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IPAP > Surgery Block 1 Cram > Flashcards

Surgery Block 1 Cram Flashcards

1
Q

Taenia coli run the length of the colon except for where?

What compartment does the large intestine pass through at different points

A

Appendix
Rectum

Ascending: retro
Transverse: intra
Descend: retro

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2
Q

? part of the large intestine is vulnerable to volvulus

Where do diverticula grow

A

Sigmoid

Between mesneteric tenia and two non-mesenteric teniae
Majority: pseudo: miss muscular layer
Minority: true, predominant in R colon

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3
Q

Define Diverticulitis

Diverticulitis usually present s w/ ? but absent of ?

Diverticulosis usually presents ? PT population and in ? part of the colon

A

Inflammation of diverticulum

Pain, no bleeding

> 80y/o, sigmoid

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4
Q

What are the RFs for developing diverticulosis

What medications could be considered protective

A

Constipation + low fiber diet
NSAIDs/acetylsalicylic acid
R side diverticula
HTN or Ischemic heart Dz

CCBs
Statins

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5
Q

What is the MC cause of lower GI bleeds

What process causes this to happen

A

Diverticulosis- BRBPR w/out abdominal pain

Thinning in vasa recta wall of out pouching

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6
Q

Ligaement of Treitz is at the junction of what two parts of small intestine

How are all suspected GI bleeds investigated

How is the source identified

A

Duodenum
Jejunum

DRE
Anoscopic

NG lavage- r/o upper
Colonoscopy- optimal, Dx and Thx

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7
Q

What does endoscopic therapy done for GI bleeds include

What is the next step for lower GI bleeds after negative colonoscopy

A

Epi injection
Bipolar coagulation
Mechanical therapy

Tagged RBC scan before angiography
CT angiography- Dx and Thx

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8
Q

Indications for surgery due to lower GI bleeds

What two procedures are considered fro Tx

A

Hemorrhage
>6 unit transfusion <24hrs
Recurrent diverticular bleed

Segmental resection
Total colectomy

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9
Q

Classic Sxs of UnComp Diverticulitis

What is seen on PE

A

LLQ pain
Low fever
Const/Diarrhea w/ urgency

LLQ guarding/rebound tender
Palpable mass
Trace stool blood

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10
Q

How is complicated diverticulitis Tx

Define Colovesical fistula

Define Colovaginal fistula

A

Small abscess- ABX, rest
Large- ABX Rest Percutaneous drainage

Pneumaturia, pain, fecaluria; Tx w/ elective resection

Gas/stool through vagina or foul smelling d/c

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11
Q

What type of diverticulitis complication required immediate emergent surgery

What is the standard of care imaging modality for diverticulitis

What is avoided in these PTs

A

Free perf

CT w/ contrast- MC findings: thickened wall, inflammation, diverticula

Colonoscopy, 8wks later
Flex Sigmoid

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12
Q

How is acute uncomplicated diverticulitis Tx

If these PTs are admitted for Sxs, complications or PO intolerant, how are they managed?

A

Bowel rest
ABX gram- and aneareobes: Cipro and Metronidazole x 7-10 days
Colonoscopy 8wks later for Ca screening

Clear liquid diet
Repeat CT
IV ABX
Surg consult

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13
Q

When is elective Tx offered for diverticulitis

What is the name of the procedure

A

Stricture High risk Abscess
Perf Fistula

Hartmann procedure: sigmoid resection + end colostomy (preferred for perfs)
Primary anastomosis w/ or w/out diversion
Interval colectomy

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14
Q

What are the most significant RFs for colorectal cancer?

What colon finding indicated PT is at increased risk for CRC?

A

Non-modifiable
Mod: red/processed meat consumption, smoking/ETOH

Adenomas- villous* tubular tubularvillous
Tx: polypectomy w/ inc surveillance
Surgery if endoscopic resection not possible

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15
Q

90% of colonic polyps are ? type

How are neoplastic polyps classified

A

Non-neoplastic: juvenile hyperplastic inflammatory
hamartomas

Haggitt- lowest is ‘in situ’

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16
Q

When are colorectal screenings started

What is Tier 1

What is Tier 2

What is Tier 3

A

USMSTF- 50y/o
ACS- 45y/o

No Ca/adenoma in any FamHx: colonoscopy q10yrs or FIT q1year; start 45 AfAm, 50 for others

Ca/adenoma in Fam Hx >60y/o: CT colonoscopy q5yrs, FIT q3yrs or FlexSig q5yrs

Capsule endoscopy q5yrs

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17
Q

CRC is the MC cause of colon obstruction in adults, how does it present if it’s L sided, R sided or rectal?

A

L: hematochezia obstruction thin stools

R: anemia occult blood
RUQ mass

Rect: hematochezia
tenesmus, metastass in PoD/Blumer shelf

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18
Q

IDA is Dx as ? until further workups

What labs are drawn

A

Colon Ca

CBC CMP CXR

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19
Q

What lab is drawn post-op to monitor for colon Ca recurrence

What procedure is done if colonoscopy can’t be done for colon Ca staging

What test is reserved only for high risk PTs

A

CEA

CT colonography or,
Air contrast barium enema

PET

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20
Q

What is curative/palaltive Tx for colon Ca

What two organs need to be examined for metastases

A

Cur: removes all Ca and nodes
Pall: remove tumor to avoid obstruction/bleeding

Liver Lungs

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21
Q

What PTHx indicates considering prophylactic colectomy

What is done prior to resection?

A

Familial polyposis

Neoadjuvant radiation and/or Chemo

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22
Q

How is the extent of colon resection dictated by the location of the primary tumor?

A

Cecum/ascending: R hemicolectomy

Hepatic: extended R colectomy

Transvserse: R/L/transverse colectomy

Splenic- L hemicolectomy

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23
Q

What are the two procedures done for CRC

What are the MC causes of colonic obstruction

A

Anterior resection
APR- loss of rectum, incontinence

Colon Ca*
Stricture
Diverticulitis

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24
Q

Bowel obstruction typically present w/ ? Sx then progresses to ?

What is the single most useful test during a colon obstruction work up

A

Pain
Distention N/V Obstipation

CT of abdomen/pelvis

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25
Q

What are the DDx for colon obstruction

A

Volvulus: cecal or sigmoid, more common in elder; Colonoscopy w/ f/u surgery

Abscess- perf appendicits or diverticulitis; suspected if PT has persistent leukocytosis

Hirschprung- lack of relaxation builds up feces

UC: no granulomas, distal to proximal inflamation

CD: bear claw ulcer, noncaseating granulomas

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26
Q

How does UC present

How does CD present

Both can present w/ or w/out ? extraintestinal manifestations

A

Proctitis, bloody/mucus stool

CD: systemic Sxs, aphthous ulcer, dysphagia, anal dz

Skin lesion
Osteopenia
Sclerosing cholangitis
Eye stuff

27
Q

What is the only ‘cure’ for UC

What is makes the hemorrhoid cushion

A

Total proctocolectomy

R anterior/posterior
L lateral aspect of anal canal

28
Q

Internal hemorrhoids are lined w/ ? and innervated by ?

External hemorrhoids are lined w/ ? and innervated by ?

A

Columnar mucosa, visceral (outpt)

Squamous, somatic (anesthesia)

29
Q

What are the MC Sxs of hemorrhoids?

What procedures are warranted for pts w/ hematochezia and IDA

A

Bleed Protrusion Pain

Anoscopy
Proctosigmoidoscopy

30
Q

How are internal hemorrhoids graded

What is the goal of Tx

A

1: bleeds
2: prolapse, reduces alone
3: prolapse, manual reduction
4: always prolapsed

Large soft stools w/ colace/metamucil

31
Q

What meds can be used topically for hemorrhoids

What surgical procedures can be done for Tx

A

Nitro or CCB

Sclerotherapy
Band ligation
Excision- if acute large thrombosed and ID’d w/in 72hrs

32
Q

Rectal prolapse is AKA

What populations are these likely in?

A

Rectal procidentia

Constipated
Female/post-meno
SurgHx

33
Q

What is the difference between prolapse or hemorrhoid

Majority of anal malignancy are ?

A

Pro: circumferential folds of mucosa
Hem: radial pattern of 3 bundles

Squamous cell- rolled everted edge w/ central ulcer
Tx: excision
Chemo: best initial Tx
APR: recurrent, residual or bulky

34
Q

What is the MC endocrine tumor of the GI tract

When are these concerning?

A

Carcinoid- hot flashes, arrhythmia, bronchospasms

1-2cm: 50% chance of node involvement
>2cm: 80% have + nodes

35
Q

Who is more likely to have anterior fissures

What is the etiology if the fissure is lateral or in multiple locations

What are the leading causes of these?

A

Women

Crohns
Syphilis
TB
SCCa

Const/diarrhea
Strain/heavy lifting

36
Q

How are fissures Tx w/ topicals

What surgical procedure is done and why is it preferred

A

Nitro and Nifedipine

Lateral intenal sphincterotomy- avoid key hole deformity

37
Q

Define Perirectal abscesses

Define Perianal abscess

A

Crypto infection
Tx w/ InD

Superficial abscess, Tx in ED
Horse shoe abscess= inc risk of fistula

38
Q

Perianal abscess post-Tx doesn’t include ABX unless ? is present

What causes Pilonidal dz

A

Cellulitis

Jeep Seat Dz: infect hair follicles develop abscesses

39
Q

What is the MC condition that simulates Pilondial Dz

How are Pilondials Tx w/ surgery

A

Hidradenitis suppurativa: infection in axilla, groin and perineum, not just in intergluteal cleft

Bascom

40
Q

What are the three functional folds that prevent rectum from being strait?

Main and accessory duct of pancreas

A

Valve of Houston

Main: Wirsung
Acc: Santorini

41
Q

Why is jaundice often the first presenting sign of pancreatic head adenocarcinoma

How does the Cullen sign form

Exocrine glands of pancreas are called

A

Close relation to CBD

Extravasation follows falciform ligament to umbilicus

Acini

42
Q

Inc pancreatitis prevalence is linked to ? epidemic

Biliary pancreas Dx is suspected w/ ? lab results

A

Obesity

Galls stones seen
Abnormal LFTs

43
Q

Why does pancreatitis present w/ N/V

What is the gold standard for IDing acute pancreatitis

A

Paralytic ileus

Serum pancreatic enzyme:
Amylase cleared quickest
Lipase/Elastase last >96hrs
Most accurate: serum lipase > 3x N

44
Q

What images are taken for pancreatitis

Dx requires two of thwat 3 criteria

A

CXR- effusion means poor prognosis
RUQ sonogram
CT w/ contrast- most accurate, establishes Dx, staging, severity

Abd pain
Serum amylase/lipase
CT/MRI findings

45
Q

Severity of acute pancreatitis can be estimated w/ ? scoring systems

What is GALLA

How much fluid can be gained

A

Glasgow
Ranson
APACHE II
BISAP

Glucose Age Leukocytosis/Lactate AST

6L

46
Q

What is BISAP

What is the most useful serum test for acute pancreatitis for severity measurement

A 
Bedside pancreatitis severity measurement
BUN >25
Impaired AMS
SIRS- systemic inflamm 
Age >60y/o
Pleural effusion

CRP

47
Q

What type of fluids are used for pancreatitis resuscitation

What chemoprophylaxis is mandatory for all PTs

A

.9% NS or LR for first 24hrs

Gastric antisecretory
Anticoagulants

48
Q

How are different severity of pancreatitis Tx

A

Mild edematous- let PT eat PO as long as no N/v

Mild biliary- elective laparascopic cholecystectymy and chlangiography

Severe and evidence of cholangitis- ERCP w/ or w/out endoscopic sphinctertomy for stone extraction

49
Q

How are pancreatic pseudocysts Tx

Define pseudoaneurysms

A

Parenchymal resection

Sequelae of pseudocyst: confirm w/ cross section image,

50
Q

What lab result may be elevated due to pancreatic trauma

How is it Dx

Injuries to the ? need to be r/o

A

Amylase

Intraoperatively w/ laparotomy- drain or resect

Lumbar spine

51
Q

How does chronic pancreatitis develop

What is the clinical triad

A

Chronic alcohol
Inflammation of glandular fibrosis causes end/exocrine insufficiency (DM/steatorrhea)

Steatorrhea
Ab pain
Weight loss
DM

52
Q

What functions need to be assessed in PTs w/ chronic pancreatitis

What metabolic abnormalities may be seen?

A

Renal
Hepatic
Nutrition
HgA1c and fecal elastase

HyperCa HyperTG

53
Q

How is chronic pancreatitis Dx

Majority of pancreatic neoplasms are ?

A

Duct w/ MRCP/ERCP
Morhology w/ CT/MRI

Ductal adenocarcinomas- 2nd MC GI tract malignancy

54
Q

What is the defining characteristic of pancreatic ductal adenocarcinomas

What is the MC manifestation of pancreatic cancer

A

Aggressiveness

Biliary obstruction: acholic stool, dark urine, jaundice
Courvoiser sign

55
Q

What labs are drawn on all PTs w/ jaundice or epigastric pain

What image is ordered

A

Serum aminotransferase
Alkaline phosphatse
Bilirubin (18mg if +neoplasm)

CT
No mass= ERCP

56
Q

How are pancreatic Cas Tx

What is the MC functional PNET and how do they present

A

Resection
Whipple- TxOC
Chemo/rad

Insulinoma- cerebral glucose deprivation= AMS/LoC
Palpitations Sweat/Tremor

57
Q

How are Insulinomas Dx criteria

How is it Dx

A

Whipple Triad:
Hypoglycemic Sxs
Glucose <50
Sx fixed w/ IV glucose

72hr monitored fast

58
Q

Gastrinomas are MC in ? PTs

They’re normally in the gastrinoma triangle which is ?

How do they present

A

60-90% malignancy in
PNET in MEN-1

Pancreatic neck
2/3rd duodenum sections
Cystic/CBD junction

Abd pain/diarrhea* w/ refractory PUD

59
Q

How are gatrinomas Dx

All PTs w/ MEN1 need to be screened for ?

A

Fasting gastrin >1—pg= Dx
Borderline gastrin= secretin provocation

HyperCa
Parathyroid adenoma/hyperplasia

60
Q

What is the most important prognosis factor of gastrinomas

Define Splenomegaly

Define Hypersplenism

A

Liver metastases

Enlarged spleen from EBV/T cell lymphoma

Unregulated intrinsic activities, panctyopenia

61
Q

Why would spleens be removed

What are the MC reason for splenectomy

A

Benign hematologic Dz

Sx relief of splenomegaly

ITP that fail 60mg Prednisone Tx

62
Q

? type of trama indicates need for splenectomy

? indicates option of a splenorrhaphy

A

HTON
Coagulopathic
Acidotic
Hypothermic

+ response to bleeding control/resuscitation

63
Q

What is the post-op splenectomy complication

A 
OPSI- 
Tx w/ ABX empircally
Post-op vaccines: Strep pneumo H Flu and Meningococcus
(encapsulated)
2wks prior to elective
2 weeks after emergent removal
On day of discharge if <2wks
3mon after chemo/rad

Thrombocytosis- Tx w/ ASA

IPAP (212 decks)

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