
Early stage - Three lesions < 3 cm with comorbidities and good liver –> ablate.
If this patient had no other comorbidities –> consider transplant
Barcelona Clinic Liver Cancer
Staging/Treatment
Intermediate
What next?
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
Barcelona Clinic Liver Cancer
Staging/Treatment
Advanced disease
What next?
Portal hypertension, extra-hepatic disease.
No options for local targeted therapies.
Need systemic therapy for > 1 year survival.
Sorafenib
Who is most likely to get post-splenectomy sepsis? When?
Malignancy 4 fold increase when compared to trauma.
Likely early after (3 years)
Two indications for galbladder polyps and surgery?
- > 10 mm
- Symptoms!
Also people older than 50 years and with sessile polyps…should get Gallbag out.
Serial US if you don’t remove!
Adrenal incidentalomas -
when to operate?
- functioning lesion
- Radiographically concerning for malignancy
> 6 cm
>10 HU
<60 % washout
ITP
Rx
- First line - Steroids and IVIg
- Second line - Thrombopoeitin R agonists - Eltrombopag
- Rituximab - MAb targetting CD20 on B-cells. Not studied in those patients without splenectomy
- SPLENECTOMY!
Chronic Pancreatitis - surveillance
Risk for pancreatic neoplasm –> CT and EUS
Hepatic Adenoma
radiologic features?
patient features?
what to do?
- HYPERINTENSE on CT.
- female, oral contraceptives
- stop hormonal therapy. monitor.
may spontaneously bleed –> angio
if growing in size, malignant features or > 5 cm –> resect
males have higher malignancy rate –> resect
pancreatic adenocarcinoma
overall treatment
surgery and chemotherapy.
Patient’s with resectable disease - surgery then adjuvant chemotherapy (gemcitabine and fluoruracil)
patient’s with borderline resctability - neoadjuvant chemo and surgery
