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IPAP > Surgery: Block 1 > Flashcards

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
Q

PT w/ elevated pre-op BUN= ?
PT w/ elevated creatinine= ?

All Pts w/ ? need to have these two labs drawn during the pre-op

A

Dehydration
Inc mortality

Renal impairement

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26
Q

Proteins/glucose found in a UA mean?

Casts found in urine mean ?

What can the urine Na/Creatinine can be used to calculate?

A

Injured glomeruli

Nephritis Glomerulonephritis Tubular necrosis

Fractional excretion of sodium- determines if origin of renal failure is pre/post renal

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27
Q

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?

A

Leukocyte esterase
Nitrites

SpecGrav- norm 1.010

Goal directed/Protocol based fluid restriction

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28
Q

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?

A

Secondary to hypovolemia
IV fluids, not diuretics

Carotid artery stenosis (bruit)

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29
Q

Define Neuropraxia

How is Neuropraxia classified

A

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

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30
Q

? type of PT Hx may indicate greater chance for development of a Surgical Site infection?

These chances are higher following ? procedures

A

DM

Cardiac
Or inc stay/infection risk in non-cardiac PTs

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31
Q

What is the desirable glucose range for critically ill PTs

Chronically hyperglycemic PTs are frequently ? and ? is used in the InPT setting for fluids

A

<140 fasting
<180 regular

Dehydrated
IV Dextrose

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32
Q

Pain causes ? release and subsequent ? release

Intravascular volume loss will cause PT to develop ? Na

A

ACTH- Epi, NorEpi, Cortisol
ADH from PostPit

Low serum Na due to water retention

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33
Q

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

A

Addisonian crisis- HOTN, HypoNa, HyperK+

Stress dose steroids

Euthyroid

Hyper: thyroid storm
Hypor: cardiac failure

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34
Q

Why would supplemental steroids be given to PTs pre-op

PTs undergoing ? moderate or ? major stress procedures should have addistional CCS administered

A

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

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35
Q

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

A

Methimazole or Propylthiouracil and BBs

Potassium Iodide

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36
Q

What findings are seen if PT has perioperative hypothermia

How is this corrected

A

Hypothyroidism

PO Levothyroxine

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37
Q

PTs w/ thyroid goiters should avoid ? imaging procedure

PTs need to stop blood thinners ? before surgery

? PE finding can indicate PT has hemophilia

A

CT w/ contrast, may provoke thyrotoxicosis

Warfarin- 5 days
7 days

Deformed joints
Joint bleeds

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38
Q

? 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?

A

Hypoalbuminemia <3.0mg

1wk

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39
Q

What use/benefit does albumin have?

What blood component is preferred and considered more superior?

A

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

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40
Q

What lab finding may suggest chronic malnutrition?

What result would suggest acute malnutrition?

A

Albumin <3g, t1/2 of 14 days

Prealbumin <16mg, t1/2 of 2 days

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41
Q

__% weight loss can result in delayed wound healing, anergy or decreased pulmonary reserve

Anergy is also indicative of ?

A

12% or more

Immune response failure

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42
Q

What fluids are used in the pre-op setting for fluid resuscitation

If internal milieu is lost, what system can suffer irreversible consequences

A

Crystalloids- NS, LR
PRBCs

Neuro

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43
Q

? of body fluid is ? while the remaining is ?

Of the remaining fluid, how is it divided up?

A

2/3 intracellular (K+)
1/3 extracellular (Na)- 1/3 similar to seawater

3/4 interstitium
1/4 intravascular

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44
Q

How are intracellular Na levels kept low?

Hypovolemic induced oliguria produces ? type of urine

What purpose does the FENa hold?

A

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

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45
Q

Hypovolemia in surgical PTs is due to loss of ? fluid

Hypovolemia stimulates aldosterone to be secreted from ? causing ?

A

Isotonic

Zone glomerulosa adrenal cortex
Inc Na/water absorption

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46
Q

What post-op findings are indicative the kidneys are trying to retain volume

Oliguria is also a consistent finding of early ?

A 
Na <20 mEq
Chloride- useless unless metabolic alkolosis
Osmolality >500
SrCr ratio >20
BUN >20

Shock in the absence of hyperosmolar induced diuresis

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47
Q

? 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

A

Oliguria

Adult: <0.5mL/kg/hr
Child: <1mL/kg/hr
Infant: <2mL/kg/hr

1L/24hrs
0.5mL/kg/hr

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48
Q

How much insensible fluid loss occurs from skin, lungs and GI tract

SpecGrav > ? indicates hypovolemia

A

Skin/lung: 600ml/24hrs
GI: 250ml/24hrs

> 1.020

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49
Q

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

A

Cold skin

Dec blood flow to skin

Hypovolemic shock

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50
Q

Criteria for profound hypovolemic shock is ? and will have ? VS always be low

After resuscitating hypovolemic shock, ? finding will always be present

A

> 30%
BP

Metabolic acidemia

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51
Q

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?

A

Volume depletion
About to be NPO > 12hrs
Inc insensible losses

Diminished flow to skin*
Difficulty getting IV access
Cold skin- early, non-specific

RA

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52
Q

What is the purpose of doing a PAC

This procedure is only done for ? PTs

A

Swan Ganz in central venous to distal PulmArt to measure:
central venous pressure
capillary wedge pressure
RV SV

Cardiac instability w/ multiple comorbidity

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53
Q

3 benefits of placing a Foley

What are the indications to place a Foley

A

Hematuria
Output monitoring
Empties bladder

Prolonged sedation
I/Os
Pre-Op
Neurogenic bladder

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54
Q

S/Sxs PT has cystitis?

S/Sxs PT has pyelonephritis

A

Dysuria, mild fever

High fever Flank pain Ileus

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55
Q

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/ ?

A

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

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56
Q

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?

A

Mental status
Urine output
HR/BP

30cc/hr

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57
Q

What are 5 issues that can cause hyponatremia

PTs w/ CNS S/Sxs related to HypoNa are Tx w/ ?

A 
CHF
CSWS
Hyperglycemia
Liver Dz
SIADH

NS and free water restriction

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58
Q

What is the adverse outcome from increase Na too quickly?

Why are DM PTs at higher risk of developing HypoNa post-surg?

A

Osmotic demyelination

Hyerpglycermia- draws water from intracellular space to extracellular space

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59
Q

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?

A

GI loss Diuretic Malnutrition

Diaphragm paralysis
Flat/inverted T
Prominent U

HypoMg Tx

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60
Q

PTs w/ prolonged alkalosis from HypoK can develop ? issue

What are the hallmark signs of HypoK

A

Paradoxical aciduria- nephron conserves HCl and K, loss of H+

Dec muscle contraction leading- diaphragm paralysis, ECG changes (flat T, prominent U, arrythmias)

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61
Q

HyperK is often cause by ? but can also be due to ?

How does HyperK present on EKG

A

Renal/adrenal insufficiency
Crush Burns

Flat P
Peaked T
Wide QRS

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62
Q

What level of HyperK is considered a medical emergency?

How is it Tx

A

> 6.5mmol, reqs conitinuous EKG monitoring

IV 50% dextrose in water
10u regular insulin
Ca gluconate
Inhaled B adrenergic agonist

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63
Q

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?

A

BIG- push K from extra to intracellular spaces
CaGlu- inc excitability threshold to protect myocardium

Loop/TZD diuretic

Hemodialysis

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64
Q

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?

A

PO Sodium Polystyrene sulfonate

Edwards EV1000 w/ serum lactate

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65
Q

After severe trauma/sepsis, how do PTs show signs of Intravascular coagulation?

When would a hemodynamically stable but critically ill PT receive blood transfusion?

A

Prolonged clotting times
Low platelets, fibrinogen
Production of fibrin degeneration products/monomers

Hgb <7.0 (Hct 21%)

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66
Q

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?

A

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)

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67
Q

Bile and fluids in small intestine have an E+ content similar to ?

Saliva, gastric juice and R colon fluids have high ? and low ?

A

LR

High K, low Na

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68
Q

What fluids are used in resuscitation secondary to hypovolemia?

Avoid adding extra ? in first 24hrs post-surg because?

A

Crytalloids- LR or NS

K, aldosterone inc post-surg= saved K+ ions

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69
Q

Define Maintenance Rate

How is Maintenance Rate maintained?

Define Replacement Rate

A

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

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70
Q

Fluid losses exceeding ?mL need to have E+ concentrations measured

Heparin/saline locks are useful when?

Abdominal pain assessment divides area into ? 3

A

1500mL

ABX, PRN pain meds

GI Biliary GU

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71
Q

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?

A

Hypothermia Coagulopathy Acidosis

20min: O- PRBCs, if unavail-
O+

Factors RBCs Ags Plasma 5/8 Anticoagulanta
Non-functional platelets and granulocytes
Massive loss/hypovolemia

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72
Q

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?

A

1g, 3%

1L isotonic crystalloid- LR/NS
Empiric transfusion
No excess crystalloids, worsens coagulopathy/vicious triad

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73
Q

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?

A 
Whole 
Plasma/RBCs Platelets 
Plasma RBCs
Plasma or RBCs
Hextend
Crystalloids- LR/PLA

Severe shock
Intraperitoneal blood
Complex pelvic Fx
Bilateral femur Fx

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74
Q

What are the colloids?

A

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

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75
Q

Hextend

Tranexamic Acid

Hypertonic Saline

A

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

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76
Q

Define Uremic bleeding and how it’s Tx

Cryoprecipitate

A

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

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77
Q

vWF levels below _% are at risk for massive hemorrhage

How is VWDz corrected

Antifibrinolytics are preferably used in ? setting

A

30%

Desmopressin, Cryoprecipitate or vWF/F8

Massive hemorrhage- Aprotinin, TranAcid, AminoCaproic Acid: reduce transfusions in elective/cardiac surgeries

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78
Q

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 ?

A

24hrs: thrombosis, infxn

Medullary sinus
24hrs

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79
Q

Where can central lines be placed

Central lines are placed using ? technique

A

Subclavian Jugular Femoral Cephalic vein

Seldinger

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80
Q

What is unique about the PICC

Indications for arterial line

What are the three broad categories of peripheral IV complications

A

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

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81
Q

MC adverse effect of internal jugular and femoral venous line attempts?

MC adverse effect of subclavian line attempts?

A

Artery puncture

Pneumothorax

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82
Q

How does an air embolism present and how is it Tx

How can this adverse outcome be avoided during line placement?

A

Severe distress HOTN
Cogwheel murmur
Durant position: Trandelenburg and LLD- emoblus to apex of RV, needle aspiration

PT in Trandelenburg position

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83
Q

IV hydration methods are good for up to ?days before need to consider ? methods

? route is used in ICU/sedated w/ secured airway?

A

7 days, P/TPN

Orogastric tube- not for conscious PT, stims gag reflex

84
Q

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?

A

E+ daily
Pre-albumin weekly

Gastric tube: NG/OG under Low Suction
Gastric tube is NOT feeding tube

Cribifrom/basilar skull Fxs

85
Q

Name of tube used for duodenal/jejunal nasoenteric feeding

Why metabolic condition may develop in PTs undergoing prolonged gastric suction/vomiting?

Define Refeeding Syndrome

A

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
Q

What are early complications in TPM therapy

PTs can start eating through feeding tubes starting ? long after placement

A

Hyperglycemia
Hyperchloremia acidosis

Day 2

87
Q

How are visceral sensations carried within the abdomen

Why is visceral pain commonly felt at midline?

A

Afferent C fibers- viscera walls, solid organs capsule from distention/inflammation/ischemia
Slow dull onset

Bilateral sensory supply of spinal cord

88
Q

How are parietal pain sensations carried?

Why is parietal pain better localized?

Cutaneous sensation of the parietal pain is due to ? spinal levels

A

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
Q

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 ?

A

4 quadrants, epigastric or central areas

<24hrs
Hx, PE w/ MC and predominant Sx: pain

90
Q

What causes rectus muscle rigidity during an abdominal exam

What effect does pressing on a PT w/ guarding have?

A

Rare neuro d/o
Renal colic
Peritoneal inflammation

Voluntary- relaxes
Involuntary- remain board like

91
Q

Scaphoid appearing abdomen are indicative of ?

When causes visible peristalsis to be seen?

What is the cause if PTs abdomen is soft/doughy

A

Perforated ulcer

Advanced bowel obstruction

Paralytic ileus/mesenteric thrombus

92
Q

What would be heard in abdomen w/ mechanical bowel obstruction

Absent bowel sounds indicates PT has?

A

High pitched tinkle/rushes

Paralytic ileus

93
Q

What could it mean if these signs are positive

Tympany on percussion indicats?

A 
Iliopsoas- abscess
Obturator- trapped bowel 
Rovsings- appendicitis
Kehr- hemoperitonium
\+CVA- pyelonephritis

Bowel obstruction
Hollow viscus perf

94
Q

Sequence of abdominal exam

? pre-op test is mandatory in elderly Pts

What lab result would be elevated in PTs w/ pancreatitis

A

Inspect Ausc Perc Palp

Electrocardiography

Lipase

95
Q

? 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?

A

Bowel ischemia due to mesenteric ischemia

Helical/spiral CT

Upright CXR, more sensitive for intraperitoneal air

96
Q

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

A

CBC Blood chemistry UA

Gas pattern
Extraluminal air
Abdominal calcifictions
Soft tissue masses

Flat/upright abdomen + CXR to look for hemo/pneumo peritoneum

97
Q

What does subdiaphragmatic air indicate?

What does a thumbprint impression an an abdominal x-ray indicate

What finding indicates a pylephlebitis

A

Perforated viscous

Ischemic colitis

Air in portal venous system

98
Q

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 ?

A

Kerkring folds- plicae circulares/valvulae conniventes

L1-2, over R renal A/V and IVC

Wide: distal LoTreitz
Narrow: prox ileocecal valve

99
Q

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

A

Mech: localized, severe, MC in small bowel
Ilius; diffuse, milder, more common post-op

Splenic

Alvimopan- selective Mu receptor antagonist

100
Q

Constipation is not indicative of obstruction, but what combo is?

NG tubes should be placed in PTs presenting w/ ? 4 things

A

Obstipation + painful distention/repeat vomit

Hematemesis Suspected obstruction Severe vomit/ileus

101
Q

What are the MC causes of SBOs and LBOs

Image finding of a ‘step-ladder’ appearance is indicative of ? and begin ?

A

Sm: Hernia Adhesion Tumor
L: Volvulus Ca Diverticula

Mechanical SMO
LUQ

102
Q

Calcification of the bladder wall is uncommon in ? 3 Dzs

What does a cloud-like amorphous/popcorn appearance indicate?

Linear/track like calcifications imply ?

A

Schistosomiasis
Bladder Ca
TB

Calc/tumor in solid organ

Calcification in walls of tubular structures

103
Q

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

A

Around nidus inside hollow lumen

24hrs, 48hrs

Gastrografin (Meglumine Diatrizoate)

104
Q

What secondary signs may be seen on CT scans?

Upper GI w/ follow through means ? and is assessed by ?

A

Fat stranding
Extravasation

Esophagus to duodenum
Barium swallow

105
Q

CT contrast enhances vessels and ?

? imaging test can be therapeutive and Dx for GI issues

What image is ordered to see bladder and urethra

A

Parenchyma

Limited BE

Retrograde urethrogram, shorter catheter than cystogram

106
Q

? 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

A

HIDA/gallium

Tc-sulfur colloid scan
Tech-pertechnetate in Meckels

F/N/V/intractable pain

107
Q

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

A

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
Q

Emergent surgery examples

During appendectomy, what anatomical landmarks can help locate the appendix

A

Blunt/Penetrating trauma
Aoritc transection
Ruptured aneurysm

Taeniae of colon, converge at base

109
Q

What blocks appendix

Appendicitis has what 3 processes occurring

A

Fecalith- adults
Hyperplasia- kids
Tumors

Obstruction= distention
Infection= ischemia
Perforation= peritonitis
110
Q

What is Alvarado’s Scoring method

A 
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
Q

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?

A

Fossa: McBurneys
Pelvis: rectal/obturator
Retro/Retro: psoas
RUQ: pregnant, pelvic mass

Retrocecal or Pelvic

Retrocecal

112
Q

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?

A

Inc wall thickness, >6mm
Fat stranding

MRI

Aerobic/faculative bacteria
anaerobes

113
Q

What ABX can be used for appendicitis

What microbes are usually isolated?

A

Pef: Cipro + Metronidazole
No Perf: Cephalosporin w/ Cefoxitin at pre-op

Milophila wadsworth
Lactobacillus
V Strep
B Fragilis
E Coli
Enterococci
P Melaninogenica
114
Q

? duct is remnant of embryonic yolk sac and can fail to fully dissolve

Define Fothergill Sign

A

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
Q

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

A

Pre-term labor, rarely delivery

Appendicitis
RUQ pain Tenderness Leukocytosis

116
Q

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

A

Kids, Developmental delay, Elderly

Obese Pregnant

Carcinoid- MC site of carcinoids in GI tract
Lymphoma
Adenocarcinoma

117
Q

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?

A

Veress needle/Hasson trocar- pneumoperitoneum w/ CO2

Midline infraumbilical port- 12mm

118
Q

What’s the name of the esophagus/stomach junction

Pertaining to the esophagus, what are the most important veins?

Why is this drainage important?

A

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
Q

Where does blood back flow into during portal HTN?

What is the MC diverticulae

A

Coronary vein/esophageal venus plexus to azygos vein to SVC

Zenker- pulsion type false diverticulae in Killian triangle, superior to cricopharyngeus muscle

120
Q

What are the Sxs of a Cricopharyngeal diverticulum

What is the first Dx test if this is suspected and what is avoided

A

Dysphagia Regurg Halitosis Mass , Possible recurrent aspiration pneumonia

Barium Swallow- shows size/location
DONT do endoscopic exam

121
Q

How is Zenkers Tx and how fast is recovery

? is present in 80% of PTs w/ GERD

A

Cricopharyngeal myotomy- division of the muscle, PT eats day after surgery

Hiatal hernia

122
Q

Sxs of esophageal GERD

Sxs of extraesophageal GERD

Criteria to Dx GERD

A

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
Q

? 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?

A

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
Q

When is an ambulatory pH monitoring test conducted

What is the best way to manage PTs w/ typical GERD Sxs

A

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
Q

What is the MC anti-reflux procedure performed in the US

What is the first initial Dx test for suspected ingestion?

A

Lapraoscopic Nissen fundoplication

AP xray of neck, chest and abdomen

126
Q

What are the 3 locations of the esophagus ingested objects can become lodged?

When is monitoring justified for swallowed objects?

A

Esophageal sphincter at Cricopharyngeus muscle
Level of aortic arch
Diaphragmatic hiatus- level to LES

Blunt/short <6cm
Narrow <2.5cm
Distal to pylorus

127
Q

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?

A

Severe contamination

Medical instrumentation, MC in cercival esophagus at cricoparyngeal area

Left posterolateral wall, above GE junction

128
Q

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?

A

Cervical: pain radiating to back, crepitus, dysphagia, Sxs of infection
Thoracic: tachy, tachy, dyspnea HOTN

L

Mediastinal crunch w/ systole- Hamman sign

129
Q

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?

A

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
Q

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

A

Broad due to polymicrobes- Staph, Strep, Pseudo and Bacteroides

Non-bloody vomit to bloody vomit, stop w/out therapy

131
Q

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

A

Injection, clipping, banding
Oversewn w/ anterior gastronomy and ligation

Coagulation- protein precipitation, eschar
Liquefactive- Frank perforation

132
Q

How is the severity of a chemical injury in esophagus determined

How are these PTs Tx

A

pH, Volume, Contact time

Fluid and Support
Possible EGD
Frank perf/instability= surgery, reconstruction w/ colonic interposition

133
Q

3 adverse outcomes from chemical burns on esophagus

A

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
Q

Carinoma of esophagus is primarily in ? PTs

Adenocarcinoma of esophagus usually appears in ? PTs

What are the MC RFs to squamous cell carcinomas?

A

Asia Africa Iran men w/ association to smoking, ETOH, Nitro and hot drinks

M w/ barretts, GERD*, obesity tobacco (lifestyle)

Smoking, Chronic alcohol

135
Q

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?

A

Dysphagia

Barium- location/extent
Endoscopy- visualization/biopsy
Bronchoscopy- if in upper/midesophagus

Endoscopic US- also allows for FNAspiration of nodes

136
Q

How are esophageal Cas Tx

What is the goal of non-op Tx

What is the most important prognosis factor for esophageal Ca

A

pT1a- EMR/RFA
T1b/T2- esophagectomy
Rad/Chemo for advanced

Relief of dysphagia

Staging

137
Q

Stomach passes through what two compartments of the body

Jejunum is AKA and starts at ?

A

Retro and Intraperitoneal

Vasa Recta
Ligament of Treitz

138
Q

What are the 4 types of hiatal hernias

What test is excellent for assessing and which one is difficult to assess w/

A

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
Q

What test is done to assess hernias if PTs have functional dysphagia

What is the gold standard Tx for hiatal hernias

A

Cine-esophogram

Laproscopic Nissen fundo w/ MGJR

140
Q

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

A

> 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
Q

? 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?

A

RYGB

Dehydration, E+ imbalance
Most concerning- anastomotic leak

LSG

142
Q

Gastric/pyloric ulcers are caused by ?

Difference in Sxs between gastric and duodenal ulcer?

What is the average incidence of gastric ulcers

A

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
Q

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?

A

Endoscopy

Fasting serum gastrin

Ulcerated malignant tumor

144
Q

What is the difference in ridges seen on endoscopy of Ca or benign ulcers

How many biopsys are taken during this procedure?

A

Ca- rolled edges w/ meniscus sign
Benign- flat edges

6 and brush biopsy from edge

145
Q

What are the characteristic findings of PTs w/ ZES?

When are PTs screened for ZES?

A

Hypergastremia
Severe PUD
Non-B islet pancreatic tumors

Distal d/j ulcer
Refractory to PPIs
Recurrent despite Tx

146
Q

How is ZES Dx

What is the imaging study of choice and how is it Tx

A

Inc fasting serum gastrin
Dec gastric pH
Inc basal acid
After 1wk of no PPIs

Somatostatin receptor scintigraphy

147
Q

What is the H Pylori Tx of choice

What is the test of choice for confirming successful eradication?

A

Amoxicillin, Clarithromycin, Omeprazole x 7 days

Urea breath test

148
Q

Surgical intervention is needed for bleeding ulcers if mor than ? packs are needed for transfusion

How are perforated duodenal ulcers Tx

A

> 6

Graham pathc- omental patch, patch w/out vagotomy needed

149
Q

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

A

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

150
Q

Dumping Syndrome can have ? 2 system Sxs

Gastric CA is predominantly seen in ? PT population

What is the primary Dx test

A

Cardio/GI

Japan, China
M>F , peak in 7th decade

Endoscopy w/ biopsy

151
Q

? 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/ ?

A

Pyloric stenosis

Abdominal US when muscles are >4mm thick/pylorus >16mm long

Cancer

152
Q

Infants w/ pyloric stenosis will present in ? metabolic condition

PTs w/ duodenal ulcers must have ? procedure w/in 24hrs

A

Hypocholremic HypoK metabolic alkalosis

EGD

153
Q

Initial management of PTs w/ UGI bleeds is ?

What is the therapeutic alternative if endoscopy fails to control bleeds?

A 
Hemodynamic stability
IV PPIs (Pantoprazole)

Angiographic embolization

154
Q

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?

A

12wks

Selective vagotomy

155
Q

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?

A

Incarcerated hernias

Upper- emesis after eating
Lower- poorly localized abdominal pain

Fever, crampy pain turns to peritonitis

156
Q

What Tx is mandatory for PTs presenting w/ SBO and strangulation

What are ominous signs of an incarcerated hernia?

A

Fluids, E+ correction
Cath to monitor I/Os
Decompress w/ NG tube

Fever Tachy AMS

157
Q

Define Volvuli

How do PTs present

How are volvuli Dx

A

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
Q

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

A

Toxic Blood per Rectum Leukocytosis/fever
Sxs absent= sigmoidscopy
Proximal

Strangulation

Barium enema

159
Q

What type of sign may be seen on barium images in PTs w/ volvulus

What will be seen if volvulus is in cecal region?

A

Target

No air distally

160
Q

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

A

6mon-2yrs
Invagination of small bowel into cecum

Lethargy

Target sign on sonogram

Air and Contrast enema

161
Q

High speed MVCs can generate ? abdominal trauma

Define Radicle

A

Mesenteric bucket handle tear= SBO

Smallest branch of vessel/nerve

162
Q

What is a rare complication of gallstones that is actually a misnomer

Define Rigler Triad

A

Ileus- obstruction of small bowel by cholecystoenteric fistula

Gallstone ileus Dx:
Pneumobilia
Bowel obstruction
Gallstone in bowel

163
Q

How are gallstone ileus’ Dx

What are the buzz words for Crohns

Normal Crohns is Tx w/ ?

A

CT

Cobble stone Skip lesion

5-ASA
Steroids ABX

164
Q

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

A

Small bowel strictureplasty- longitudinal enterotomy close in horizontal fashion

B :Leiomyomas Adenomas
Ca: adenocarcinoma

Prox to Dist
Adenocarcinomas

165
Q

What are the MC endocrine tumors of the GI tract

What is the MC presentation of benign tumors

A

Carcinoid

Episodic cramps w/ intussception, then chronic bleeds/IDA

166
Q

Define Carcinoid Syndrome

A

Hot flashes
Bronchospasm
Arrhythmias
Associated w/ carcinoid tumors in GI tract and liver can’t compensate

167
Q

Majority of small bowel malignancy are ? 3

Adenocarcinomas in the duodenum are Dx by ?

Lesions in first 100cm of small bowel are evaluated viz ?

A

Carcinoid
Adenocarcinoma
Lymphoma

EGD

Push enteroscopy

168
Q

Define Bezoar

What are the 4 types

What is the MC culprit

A

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
Q

Cystic duct joins ? to form the ?

? artery feeds the R side of the liver and gallbladder

A

Common hepatic
Common bile duct

Cystic, branch of R hepatic

170
Q

Location and function of Sphincter of Odi

Define Chole

Defie Cholecyst

A

Surrounds common bile duct w/ Ampulla of Vater.
Directs bile into duodenum/gallbladder

Bile/gall

171
Q

Define Cholecystitis

Define Cholelithiasis

Define Choledocho

A

Inflammation of gallbladder

Stone in gallbladder

Bile duct

172
Q

Define Choledocholithiasis

Normal gallbladder wall is ? thick

Name of therapeutic preferred procedure to view biliary tree, remove stones and view ducts in gallbladder

A

Stones in bile duct

4mm or less

ERCP

173
Q

What test is a non-invasive way to view biliary tree and is equivalent to ERCP/cholangiogram

What is the advantage of this procedure

A

MRCP

No contrast

174
Q

What is the most sensitive/specific study for Dx acute cholecystitis

If cystic duct is blocked, what will be seen during this procedure?

A

Cholescintigraphy (HIDA)- gives anatomic and functional info

Gallbladder not visualized
CBD and duodenum fill w/ tracer after 1hr

175
Q

What is the MC abdominal surgery

What factors inc the formation of bile stones

A

Cholecystectomies

Estrogen- inc cholesterol
Hemolysis- inc unconjugated bili, collects as CaBilirubinate

176
Q

Syptomatic Cholelithiasis usually present how?

What PTs w/ chornic cholecystitis are recommended for MRCP

A

Post-high fat meals

Transaminitis
H/o biliary pancreatitis
CBD dilation

177
Q

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?

A

PO ursodeoxycholic acid (UCDA), most effective if stone is <15mm
ESWL if stones are <2mm

Pain N/V/F

Neg/equivocal US

178
Q

What is the optimum time for performing laproscopic cholecystectomy

Define Primary/Secondary Choledocholithiasis

A

72hrs since Sx onset

P: stricture and choledochal cyst
S: gallstone in CBD

179
Q

How does choledocholithiasis present

This condition is a leading etiology of ?

What will be seen on lab results

A

Abd pain radiating to back
Acholic stool
Jaundice

Pancreatitis

Leukocytosis
Inc Serum bilirubin
Inc ALP

180
Q

What PTs are considered high risk w/ suspected choledocholithiasis

Define Charcot’s Triad

Define Reynold pentad

A

> 55y/o
Bili >30
CBD >6mm
Visible stone on US

Cholangitis- Biliary colic Jaundice Fever
Charcot w/ HOTN and AMS

181
Q

What are the predominant microbes in cholangitis

What procedure is dangerous during this condition

A 
E coli
Klebsiella
Pseudomonas
Enterococci
Proteus

Cholangiography

182
Q

Most cases of cholangitis can be Tx w/ ? ABX

What are the indications for a cholecystectomy

A

Cipro + Metron

Sx cholelithiasis
Cholecystitis
Cholangitis
Cholangiocarcinoma

183
Q

Open cholecystectomy is done via ? incision

? division puts liver in 8 segments

Where does the common hepatic artery arise from

A

Kochers

Couinaud

Celiac axis

184
Q

What is the portal triad

Liver is the only source for ? and ?

Production of ? is the primary index of hepatic function

A

Hepatic artery
Portal vein
Biliary duct

Albumin Alpha globulin

Serum protein

185
Q

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

A

2 7 9 10

Biliary fistulae

Hepatic arteriography/embolization

186
Q

What are the findings if pneumobilia is present

Define Biloma and how are they Tx

A

Ischemic bowel
Necrotic gall bladder

Isolated collection of bile
ERCP and sphincterotomy

187
Q

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

A

Simple

Echinococcosis

Cystadenoma

188
Q

Define Cyst Fenestration

What type of Polycystic liver dz needs a transplant

What is the MC liver tumor

A

Type I PLD: <10 cysts 10cm or larger

Type 3

Hemangioma

189
Q

Hepatic adenomas may be associated w/ ? Hx

Define Focal Nodular Hyperplasia

What is the major RF for hepatocellular carcinoma

A

OCP
Androgen steroid use

Female 30-50 w/ hot nodule

Liver Dz- Hep B/C
Aflatoxin B1
A1-antitrypsin
Hemachromatosis 
Primary cirrhosis
190
Q

Define Acute Liver Failure

Define Fulminant hepatic failure

What is the primary cause of Acute liver failure

A

No liver Dz, dz develops w/in 8wks of onset

Encephalopathy w/in 2wks of jaundice onset

Tylenol toxicity

191
Q

What can be give to PTs w/ chronic liver dz to prevent first bleed

Define Budd-Chiari syndrome

A

BBs

ALF in women w/ hpercoagulable states

192
Q

Main pancreatic duct is called ?
Accessory duct is called ?

First sign of pancreatic head adenocarcinoma

A

Wirsung
Santorini

Jaundice

193
Q

Exocrine glands of pancreas are called

Best Dx imaging for pancreatitis is ?

Dx reqs two of what 3 criteria

A

Acini- enzymes, pancrease fluid, E+

CT w/ contrast

Abd pain
Serum amylase/lipase
CT/MRI finding

194
Q

Define BISAP acronym

What is the most useful serum test in pancreatitis

A 
Bedside index of acute pancreatitis severity
BUN >25
Impaired mental status
SIRS
Age >60
Pleural effusion

CRP >150

195
Q

? Tx step is required in all pancreatitis PTs

What is the clinical tetrad of chronic pancreatitis

What metabolic abnormalities are sometimes seen

A

Chemoprophylaxis

Abd pain
Weight loss
Diabetes
Steatorrhea

Hyper Ca/TG

196
Q

Large duct pancreatitis are Tx w/ ? procedure?

Smalle duct is Tx by ?

A

Puestow or Frey

Whipple Beger Frey

197
Q

What is the 2nd MC GI tract malignancy

What is a defining characteristic of this type of Ca

A

Ductal adenocarcinomas

Aggressive

198
Q

How does pancreatic cancer present

These PTs get ? scans in order

A

Biliary obstructions w/: courvoiser sign, acholic, dark urine, jaundice

All get CT
ERCP if no masses
Upper GI series

199
Q

What is the operative procedure of choice for pancreatic cancer

What is the most common PNET

What are the Sxs related to

A

Whipple- pancreaticoduodenectomy

Insulinoma

Cerebral glucose deprivation
Weight gain

200
Q

Define Whipple Triad

How are insulinomas Dx

A

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
Q

What is the MC type of gastrinoma

Most are located within ?

A

PNET in MEN-1

Gastrinoma triangle:
pancreatic neck
2 and 3rd portion of duodenum junction
Cystic and Common duct juntion

202
Q

How do PTs w/ gastrinoma present

How is it Dx

All PTs w/ MEN-1 should be screened for ?

A

Abd pain and diarrhea w/ absent PUD

Fasting serum gastrin >1000pg
If level is borderline, do secretin provocation test

HyperCa
Parathyroid adenoma

203
Q

75% of accessory spleens are located ?

What are the major functions of the spleen

A

Splenic hilum

Red pulp- hematologic
White pulp- ImmGbn
Marginal zone- macrophage, B-cell

204
Q

PTs w/ ? Sxs due to trauma may need spleenectomy

What procedure may be done it PT is responding to bleeding control/resuscitation efforts

A

HOTN
Coagulopathic
Acidotic
Hypothermic

Splenorrhaphy/mesh wrap

205
Q

? type of micrboes are of concern in post-op spleen PTs

When do these PTs need to get vaccines

A

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

IPAP (212 decks)

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