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clin med > surgery exam 2 > Flashcards

surgery exam 2 Flashcards

1
Q

indications for esophagectomy

A

cancer - SCC (upper and middle third), AdenoCa (usually lower third), high grade dysplasia (barrett’s)

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2
Q

esophagectomy surgical options

A

transhiatal esophagectomy (upper abdomen and cervical incision)

transthoracic esophagectomy (right thoracotomy ad upper abdominal incision)

tri-incisional esophagectomy (Thoracotomy + laparotomy + cervical)

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3
Q

post-esophagectomy complications

A
  • anastomotic stricture –> -dysphagia
  • leak
  • ischemia (avoid Hypotn & vasopressors!)
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4
Q

post-esophagectomy diet

A

no stomach reservoir- small, frequent meals

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5
Q

achalasia

A

motility disorder, loss of peristalsis in distal 2/3 of esophagus and impaired relaxation of LES

-gradual, progressive dysphagia for solids and liquids, regurgitation of food, weight loss

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6
Q

treatment for achalasia

A

medical - CCB, nitrates, Botulinum injection to LES

Balloon dilation – stretch LES

***(Heller) Myotomy +/- Fundoplication– highest success rate

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7
Q

Hiatal Hernia repair

A

Reduce stomach herniation, close defect, +/- gastropexy

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8
Q

Anti-reflux Procedures (GERD):

A

Nissen Fundoplication
(360⁰ wrap)
Partial Fundoplication
(Toupet, Dor, etc.)

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9
Q

post-op diet for GERD and PEH surgery

A

full liquids for 1-2 weeks, slowly transition to soft diet

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10
Q

what is a subtotal distal gastrectomy?

A

distal 2/3 of stomach (Gastroduodenostomy (Billroth I)

Gastrojejunostomy (Billroth II)

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11
Q

what is a total gastrectomy?

A

proximal disease (fundus, cardia) - esophagojejunostomy

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12
Q

reasons for gastrectomy

A

pailliative resection for cancer (reduce risk of bleeding, obstruction), peptic or duodenal ulcer, GIST

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13
Q

Post-gastrectomy syndromes

A 
Early: leak, retention, hemorrhage
Postvagotomy diarrhea
Dumping syndrome
Alkaline reflux gastritis
Gastroparesis
Anemia – Iron/B12 Deficiency
Early satiety
Recurrent ulcer
Fistula (Gastrojejunocolic & Gastrocolic)
Afferent loop syndrome
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14
Q

gastric volvulus

A

stomach rotates on its long axis or mesenteroaxial axis

secere abd pain, emesis, retching, inability to vomit, inability pass NGT

gastric infarction = surgical emergency for resection

Borchardt triad=acute epigastric pain, violent retching, inability to pass NGT

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15
Q

small bowel obstruction causes

A

ABC

adhesions (70%)
bulges (incarcerated hernias)
carcinoma

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16
Q

SBO treatment

A

conservative:
IVF, NGT decompression
+/- foley
serial abdominal exams and await clinical improvement

surgery- exploratory laparotomy (“ex lap”), lysis of adhesions, possible bowel resection, possible ostomy

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17
Q

Small Bowel Resection

A 
SBO
Intussusception
Ischemia
Hemorrhage
Crohn’s Disease
Fistula
Congenital anomalies
Bezoar
Neoplasm
Adenoma=Most common SB benign
AdenoCA=most common SB primary malignant
Malignant tumors of SB=2% of all GI cancers
GIST
18
Q

presence of stone(s) in GB

A

cholelithiasis

19
Q

stone(s) in the CBD

A

choledocholithiasis

20
Q

inflammatory state of GB, acute or chronic

A

cholecystitis

21
Q

inflammation/infection of biliary tree

A

cholangitis

22
Q

acute cholecystitis in absence of gallstones

A

Acalculous cholecystitis

23
Q

indications for cholecystectomy

A

symptomatic gallstones (biliary colic, acute or chronic cholecystitis, gallstone ileus)

gallstone pancreatitis

acalculous cholecystitis

large gallbladder polyps (>10mm)

whipple resection or bile duct resection (as part of hepatectomy)

malignancy

24
Q

Relative CONTRAINDICATIONs for cholecystecomy

A

Cirrhosis and Portal HTN

25
Q

intra-op and post-op complications of cholecystectomy

A 
Intra-op
Bile duct injury
Bleeding – cystic artery or right hepatic artery 
Post-op
Bile leak – small vs. large
Jaundice – major duct obstruction/excision
Subphrenic fluid collection
Diarrhea
26
Q

Courvoisier law

A

palpable, painless gallbladder + jaundice, indicative of obstruction unlikely to be due to gallstone

27
Q

when is pancreatic cancer unresectable?

A

Extensive peripancreatic lymphatic involvement, nodal involvement beyond the peripancreatic tissues, and/or distant metastases.

Direct involvement of SMA, IVC, aorta, celiac axis, or hepatic artery, as defined by the absence of a fat plane between the tumor and these structures on CT scan

28
Q

what is a “whipple” procedure

A

Distal gastrectomy (antrectomy), removal of pancreatic head, duodenum, part of jejunum, CBD, GB

Pancreaticoduodenectomy

29
Q

whipple complications

A 
Delayed gastric emptying
Bile leak
Pancreatic fistula
Dumping, steatorrhea
Bile reflux gastritis
30
Q

most common age for appendicitis

A

10-30

31
Q

operation for right sided colon cancer

A

right hemicolectomy

32
Q

skip lesions are associated with what?

A

chron’s disease

33
Q

continuous lesions are associated with what?

A

ulcerative colitis

34
Q

indication to operate for IBD

A
  • Intractability to medical therapy
  • Intra-abdominal abscess
  • Intractable fistula
  • Massive bleeding
  • Intestinal obstruction, perforation
  • Cancer
  • Symptomatic, refractory internal or perianal fistulas (in Crohn’s
35
Q

definitive treatment (cure) for UC

A

colectomy

36
Q

treatment for cecal volvulus

A

emergent surgery

viable: cecopexy
compromised: right hemicolectomy with primary anastomosis OR ileostomy and mucus fistula

37
Q

management for diverticular disease

A

NPO, antibiotics

sx management: sigmoidectomy, diverting ostomy (hartmann’s procedure)

Post dz diet: low fiber, transition to high fiber usually 4-6 weeks out

38
Q

three different types of hernias

A

reducible - contents can be replaced within surrounding musculature

irreducible/incarcerated - cannot be reduced

strangulated - compromised blood supply, potentially serious
Large hernias through small orifice
Highest rate of strangulation = femoral

39
Q

spigelian ventral hernia

A

at lateral border of rectus at the linea semicircularis

40
Q

rectus diastasis

A

separation of 2 rectus abdominus muscles when linea alba becomes stretched, appears as midline ridge. NO FASCIAL DEFECT, no risk of incarceration or strangulation

clin med (12 decks)

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