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General Surgery > Set 4 (10/14) > Flashcards

Set 4 (10/14) Flashcards

1
Q

Blood Supply to appendix

A

appendiceal artery (branche of ileocolic artery)

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2
Q

Obturator Sign

A

pain with internal rotation of leg w/ hip and knee flexed

(+) in appendicitis

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3
Q

Rovsing’s Sign

A

rebound pressure of LLQ causes pain in RLQ

seen in appendicitis

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4
Q

Differential Diagnosis of Appendicitis

A

Meckel’s diverticulum, Crohn’s disease, perforated ulcer, pancreatitis, mesenteric lymphadenitis, constipation, gastroenteritis, volvus, intussusception, UTI, pyelonephritis, cholecystitis, fiverticulitis

Females: ectopic pregnancy, ovarian cyst, ovarian torsion, PID

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5
Q

Urinalysis in Appendicitis

A

can have mild hematuria and pyuria d/t pevlic inflammation → inflammation of ureter

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6
Q

CT Findings in acute appendicitis

A

periappendiceal fat stranding, appendiceal diameter >6mm, periappendiceal fluid, fecalith

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7
Q

Treatment of non-perforated appendicitis

A

appendectomy, 24h of Abx, go home on POD#1

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8
Q

Treatment of perforated appendicitis

A

IV fluid resuscitation, appendectomy, post-op Abx for 3-7 days, wound left open after closing fascia

Abx Options: Cefoxitin, Cefotetan, Unasyn, Cipro, Flagyl

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9
Q

Treatment of appendiceal abscess diagnosed pre-op

A

percutaneous drainage of abscesss, Abx, elective appendectomy ~6wks later

Abx: broadd spectrum (Amp/ Cipro/ Clinda or Zosyn)

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10
Q

Layers of abdominal wall with McBurney’s incision

A

Skin, SQ fat, Scarpa’s fascia, external oblique, internal oblique, transversus muscle, transversalis fascia, periotneal fat, peritoneum

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11
Q

Most common appendiceal tumors

A

carcinoid tumor

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12
Q

Carcinoid Tumor

A

tumor arising from neuroendocrine cells (Kulchitsky cells)

secretes serotonin

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13
Q

Most common sites of carcinoid tumors

A

“AIR”: Appendix, Ileum, Rectum, and bronchus

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14
Q

Pellagra-like symptoms

A

can occur in carcinoid tumors

Dermatitis, Diarrhea, Dementia

d/t ↓niacin production

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15
Q

Sx of Carcinoid Syndrome

A

“B FDR”: Bronchospasm, Flushing (skin), Diarrhea, Right-sided heart failure (Tricuspid insifficiency and pulmonary stenosis: “TIPS”)

Caused by serotonin and vasoactive peptides

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16
Q

Tx of carcinoid syndrome

A

Octreotide IV

If only diarrhea then treat with Ondansetron (Zofran) which is serotonin antagonist

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17
Q

What does liver break down serotonin into?

A

5-HIAA (5-hydroxyindoleacetic acid) which is elevated in urine in 50% of patients w/ carcinoid

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18
Q

Prognosis of Carcinoid tumors

A

66% alive at 5 years

50% with liver metss or carcinoid syndrome are alive at 3 years

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19
Q

Causes of enterocutanoeus fistula

A

(GI tract to skin)

anastomosis leak, trauma to bowel/ colon, Crohn’s disease, abscess, diverticulitis, inflammation/ infection

20
Q

Colonic Fistula Most common

A

colovesical fistula (tx: segmental colon resection)

21
Q

External Pancreatic Fistula

A

drainage of pancreatic exocrine ecretions through to skin

Tx: NPO, TPN, skin protection, octreotide

22
Q

Most common carcinoma of anus

A

Squamous cell carcinoma (ASS: anal squamous superior) (80%)

Cloacogenic (tansitional cell) and adenocarcinoma/ melanoma/ mucoepidermal also occur

23
Q

Anal epidermal carcinoma treatment

A

NIGRO Protocol

Chemo w/ 5-FU and mitomycin C

Radiation

Postradiation therapy scar Bx (6-8wks after radiation)

24
Q

Goodsall’s Rule

A

fistulas anterior to anus will have a straight course; those exiting posterior will have curved tract

Dog has straight nose (anterior) and curved tail (posterior)

25
Q

Seton

A

thick suture placed through fistula tract to allow slow transection of sphincter muscle; scar tissue will hold muscle in place allowing for continence after transection

26
Q

Degrees of Hemorrhoids

A
  • 1st degree: does not prolapse
  • 2nd degree: prolapses w/ defecation but returns on own
  • 3rd degree: prolapses with valsalva and requires active manual reduction
  • 4th degree: prolapsed hemorrhoid that cannot be reduced
27
Q

Hematochezia

A

bright red blood per rectum

28
Q

Causes of Lower GI Bleed

A

diverticulitis, vascular ectasia, colon cnacer, hemorrhoids, trauma, intussusception, volvus, ischemic colitis, IBD (esp UC), rectal cancer, Meckel’s diverticulum, stercoral ulcer, infectious colitis, chemo, irradiation injury, infarcted bowel, strangulated hernia, anal fissure

29
Q

What must be ruled out in lower GI bleed

A

upper GI bleed (get NGT aspiration with bile, if clear then most likely no upper GI bleed)

30
Q

Tests for Lower GI bleeding

A
  • NGT aspiration to r/o upper GI bleed
  • slow to moderate bleeding = colonoscopy
  • faster bleeding = mesenteric angiography to locate source
31
Q

Child’s Classification (liver)

A

A BEAP: Ascites, Bilirubin, Encephalopathy, Albumin, PT

Class A has 10% operative mortality

Class B has 30% mortality

Class C has 75% mortality

32
Q

MELD Score

A

uses INR, total bilirubin, serum creatinine

increased mortality by 1% for every 1pt up to 20 then 2% for every MELD point

33
Q

Liver Tumors

A

most common is metastatic disease

most common primary malignant tumor is hepatocellular carcinoma

most common primary benign tumor is hemangioma

34
Q

Chemicals that increase risk for liver hemangiomas

A

Vinyl chloride, arsenic, thorotrast contrast

35
Q

Hepatocellular Adenomas

A
  • normal hepatocytes without bile ducts
  • Risks: women, birth control pills, anabolic steroids, glycogen storage disease
  • avg age of 30-35yo
  • SSx: RUQ pain/ mass/ fullness, bleedign (rare)
  • Tx: stop OCPs if small or surgical resection
36
Q

Focal Nodular Hyperplasia

A

benign liver tumor; liver mass with central scar; more common in women; normal hepatocytes and bile ducts (adenoma has no bile ducts)

more common in women

Tx: resection or embolization if symptomatic; stop OCPs

37
Q

Risks for Hepatocellular Carcinoma

A

Hep B, cirrhosis, aflatoxin

38
Q

Tumor Marker for Hepatocellular Carcinoma

A

α-fetoprotein

39
Q

Indications for Liver Transplant

A

cirrhosis and NO distant or LN mets and no vascular invasion; <5cm tumor or 3 nodules all <3cm

40
Q

Causes of Liver Abscesses

A
  • Bacterial- E Coli, Klebsiella, Proteus
    • Causes: cholangitis, diverticulitis, liver cancer, liver mets
  • Amebic- Entamoeba histolytica (typically intestinal amebiasis that goes through portal vein)
41
Q

Hydatid Liver Cyst

A

Cause: Echinococcus granulosus

SSx: RUQ pain, jaundice, RUQ mass

Dx: serologic testing, Casoni skin test, US, CT (calcified outline of cyst)

MUST NOT rupture cyst when removing → fatal anaphylaxis

Tx: mebendazole then surgical resection

42
Q

Hemobilia

A

bleeding from liver through portal vein to GI tract; occurs after liver trauma

43
Q

most common physical findings in protal HTN

A

splenomegaly (most common), esophageal varices (via coronary vein), caput medusae (engorgemetn of periumbilical veins), hemorrhoids

spider angiomas, palmar erythema, ascites, truncal obesity, peripheral wasting, encephalopathy, asterixis (liver flap), gynecomastia, jaundice

44
Q

Budd-Chiari Syndrome

A

thrombosis of hepatic veins

45
Q

Tx of bleeding Esophageal Varices

A
  • IV fluids, type and cross, correct coag, +/- intubate
  • Emergent endoscopic sclerotherapy
  • Endoscopic Band Ligation
  • Somatostatin or IV vasopressin to cause vasoconstriction
  • Sengstaken-Blackmore Tube- gastric/ esophageal balloon for tamponade of esophageal bleed
  • TIPS: Transjugular Intrahepatic Portosystemic Shunt
46
Q

Which lab correlates with degree of hepatic encephalopathy?

A

Serum ammonia level

General Surgery (6 decks)

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