Surgery: Block 1 Flashcards

1
Q

What is one of the most important features of a SurgHx?

What is the first part when investigating this feature?

What is the most important aspect of this feature?

A

Pain

How it began

PTs reaction to it

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2
Q

PT shrieking/thrashing is either ? or could have ?

PT in true pain due to infection, inflammation or vascular dz may present what type of movement?

A

Gross over reaction
Renal/biliary colic

Extremely restricted movement

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3
Q

What is a common complaint found during a pre-op Hx that is not of much significance?

When does this become an issue?

A

Change in bowel habits

Constant/regular becomes cyclic diarrhea/constipation= suspect colon Ca

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4
Q

What is the MC error when providers are presented with bleeding from the rectum?

A complete exam of a surgical PT includes what five steps?

A

Hemorrhoid Dx

PE Special Labs X-rays F/u exams

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5
Q

What is the first and second thing immediately assessed when conducting an elective surgery PE?

What are the objectives of doing Labs during a pre-op work up?

Why is a Neg GI study not truly negative?

A

Physique/habitus and then, hands

Screening for ASx Dz (anemia, DM)
Dz c/i elective/req Tx prior to surgery (DM, HF)
D/o requiring surgery (HyperThyroid, Pheo)
Metabolic/septic complications

Ulcers/Neoplasms not excluded, especially in R colon

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6
Q

Ordering INR/PTT would be warranted during a Pre-Op prior to ? procedures?

What is the relation w/ the blood bank prior to a surgery?

A

Little post-op bleeds threshold (brain, spine, neck)
INR- bile obstruction, malnutrition, absent terminal ileum= dec Vit K absorption

Blood typing alone

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7
Q

Pre-op labs include ?

What is a True Liver function test?

What is MC acquired nosocomial infection and RFs

A

CBC CMP PT/INR

PT/INR + Total Bili, Albumin

Lower UTI- Retention Instrumentation Contamination
Dx by exam, confirm w/ culture

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8
Q

Who signs a pre-op consent form?

When can consent form signing be waived?

Who can sign for the PT if they’re unavailable or physically able to sign

A

Surgery team member, PT, Witness NOT on team

Emergencies, two Drs sign

Medical power of attorney

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9
Q

If emergency surgery is needed and signed consent may be affected, who needs to be notified?

What is the universal protocol for pre-op precautions

When/how is hair removed from a surgical site?

A

Hospital administrator

Site/sign location
Time out prior to first cut

Electric clippers immediately prior

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10
Q

What meds may be taken on the day of surgery w/ sip of water

A

HN
Hormones Neuro

BARHOPS
BB Alpha ant/agonist Reflux HTN OCP Psych

CCC
CBC Cardiac rhythm COPD

HNP
Hormone Nitrate Peptic diatheses

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11
Q

Why may PTs be advised to NOT take their ACEI prior to surgery

When are ABX given prior to surgery

If additional ABX are needed during surgery, when are they given?

A

General anesthesia refractory HOTN

W/in 1hr of incision

Every 2 t1/2 (q4hrs for Cefazolin*, Augmenten)

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12
Q

Operations that involve bacteroides should have ? ABX added to the regime

Surgical ABX are chosen by ?

Multiple doses or prolong ABX use post-op are more likely during ? procedures?

A

Metronidazole

Hospital antibiogram

GI Tract
Implantation
Contaminated wounds
ImmComp PTs

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13
Q

ABX given to PTs for prophylaxis are not continued after surgery except for ? procedures?

What is the ASA Classification system for?

A

Vascular grafts
Cardiac surgery
Joint replacement

Degree of perioperative risk for PTs

1: health PT, no systemic d/o
5: moribund, won’t survive 24hrs w/out operation

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14
Q

What are examples of Cat 5 ASA PT

What is the APACHE II System for?

How is the Mallampati classification scoring done?

A

Trauma w/ shock
Ruptured AAA w/ shock
Cerebral trauma w/ inc ICP
Massive PE

Severity of illness in ICU PTs to predict mortality

Open mouth, tongue out w/out saying ‘ah’

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15
Q

What are the 6 things evaluated when conducting a Mallampati

A

NTC PST

TMJ C-spine Dentition Short neck Tracheal deviation Neck mass

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16
Q

Respiratory complications are bad because of what 4 increased things

Pulmonary complications can be as minor as ? and extend in severity up to ?

A

Most costly
Inc re/admission, 30 day mortality

Atelectasis
Pneumonia/Resp Failure

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17
Q

What are the risk factors for a PT to develop post-op pulmonary complications?

What PE findings may indicate an underlying pulmonary Dz

A

Functional dependence AMS Malnutrition
CHF Alcohol COPD Inc age ASA

Dec breath sounds
Wheeze
Rhonchi
Prolonged expiratory phases

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18
Q

If PT has mitigating pulmonary complications during pre-op, what two tests may be done prior to surgery, especially ? procedure

How are PTs w/ very low, low, mod or high risk of VTEs managed post-op?

A

PFT ABG
Lung resection

Very Low= early ambulation Low= mechanical prophylaxis and ICPs
Mod= LMWH, UFH, IPC
High= IPC and LMWH/UFH

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19
Q

What are the 6 independent factors in a RCRI

If PT has findings indicative of ischemic heart dz, cardiac Sxs or abnormal EKG on pre-op have what f/u test ordered?

Deck 1, Slide 24

A
Hx ischemic Heart Dz
CHF- JVD/S3
CerebroVDz 
High risk operation 
Pre-op Tx w/ insulin
Pre-op SrCr >2.0mg

Stress test: Treadmill,
Dipyridamole/Adenosine-thallium
Dobutamine echo

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20
Q

What is the most widely used Dx test to evaluate for CADz

If there is a risk of a peri-operative re-infarct after an MI, try to postpone surgery by ? mon

A

Exercise electrocardiography until Sxs or ST segment shifts, enhanced w/ T-201

> 6mon

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21
Q

What are the two goals of pre-op fasting?

Avoid drinking/eating how far in advance to surgery?

A

Min volume, max pH

No drinking 2hrs prior
No light/heavy meals 6-8hrs
Infant- 4hrs breast milk, 6hrs formula

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22
Q

What would be signs that liver failure is occurring post-op and what labs would be ordered?

Pre-op eval of the hepatic system includes ? two measurements used for calculating ?

A

Spider telangiectasis
Jaundice
PT INR PTT

Total bili and INR
CTP or MELD

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23
Q

What are PTs given who are identified to have bleeding risks and when are they given?

If PT w/ hepatic issues develops worsening encephalopathy, ? is accumulating and it’s Tx w/ ?

A

Vit K/FFP- on call to OR

Ammonia tx w/ Lactulose

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24
Q

PTs w/ liver dz risk ? outcome w/ surgery

What are the decompensation risk %s per CTP scoring

A

Decompensation

Class A: 2-10%
Class B: 12-30%
Class C: 12-82% w/ 63% mortality rate

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25
PT w/ elevated pre-op BUN= ? PT w/ elevated creatinine= ? All Pts w/ ? need to have these two labs drawn during the pre-op
Dehydration Inc mortality Renal impairement
26
Proteins/glucose found in a UA mean? Casts found in urine mean ? What can the urine Na/Creatinine can be used to calculate?
Injured glomeruli Nephritis Glomerulonephritis Tubular necrosis Fractional excretion of sodium- determines if origin of renal failure is pre/post renal
27
What would be seen in a UA indicating an infection? What part of the UA results indicate the PTs hydration level? What is the name of the peri-operative fluid management program showing to reduce incidences of adverse post-op events?
Leukocyte esterase Nitrites SpecGrav- norm 1.010 Goal directed/Protocol based fluid restriction
28
If post-op PT has oliguria, what is it due to and how is it corrected? What step may be done during pre-op neuro eval to examine for occult Dzs?
Secondary to hypovolemia IV fluids, not diuretics Carotid artery stenosis (bruit)
29
# Define Neuropraxia How is Neuropraxia classified
Mildest form of nerve injury from over stretching joints; MC Sx- loss of motor function Transient conduction block of motor/sensory function w/out nerve degeneration
30
? type of PT Hx may indicate greater chance for development of a Surgical Site infection? These chances are higher following ? procedures
DM Cardiac Or inc stay/infection risk in non-cardiac PTs
31
What is the desirable glucose range for critically ill PTs Chronically hyperglycemic PTs are frequently ? and ? is used in the InPT setting for fluids
<140 fasting <180 regular Dehydrated IV Dextrose
32
Pain causes ? release and subsequent ? release Intravascular volume loss will cause PT to develop ? Na
ACTH- Epi, NorEpi, Cortisol ADH from PostPit Low serum Na due to water retention
33
Why should pre-op PTs not suddenly stop use of steroids What is the recommendation instead of stopping PTs must have ? thyroid prior to surgery What can happen if this requirement is not met
Addisonian crisis- HOTN, HypoNa, HyperK+ Stress dose steroids Euthyroid Hyper: thyroid storm Hypor: cardiac failure
34
Why would supplemental steroids be given to PTs pre-op PTs undergoing ? moderate or ? major stress procedures should have addistional CCS administered
1* or 2* adrenal insufficiency Currently on >20mg of Pred Hx chronic steroid use and Cushingoid appearance Mod: LE revascularization, total joint replacement Sev: cardiothoracic, abdominal, CNS
35
What is used to prevent a thyrotoxicosis development What med is used for Graves PTs to reduce the vascularity of the gland and control hyperthyroidism
Methimazole or Propylthiouracil and BBs Potassium Iodide
36
What findings are seen if PT has perioperative hypothermia How is this corrected
Hypothyroidism PO Levothyroxine
37
PTs w/ thyroid goiters should avoid ? imaging procedure PTs need to stop blood thinners ? before surgery ? PE finding can indicate PT has hemophilia
CT w/ contrast, may provoke thyrotoxicosis Warfarin- 5 days 7 days Deformed joints Joint bleeds
38
? blood component is an independent risk factor for developing SSI? If PT is mod/sev malnourished, how long will it take on re-feeding regime before changes are seen?
Hypoalbuminemia <3.0mg 1wk
39
What use/benefit does albumin have? What blood component is preferred and considered more superior?
Long t1/2, low Sen/Spec Malnutrition PTs don't always have hypoalbuminemia Critical care PT- reflects Dz severity Preablbumin- High sensitivity, short t1/2 Inc PAB= dec inflammation, response, not improved nutrition
40
What lab finding may suggest chronic malnutrition? What result would suggest acute malnutrition?
Albumin <3g, t1/2 of 14 days Prealbumin <16mg, t1/2 of 2 days
41
__% weight loss can result in delayed wound healing, anergy or decreased pulmonary reserve Anergy is also indicative of ?
12% or more Immune response failure
42
What fluids are used in the pre-op setting for fluid resuscitation If internal milieu is lost, what system can suffer irreversible consequences
Crystalloids- NS, LR PRBCs Neuro
43
? of body fluid is ? while the remaining is ? Of the remaining fluid, how is it divided up?
2/3 intracellular (K+) 1/3 extracellular (Na)- 1/3 similar to seawater 3/4 interstitium 1/4 intravascular
44
How are intracellular Na levels kept low? Hypovolemic induced oliguria produces ? type of urine What purpose does the FENa hold?
NaKATP pump Low volume/Na, hypertonic Differentiating cause of oliguria 1% or less= Prerenal azotemia, aggressive Na reclamation >1%= Tubular injury preventing proper Na reclamation
45
Hypovolemia in surgical PTs is due to loss of ? fluid Hypovolemia stimulates aldosterone to be secreted from ? causing ?
Isotonic Zone glomerulosa adrenal cortex Inc Na/water absorption
46
What post-op findings are indicative the kidneys are trying to retain volume Oliguria is also a consistent finding of early ?
``` Na <20 mEq Chloride- useless unless metabolic alkolosis Osmolality >500 SrCr ratio >20 BUN >20 ``` Shock in the absence of hyperosmolar induced diuresis
47
? is a consistent finding of early and moderate shock All hypovolemic PTs have inadequate output if urine output is less than ? after 30min wait What is considered normal urine output for an adult
Oliguria Adult: <0.5mL/kg/hr Child: <1mL/kg/hr Infant: <2mL/kg/hr 1L/24hrs 0.5mL/kg/hr
48
How much insensible fluid loss occurs from skin, lungs and GI tract SpecGrav > ? indicates hypovolemia
Skin/lung: 600ml/24hrs GI: 250ml/24hrs >1.020
49
What is an early but non-specific sign of shock? What is the most sensitive of all the early signs of shock? PTs w/ distended neck veins while elevated to 30* and no cardiac compression need to have ? r/o
Cold skin Dec blood flow to skin Hypovolemic shock
50
Criteria for profound hypovolemic shock is ? and will have ? VS always be low After resuscitating hypovolemic shock, ? finding will always be present
>30% BP Metabolic acidemia
51
What are three reasons to start an IV? What are early signs of shock? There is always a low filling pressure to ? chamber of the heart during hypovolemic shock?
Volume depletion About to be NPO > 12hrs Inc insensible losses Diminished flow to skin* Difficulty getting IV access Cold skin- early, non-specific RA
52
What is the purpose of doing a PAC This procedure is only done for ? PTs
Swan Ganz in central venous to distal PulmArt to measure: central venous pressure capillary wedge pressure RV SV Cardiac instability w/ multiple comorbidity
53
3 benefits of placing a Foley What are the indications to place a Foley
Hematuria Output monitoring Empties bladder Prolonged sedation I/Os Pre-Op Neurogenic bladder
54
S/Sxs PT has cystitis? S/Sxs PT has pyelonephritis
Dysuria, mild fever High fever Flank pain Ileus
55
Following few days post-surgery, what type of fluid balance change is commonly seen? Post-op PT w/ HypoNa is Tx w/ ? but NOT ? Post-op PT w/ dec UOP is Tx w/ ?
Fluid/E+ retention due to ADH secreted from pain, N/V, opiates or PPV NS and water restriction No hypertonic saline Bolus IVF, not diuretic
56
In PTs w/ normal renal function, what are some of the best indicators of fluid volume status? How much urine output indicates successful resuscitation for shock has occurred?
Mental status Urine output HR/BP 30cc/hr
57
What are 5 issues that can cause hyponatremia PTs w/ CNS S/Sxs related to HypoNa are Tx w/ ?
``` CHF CSWS Hyperglycemia Liver Dz SIADH ``` NS and free water restriction
58
What is the adverse outcome from increase Na too quickly? Why are DM PTs at higher risk of developing HypoNa post-surg?
Osmotic demyelination Hyerpglycermia- draws water from intracellular space to extracellular space
59
In surgical settings, HypoK is developed by ? 3 things What are the S/Sxs of HypoK Refractory HypoK to parenteral Tx methods get ? as the next step?
GI loss Diuretic Malnutrition Diaphragm paralysis Flat/inverted T Prominent U HypoMg Tx
60
PTs w/ prolonged alkalosis from HypoK can develop ? issue What are the hallmark signs of HypoK
Paradoxical aciduria- nephron conserves HCl and K, loss of H+ Dec muscle contraction leading- diaphragm paralysis, ECG changes (flat T, prominent U, arrythmias)
61
HyperK is often cause by ? but can also be due to ? How does HyperK present on EKG
Renal/adrenal insufficiency Crush Burns Flat P Peaked T Wide QRS
62
What level of HyperK is considered a medical emergency? How is it Tx
>6.5mmol, reqs conitinuous EKG monitoring IV 50% dextrose in water 10u regular insulin Ca gluconate Inhaled B adrenergic agonist
63
What does the HyperK Tx meds to for protection/Tx What Tx step can be added to Tx of HyperK if PTs kidneys are intact and normal? What is the method if kidney function is severely decreased?
BIG- push K from extra to intracellular spaces CaGlu- inc excitability threshold to protect myocardium Loop/TZD diuretic Hemodialysis
64
If PT developed HyperK w/ slow/gradual onset, what PO med can be used for Tx? What is an automated hydration status device used for monitoring and what is it used in conjunction with?
PO Sodium Polystyrene sulfonate Edwards EV1000 w/ serum lactate
65
After severe trauma/sepsis, how do PTs show signs of Intravascular coagulation? When would a hemodynamically stable but critically ill PT receive blood transfusion?
Prolonged clotting times Low platelets, fibrinogen Production of fibrin degeneration products/monomers Hgb <7.0 (Hct 21%)
66
What is the antifibrinolytis used for adjuncts to hemorrhage control? How does initial fluid resuscitation begin? What fluid is preferred in the ER trauma bays?
Tranexamic acid Warm crystalloid: NS or LR Severe shock AND arterial pH <7.20= LR Lactate + H+= lactic acid LA liver oxidized into H2O/CO2, removed by lung/kidney Isotonic crystalloid LR- lower Cl (NS Cl ions hyperchloremic metabolic acidosis)
67
Bile and fluids in small intestine have an E+ content similar to ? Saliva, gastric juice and R colon fluids have high ? and low ?
LR High K, low Na
68
What fluids are used in resuscitation secondary to hypovolemia? Avoid adding extra ? in first 24hrs post-surg because?
Crytalloids- LR or NS K, aldosterone inc post-surg= saved K+ ions
69
# Define Maintenance Rate How is Maintenance Rate maintained? Define Replacement Rate
Dehydrated or NPO >12hrs, Factored at 30ml/kg/24hr 5% Dextrose in 0.45% NaCl w/ 20mEq K/L LR replacement to avoid causing E+ imbalance
70
Fluid losses exceeding ?mL need to have E+ concentrations measured Heparin/saline locks are useful when? Abdominal pain assessment divides area into ? 3
1500mL ABX, PRN pain meds GI Biliary GU
71
What is the bloody vicious triad Type specific blood products should be available w/in ? long, otherwise use ? What does whole blood contain and when is it used?
Hypothermia Coagulopathy Acidosis 20min: O- PRBCs, if unavail- O+ Factors RBCs Ags Plasma 5/8 Anticoagulanta Non-functional platelets and granulocytes Massive loss/hypovolemia
72
In a non-bleeding 70kg PT, a transfusion of one RBC unit will inc Hgb by ? and Hct by ? What is the first step in a massive transfusion protocol?
1g, 3% 1L isotonic crystalloid- LR/NS Empiric transfusion No excess crystalloids, worsens coagulopathy/vicious triad
73
Per TCCC guidelines, what is the fluid of choice for resuscitation from most to least? What type of Trauma PT would receive the 1:1:1 fluid resuscitation?
``` Whole Plasma/RBCs Platelets Plasma RBCs Plasma or RBCs Hextend Crystalloids- LR/PLA ``` Severe shock Intraperitoneal blood Complex pelvic Fx Bilateral femur Fx
74
What are the colloids?
FFP- clotting factors, 30min thaw Whole blood: RBCs, plasma from walking donors w/ Ag, low titer O- Albumin- not for acute resuscitation; volume expansion- LF, burns, nephrotic syndrome PRBC- preferred over whole blood PLT- for active bleeds w/ platelets <50K; 1unit inc x 25K
75
Hextend Tranexamic Acid Hypertonic Saline
6% hetastarch in lactated E+ w/ large sugars to inc intravascular volumes; max 1500ml/24hr- inc mortality/AKI Antifibrinolytic- strengthens clots, improves survival <3hrs of injury (CRASH-2 Trial- HOTN/Tachy w/in 8hrs) 3-23.4%- fluids to intravascular space during head injuries- inc cerebral perfusion pressure, dec ICP Not through peripheral IVs
76
# Define Uremic bleeding and how it's Tx Cryoprecipitate
Renal Dz- platelet dysfunction w/ severe anemia and uremia Tx w/ DDAVP, Conjugated Estrogen, Cryoprecipitate or RRT- stims vWF release Cardiac surgery- soluble coag factors: vWF, Fibrinogen/ectin, Factor 8/9 Multiple factor deficiencies
77
vWF levels below _% are at risk for massive hemorrhage How is VWDz corrected Antifibrinolytics are preferably used in ? setting
30% Desmopressin, Cryoprecipitate or vWF/F8 Massive hemorrhage- Aprotinin, TranAcid, AminoCaproic Acid: reduce transfusions in elective/cardiac surgeries
78
If LE veins used for IV access, must be decannulated w/in __hrs to minimize risk for ? IO infusions target veins where but is not recommended for longer than ?
24hrs: thrombosis, infxn Medullary sinus 24hrs
79
Where can central lines be placed Central lines are placed using ? technique
Subclavian Jugular Femoral Cephalic vein Seldinger
80
What is unique about the PICC Indications for arterial line What are the three broad categories of peripheral IV complications
Peripheral vein to SVC= central venous catheter No risk for PTx Arterial pressure monitor Repeat ABGs/blood samples NOT for volume replacement Mechanical (MC thrombophlebitis) Infection Metabolic
81
MC adverse effect of internal jugular and femoral venous line attempts? MC adverse effect of subclavian line attempts?
Artery puncture Pneumothorax
82
How does an air embolism present and how is it Tx How can this adverse outcome be avoided during line placement?
Severe distress HOTN Cogwheel murmur Durant position: Trandelenburg and LLD- emoblus to apex of RV, needle aspiration PT in Trandelenburg position
83
IV hydration methods are good for up to ?days before need to consider ? methods ? route is used in ICU/sedated w/ secured airway?
7 days, P/TPN Orogastric tube- not for conscious PT, stims gag reflex
84
PTs receiving TEN need to have ? weekly/daily checks? If PT has eaten w/in 6hrs of a surgery, what can be used to remove the contents? When is this method c/i?
E+ daily Pre-albumin weekly Gastric tube: NG/OG under Low Suction Gastric tube is NOT feeding tube Cribifrom/basilar skull Fxs
85
Name of tube used for duodenal/jejunal nasoenteric feeding Why metabolic condition may develop in PTs undergoing prolonged gastric suction/vomiting? Define Refeeding Syndrome
Dobhoff tube- post-pyloric placement Metabolic alkalosis- loss of Cl Tx w/ K+Cl Inc inuslin moves E+ from extra to intra= HypoK, Mg, PHO4
86
What are early complications in TPM therapy PTs can start eating through feeding tubes starting ? long after placement
Hyperglycemia Hyperchloremia acidosis Day 2
87
How are visceral sensations carried within the abdomen Why is visceral pain commonly felt at midline?
Afferent C fibers- viscera walls, solid organs capsule from distention/inflammation/ischemia Slow dull onset Bilateral sensory supply of spinal cord
88
How are parietal pain sensations carried? Why is parietal pain better localized? Cutaneous sensation of the parietal pain is due to ? spinal levels
Direct irritation of parietal peritoneum, C/A delta fibers: A-d carries sharp/localized pain Somatic afferent fibers directed to one side of NS T6-L1
89
Abdominal parietal pain is done by dividing the abdomen into ? An 'acute' abdomen is any non-traumatic pain lasting ? and the fundamental aspect of eval is ?
4 quadrants, epigastric or central areas <24hrs Hx, PE w/ MC and predominant Sx: pain
90
What causes rectus muscle rigidity during an abdominal exam What effect does pressing on a PT w/ guarding have?
Rare neuro d/o Renal colic Peritoneal inflammation Voluntary- relaxes Involuntary- remain board like
91
Scaphoid appearing abdomen are indicative of ? When causes visible peristalsis to be seen? What is the cause if PTs abdomen is soft/doughy
Perforated ulcer Advanced bowel obstruction Paralytic ileus/mesenteric thrombus
92
What would be heard in abdomen w/ mechanical bowel obstruction Absent bowel sounds indicates PT has?
High pitched tinkle/rushes Paralytic ileus
93
What could it mean if these signs are positive Tympany on percussion indicats?
``` Iliopsoas- abscess Obturator- trapped bowel Rovsings- appendicitis Kehr- hemoperitonium +CVA- pyelonephritis ``` Bowel obstruction Hollow viscus perf
94
Sequence of abdominal exam ? pre-op test is mandatory in elderly Pts What lab result would be elevated in PTs w/ pancreatitis
Inspect Ausc Perc Palp Electrocardiography Lipase
95
? is DDx in PT w/ abdominal POP w/ Hx of CAD What is the most efficient imaging modality for assessing abdominal masses? ? image test is essential in all acute abdomen cases?
Bowel ischemia due to mesenteric ischemia Helical/spiral CT Upright CXR, more sensitive for intraperitoneal air
96
What 3 lab tests are almost always obtained prior to making a decision to operate? What are the 4 steps in reading a plain abdomen x-ray What is a 3-way abdomen
CBC Blood chemistry UA Gas pattern Extraluminal air Abdominal calcifictions Soft tissue masses Flat/upright abdomen + CXR to look for hemo/pneumo peritoneum
97
What does subdiaphragmatic air indicate? What does a thumbprint impression an an abdominal x-ray indicate What finding indicates a pylephlebitis
Perforated viscous Ischemic colitis Air in portal venous system
98
How can the first portion of duodenum be isolated on visual exam from the second part Where does the small intestine travel after the stomach connection? The most dilated portion of the small bowel is ? w/ the most narrow portion at ?
Kerkring folds- plicae circulares/valvulae conniventes L1-2, over R renal A/V and IVC Wide: distal LoTreitz Narrow: prox ileocecal valve
99
How are ileus obstructions differentiated from mechanical ones? Reflex ileus is often induced by afferent fibers of ? nerve What drug can be used w/ ERAS w/ ability to accelerate GI recovery
Mech: localized, severe, MC in small bowel Ilius; diffuse, milder, more common post-op Splenic Alvimopan- selective Mu receptor antagonist
100
Constipation is not indicative of obstruction, but what combo is? NG tubes should be placed in PTs presenting w/ ? 4 things
Obstipation + painful distention/repeat vomit Hematemesis Suspected obstruction Severe vomit/ileus
101
What are the MC causes of SBOs and LBOs Image finding of a 'step-ladder' appearance is indicative of ? and begin ?
Sm: Hernia Adhesion Tumor L: Volvulus Ca Diverticula Mechanical SMO LUQ
102
Calcification of the bladder wall is uncommon in ? 3 Dzs What does a cloud-like amorphous/popcorn appearance indicate? Linear/track like calcifications imply ?
Schistosomiasis Bladder Ca TB Calc/tumor in solid organ Calcification in walls of tubular structures
103
Lamellar calcification indicates calcification has occurred ? DM should avoid metformin for how long before and after receiving IV contrast What is the name of the contrast used if suspected bowel perforation
Around nidus inside hollow lumen 24hrs, 48hrs Gastrografin (Meglumine Diatrizoate)
104
What secondary signs may be seen on CT scans? Upper GI w/ follow through means ? and is assessed by ?
Fat stranding Extravasation Esophagus to duodenum Barium swallow
105
CT contrast enhances vessels and ? ? imaging test can be therapeutive and Dx for GI issues What image is ordered to see bladder and urethra
Parenchyma Limited BE Retrograde urethrogram, shorter catheter than cystogram
106
? NucMed test for intra-abdominal abscesses? Which one IDs slow intestinal bleeds What is the 'strict return' policy for PTs after released from GI assessments
HIDA/gallium Tc-sulfur colloid scan Tech-pertechnetate in Meckels F/N/V/intractable pain
107
Normally PTs are not sent home for GI issues if ? is needed but w/ ? exception Four examples of urgent surgery needed done w/in 24hrs Define Vermiform Appendix
Narcotics, Renal colic Appendicitis Ectopic Incarcerated hernia LUQ pain Blind intestinal diverticulum from posteromedial aspect of cecum, 2cm inferior to ileocecal valve, acts as 2* lymphoid organ (MALT)
108
Emergent surgery examples During appendectomy, what anatomical landmarks can help locate the appendix
Blunt/Penetrating trauma Aoritc transection Ruptured aneurysm Taeniae of colon, converge at base
109
What blocks appendix Appendicitis has what 3 processes occurring
Fecalith- adults Hyperplasia- kids Tumors ``` Obstruction= distention Infection= ischemia Perforation= peritonitis ```
110
What is Alvarado's Scoring method
``` MANTRELS Migrate to R iliac fossa (2) Anorexia N/V Tender R fossa Rebound pain Elevated fever Leukocytosis+10K, neutrophils (2) Left Shift ``` 9-10: very probably 7-8: probable, CT 5-6: compatible
111
Where would pain be localized if appendix was in Iliac Fossa, pelvis, retro peritoneal/cecal or RUQ? ? locations of appendicitis can present w/ hematuria? What type would cause inc WBCs in UA?
Fossa: McBurneys Pelvis: rectal/obturator Retro/Retro: psoas RUQ: pregnant, pelvic mass Retrocecal or Pelvic Retrocecal
112
What are the most useful CT findings of appendicitis? How are Pediatric appendicitis cases imaged? What are the MC microbes isolated from peritoneal cultures during appendicitis?
Inc wall thickness, >6mm Fat stranding MRI Aerobic/faculative bacteria anaerobes
113
What ABX can be used for appendicitis What microbes are usually isolated?
Pef: Cipro + Metronidazole No Perf: Cephalosporin w/ Cefoxitin at pre-op ``` Milophila wadsworth Lactobacillus V Strep B Fragilis E Coli Enterococci P Melaninogenica ```
114
? duct is remnant of embryonic yolk sac and can fail to fully dissolve Define Fothergill Sign
Omphalomesenteric/vitelline duct- MC= meckels Rectus sheath hematoma- PT raises head when supine= accentuated= inc tenderness/swelling Masses/pain that dec w/ head raise= intra-abdominal mass
115
Pregnant female that has appendectomy can have ? sequelae What is the MC non-OB surgical Dz of the abdomen during pregnancy and how does it present
Pre-term labor, rarely delivery Appendicitis RUQ pain Tenderness Leukocytosis
116
Appendicitis perfs are more common in ? PT populations What populations benefit from laproscopic appendectomy's? What is the MC rare pathology report for appendectomy and what other possibilities could it be
Kids, Developmental delay, Elderly Obese Pregnant Carcinoid- MC site of carcinoids in GI tract Lymphoma Adenocarcinoma
117
What is the name of the procedure to gain access to the abdomen for laprascopic appendectomy and what is then made? What hole is larger?
Veress needle/Hasson trocar- pneumoperitoneum w/ CO2 Midline infraumbilical port- 12mm
118
What's the name of the esophagus/stomach junction Pertaining to the esophagus, what are the most important veins? Why is this drainage important?
Antrum cardiacum Lower, drain to coronary veins, part of portal vein Direct communication between portal circulation and venous drainage of lower esophagus/upper stomach
119
Where does blood back flow into during portal HTN? What is the MC diverticulae
Coronary vein/esophageal venus plexus to azygos vein to SVC Zenker- pulsion type false diverticulae in Killian triangle, superior to cricopharyngeus muscle
120
What are the Sxs of a Cricopharyngeal diverticulum What is the first Dx test if this is suspected and what is avoided
Dysphagia Regurg Halitosis Mass , Possible recurrent aspiration pneumonia Barium Swallow- shows size/location DONT do endoscopic exam
121
How is Zenkers Tx and how fast is recovery ? is present in 80% of PTs w/ GERD
Cricopharyngeal myotomy- division of the muscle, PT eats day after surgery Hiatal hernia
122
Sxs of esophageal GERD Sxs of extraesophageal GERD Criteria to Dx GERD
Burn Regurg Angina Dysphagia Hoarse Cough Laryngitis Asthma Dental erosion + pH test Esophageal muscle breaks on endoscopy Barret esophagus on biopsy Peptic stricture w/out Ca
123
? procedure is important when evaluating GERD? What is the gold standard and additional criteria for Dx GERD? What prep do PTs need to do before the gold standard test?
EGD Ambulatory pH monitor* Mucosal breaks during scope Barrett esophagus on biopsy Peptic stricture w/out Ca Stop H2s 3 days prior Stop PPIs 7 days prior Maintain diet/exercise
124
When is an ambulatory pH monitoring test conducted What is the best way to manage PTs w/ typical GERD Sxs
No response to medical therapy Relapse after d/c medical therapy Before anti-reflux surgery Eval Atypical Sxs- cough, hoarse, chest pain PPIs- strongest acid suppressors- take 5 days for relief x 8wk trial
125
What is the MC anti-reflux procedure performed in the US What is the first initial Dx test for suspected ingestion?
Lapraoscopic Nissen fundoplication AP xray of neck, chest and abdomen
126
What are the 3 locations of the esophagus ingested objects can become lodged? When is monitoring justified for swallowed objects?
Esophageal sphincter at Cricopharyngeus muscle Level of aortic arch Diaphragmatic hiatus- level to LES Blunt/short <6cm Narrow <2.5cm Distal to pylorus
127
What is almost guaranteed to be present in an esophageal perforation >24hrs old What is the MC cause Where do Spontaneous Perf/Boerhaave Syndromes usually occur?
Severe contamination Medical instrumentation, MC in cercival esophagus at cricoparyngeal area Left posterolateral wall, above GE junction
128
How do spontaneous perfs of the cervical or thoracic region present Perfs of the thoracic region usually affect ? side What finding may be heard on EP?
Cervical: pain radiating to back, crepitus, dysphagia, Sxs of infection Thoracic: tachy, tachy, dyspnea HOTN L Mediastinal crunch w/ systole- Hamman sign
129
What will be seen on x-rays of esophageal perfs in cervical or thoracic regions? What is the first and second test performed on all PTs w/ suspected esophageal perf? What would be seen on fluid analysis of a thoracentesis?
Cervical: air in soft tissues Thoracic: mediastinal widening, effusion, PTX Esophogram w/ water soluble contrast, if no leak- Repeat w/ barium Chest CT- best to localize Inc Amylase along w/ serum amylase if long standing
130
All spontaneous esophageal perfs receive ? ABX immediately What type of PT is suspected of having Mallor Weis tear and what is the rule about them
Broad due to polymicrobes- Staph, Strep, Pseudo and Bacteroides Non-bloody vomit to bloody vomit, stop w/out therapy
131
Since most resolve spontaneously, what surgical procedure is done if needed? Ingestion of acids lead to ? necrosis and ingestion of alkalines leads to ? necrosis and result in ? perf
Injection, clipping, banding Oversewn w/ anterior gastronomy and ligation Coagulation- protein precipitation, eschar Liquefactive- Frank perforation
132
How is the severity of a chemical injury in esophagus determined How are these PTs Tx
pH, Volume, Contact time Fluid and Support Possible EGD Frank perf/instability= surgery, reconstruction w/ colonic interposition
133
3 adverse outcomes from chemical burns on esophagus
Webs- fold into lumen in middle/lower 1/3, Dx w/ BSwallow; Tx dilation w/ Savary Bougies/balloon Rings- lower 1/3, mucosal or muscular (no dysphagia/Schatzki at z-line w/ GERD; same Tx as webs Stricture- end stage of reflux ulcerative esophagitis; Tx w/ acid suppression, biopsy and dilation
134
Carinoma of esophagus is primarily in ? PTs Adenocarcinoma of esophagus usually appears in ? PTs What are the MC RFs to squamous cell carcinomas?
Asia Africa Iran men w/ association to smoking, ETOH, Nitro and hot drinks M w/ barretts, GERD*, obesity tobacco (lifestyle) Smoking, Chronic alcohol
135
What is the MC Sx of esophageal Ca since they're usually ASx How are these growths viewed What test is the most sensitive to assess the depth of penetration?
Dysphagia Barium- location/extent Endoscopy- visualization/biopsy Bronchoscopy- if in upper/midesophagus Endoscopic US- also allows for FNAspiration of nodes
136
How are esophageal Cas Tx What is the goal of non-op Tx What is the most important prognosis factor for esophageal Ca
pT1a- EMR/RFA T1b/T2- esophagectomy Rad/Chemo for advanced Relief of dysphagia Staging
137
Stomach passes through what two compartments of the body Jejunum is AKA and starts at ?
Retro and Intraperitoneal Vasa Recta Ligament of Treitz
138
What are the 4 types of hiatal hernias What test is excellent for assessing and which one is difficult to assess w/
1: sliding, GI contents move into mediastinum w/ burn/regurg MC sxs 2-4: paraesophageal hernia; risk for strangulation Upper GI series w/ barium -EGD
139
What test is done to assess hernias if PTs have functional dysphagia What is the gold standard Tx for hiatal hernias
Cine-esophogram Laproscopic Nissen fundo w/ MGJR
140
Obese is classified as BMI > ? and the only effective intervention is ? What are the MC adverse effects of LAGB procedure What are the criteria for PTs to be considered for surgery
>30kg/m^2, bariatric surgery Slippage Pouch dilation BMI >40/>35 w/ apnea, cardiomyopathy, DM 12-18/>65y/o w/ BMI 30-34.9 w/ obesity comorbidity Non-surg Tx failure
141
? GI procedure has shown to inc survivability x 10yrs What is the MC adverse Sx after surgery What is the MC weight loss surgery done in the US?
RYGB Dehydration, E+ imbalance Most concerning- anastomotic leak LSG
142
Gastric/pyloric ulcers are caused by ? Difference in Sxs between gastric and duodenal ulcer? What is the average incidence of gastric ulcers
H pylori NSAIDs Hypersecretory state (Zollinger Syndrome) D: better w/ food G: worse w/ food, less common though 40-60 or 10yrs older than duodenal ulcers
143
What is the most accurate method to Dx peptic ulcers What lab test is useless unless PT has Zollinger Syndrome? What does an ulcer seen on x-ray signify?
Endoscopy Fasting serum gastrin Ulcerated malignant tumor
144
What is the difference in ridges seen on endoscopy of Ca or benign ulcers How many biopsys are taken during this procedure?
Ca- rolled edges w/ meniscus sign Benign- flat edges 6 and brush biopsy from edge
145
What are the characteristic findings of PTs w/ ZES? When are PTs screened for ZES?
Hypergastremia Severe PUD Non-B islet pancreatic tumors Distal d/j ulcer Refractory to PPIs Recurrent despite Tx
146
How is ZES Dx What is the imaging study of choice and how is it Tx
Inc fasting serum gastrin Dec gastric pH Inc basal acid After 1wk of no PPIs Somatostatin receptor scintigraphy
147
What is the H Pylori Tx of choice What is the test of choice for confirming successful eradication?
Amoxicillin, Clarithromycin, Omeprazole x 7 days Urea breath test
148
Surgical intervention is needed for bleeding ulcers if mor than ? packs are needed for transfusion How are perforated duodenal ulcers Tx
>6 Graham pathc- omental patch, patch w/out vagotomy needed
149
What are 3 complications that can occur after upper GI surgery How is dumping syndrome managed It is typically seen in PTs that had ? procedure
Post-antrectomy- leakage Delayed emptying >60% of stomach removed= loss of reservoir function Diet therapy w/ low carb/high fat/protein diet to reduce jejunal osmolality RYGB and foods w/ sugars
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Dumping Syndrome can have ? 2 system Sxs Gastric CA is predominantly seen in ? PT population What is the primary Dx test
Cardio/GI Japan, China M>F , peak in 7th decade Endoscopy w/ biopsy
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? is the MC surgical d/o producing emesis in infants What is the most sensitive/specific test for this condition? Duodenal ulcers are not associated w/ ?
Pyloric stenosis Abdominal US when muscles are >4mm thick/pylorus >16mm long Cancer
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Infants w/ pyloric stenosis will present in ? metabolic condition PTs w/ duodenal ulcers must have ? procedure w/in 24hrs
Hypocholremic HypoK metabolic alkalosis EGD
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Initial management of PTs w/ UGI bleeds is ? What is the therapeutic alternative if endoscopy fails to control bleeds?
``` Hemodynamic stability IV PPIs (Pantoprazole) ``` Angiographic embolization
154
Ulcers lasting longer than ? need to be resected to r/o GI Ca What is the acid reducing procedure of choice in PTs w/ duodenal ulcers?
12wks Selective vagotomy
155
What is the MC cause of SBOs What is the difference in presenting Sxs of an upper or lower SBO How does the PT present if there is a strangulation present?
Incarcerated hernias Upper- emesis after eating Lower- poorly localized abdominal pain Fever, crampy pain turns to peritonitis
156
What Tx is mandatory for PTs presenting w/ SBO and strangulation What are ominous signs of an incarcerated hernia?
Fluids, E+ correction Cath to monitor I/Os Decompress w/ NG tube Fever Tachy AMS
157
# Define Volvuli How do PTs present How are volvuli Dx
Closed loop obstruction w/ high risk of strangulation/infarct/perf MC sigmoid then cecal N/V massive distension, acute pain Colonic- x-ray SmInt: CT
158
PTs with a sigmoid volvulus will need surgery if presenting w/ ? Sxs or if volvulus is ? to sigmoid Volvulus proximal to sigmoid have higher chances of ? If Dx is unclear, what test is next
Toxic Blood per Rectum Leukocytosis/fever Sxs absent= sigmoidscopy Proximal Strangulation Barium enema
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What type of sign may be seen on barium images in PTs w/ volvulus What will be seen if volvulus is in cecal region?
Target No air distally
160
Intussusception usually develops between ? ages in ? way Other than obstruction Sxs and bloody stools, PTs present w/ ? How is it Dx How is it Tx
6mon-2yrs Invagination of small bowel into cecum Lethargy Target sign on sonogram Air and Contrast enema
161
High speed MVCs can generate ? abdominal trauma Define Radicle
Mesenteric bucket handle tear= SBO Smallest branch of vessel/nerve
162
What is a rare complication of gallstones that is actually a misnomer Define Rigler Triad
Ileus- obstruction of small bowel by cholecystoenteric fistula Gallstone ileus Dx: Pneumobilia Bowel obstruction Gallstone in bowel
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How are gallstone ileus' Dx What are the buzz words for Crohns Normal Crohns is Tx w/ ?
CT Cobble stone Skip lesion 5-ASA Steroids ABX
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What surgical procedure may provide Crohns PTs relief What are the MC benign and Ca tumors of the small bowel Malignant tumors tend to inc in frequency when heading in ? direction of the GI tract but w/ ? exception
Small bowel strictureplasty- longitudinal enterotomy close in horizontal fashion B :Leiomyomas Adenomas Ca: adenocarcinoma Prox to Dist Adenocarcinomas
165
What are the MC endocrine tumors of the GI tract What is the MC presentation of benign tumors
Carcinoid Episodic cramps w/ intussception, then chronic bleeds/IDA
166
Define Carcinoid Syndrome
Hot flashes Bronchospasm Arrhythmias Associated w/ carcinoid tumors in GI tract and liver can't compensate
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Majority of small bowel malignancy are ? 3 Adenocarcinomas in the duodenum are Dx by ? Lesions in first 100cm of small bowel are evaluated viz ?
Carcinoid Adenocarcinoma Lymphoma EGD Push enteroscopy
168
# Define Bezoar What are the 4 types What is the MC culprit
Foreign material stuck in stomach/tract usuallly in post-gastreoectoy PTs Phyto- vegetable fiber Lacto- milk Pharm- meds Tricho- hair Orange segments Fruits w/ high cellulose
169
Cystic duct joins ? to form the ? ? artery feeds the R side of the liver and gallbladder
Common hepatic Common bile duct Cystic, branch of R hepatic
170
Location and function of Sphincter of Odi Define Chole Defie Cholecyst
Surrounds common bile duct w/ Ampulla of Vater. Directs bile into duodenum/gallbladder Bile/gall
171
# Define Cholecystitis Define Cholelithiasis Define Choledocho
Inflammation of gallbladder Stone in gallbladder Bile duct
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# Define Choledocholithiasis Normal gallbladder wall is ? thick Name of therapeutic preferred procedure to view biliary tree, remove stones and view ducts in gallbladder
Stones in bile duct 4mm or less ERCP
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What test is a non-invasive way to view biliary tree and is equivalent to ERCP/cholangiogram What is the advantage of this procedure
MRCP No contrast
174
What is the most sensitive/specific study for Dx acute cholecystitis If cystic duct is blocked, what will be seen during this procedure?
Cholescintigraphy (HIDA)- gives anatomic and functional info Gallbladder not visualized CBD and duodenum fill w/ tracer after 1hr
175
What is the MC abdominal surgery What factors inc the formation of bile stones
Cholecystectomies Estrogen- inc cholesterol Hemolysis- inc unconjugated bili, collects as CaBilirubinate
176
Syptomatic Cholelithiasis usually present how? What PTs w/ chornic cholecystitis are recommended for MRCP
Post-high fat meals Transaminitis H/o biliary pancreatitis CBD dilation
177
If PT is not candidate for cholecystectomy, what can be attempted for non-surg Tx How do PTs w/ acute cholecystitis present When/why would a HIDA be done?
PO ursodeoxycholic acid (UCDA), most effective if stone is <15mm ESWL if stones are <2mm Pain N/V/F Neg/equivocal US
178
What is the optimum time for performing laproscopic cholecystectomy Define Primary/Secondary Choledocholithiasis
72hrs since Sx onset P: stricture and choledochal cyst S: gallstone in CBD
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How does choledocholithiasis present This condition is a leading etiology of ? What will be seen on lab results
Abd pain radiating to back Acholic stool Jaundice Pancreatitis Leukocytosis Inc Serum bilirubin Inc ALP
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What PTs are considered high risk w/ suspected choledocholithiasis Define Charcot's Triad Define Reynold pentad
>55y/o Bili >30 CBD >6mm Visible stone on US Cholangitis- Biliary colic Jaundice Fever Charcot w/ HOTN and AMS
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What are the predominant microbes in cholangitis What procedure is dangerous during this condition
``` E coli Klebsiella Pseudomonas Enterococci Proteus ``` Cholangiography
182
Most cases of cholangitis can be Tx w/ ? ABX What are the indications for a cholecystectomy
Cipro + Metron Sx cholelithiasis Cholecystitis Cholangitis Cholangiocarcinoma
183
Open cholecystectomy is done via ? incision ? division puts liver in 8 segments Where does the common hepatic artery arise from
Kochers Couinaud Celiac axis
184
What is the portal triad Liver is the only source for ? and ? Production of ? is the primary index of hepatic function
Hepatic artery Portal vein Biliary duct Albumin Alpha globulin Serum protein
185
Vit K dependent clotting factors made in the liver What is the MC sequelae injury after the MC trauma of blunt force trauma? If arterial psuedoaneurysm forms, how are they best Tx
2 7 9 10 Biliary fistulae Hepatic arteriography/embolization
186
What are the findings if pneumobilia is present Define Biloma and how are they Tx
Ischemic bowel Necrotic gall bladder Isolated collection of bile ERCP and sphincterotomy
187
What is the most common hepatic cyst What type of liver cyst should not be aspirated but only resected What is the name of a pre-malignant liver cyst
Simple Echinococcosis Cystadenoma
188
# Define Cyst Fenestration What type of Polycystic liver dz needs a transplant What is the MC liver tumor
Type I PLD: <10 cysts 10cm or larger Type 3 Hemangioma
189
Hepatic adenomas may be associated w/ ? Hx Define Focal Nodular Hyperplasia What is the major RF for hepatocellular carcinoma
OCP Androgen steroid use Female 30-50 w/ hot nodule ``` Liver Dz- Hep B/C Aflatoxin B1 A1-antitrypsin Hemachromatosis Primary cirrhosis ```
190
# Define Acute Liver Failure Define Fulminant hepatic failure What is the primary cause of Acute liver failure
No liver Dz, dz develops w/in 8wks of onset Encephalopathy w/in 2wks of jaundice onset Tylenol toxicity
191
What can be give to PTs w/ chronic liver dz to prevent first bleed Define Budd-Chiari syndrome
BBs ALF in women w/ hpercoagulable states
192
Main pancreatic duct is called ? Accessory duct is called ? First sign of pancreatic head adenocarcinoma
Wirsung Santorini Jaundice
193
Exocrine glands of pancreas are called Best Dx imaging for pancreatitis is ? Dx reqs two of what 3 criteria
Acini- enzymes, pancrease fluid, E+ CT w/ contrast Abd pain Serum amylase/lipase CT/MRI finding
194
# Define BISAP acronym What is the most useful serum test in pancreatitis
``` Bedside index of acute pancreatitis severity BUN >25 Impaired mental status SIRS Age >60 Pleural effusion ``` CRP >150
195
? Tx step is required in all pancreatitis PTs What is the clinical tetrad of chronic pancreatitis What metabolic abnormalities are sometimes seen
Chemoprophylaxis Abd pain Weight loss Diabetes Steatorrhea Hyper Ca/TG
196
Large duct pancreatitis are Tx w/ ? procedure? Smalle duct is Tx by ?
Puestow or Frey Whipple Beger Frey
197
What is the 2nd MC GI tract malignancy What is a defining characteristic of this type of Ca
Ductal adenocarcinomas Aggressive
198
How does pancreatic cancer present These PTs get ? scans in order
Biliary obstructions w/: courvoiser sign, acholic, dark urine, jaundice All get CT ERCP if no masses Upper GI series
199
What is the operative procedure of choice for pancreatic cancer What is the most common PNET What are the Sxs related to
Whipple- pancreaticoduodenectomy Insulinoma Cerebral glucose deprivation Weight gain
200
# Define Whipple Triad How are insulinomas Dx
Dx criteria for insulinoma: Hypoglycemic Glucose <50 during Sxs Relief of Sxs by IV glucose 72 monitored fast: glucose insulin, c-peptide, proinslin, b-hydroxybutyrate
201
What is the MC type of gastrinoma Most are located within ?
PNET in MEN-1 Gastrinoma triangle: pancreatic neck 2 and 3rd portion of duodenum junction Cystic and Common duct juntion
202
How do PTs w/ gastrinoma present How is it Dx All PTs w/ MEN-1 should be screened for ?
Abd pain and diarrhea w/ absent PUD Fasting serum gastrin >1000pg If level is borderline, do secretin provocation test HyperCa Parathyroid adenoma
203
75% of accessory spleens are located ? What are the major functions of the spleen
Splenic hilum Red pulp- hematologic White pulp- ImmGbn Marginal zone- macrophage, B-cell
204
PTs w/ ? Sxs due to trauma may need spleenectomy What procedure may be done it PT is responding to bleeding control/resuscitation efforts
HOTN Coagulopathic Acidotic Hypothermic Splenorrhaphy/mesh wrap
205
? type of micrboes are of concern in post-op spleen PTs When do these PTs need to get vaccines
Encapsulated: Strep Pneumo, H flu, Meningococcus 2ks prior to elective surgery 2wks after emergent surgery On day of d/c if <2wks 3mon after chemo/rad