surgery exam 2 Flashcards by Kelly Rose

indications for esophagectomy

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

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esophagectomy surgical options

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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post-esophagectomy complications

anastomotic stricture –> -dysphagia
leak
ischemia (avoid Hypotn & vasopressors!)

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post-esophagectomy diet

no stomach reservoir- small, frequent meals

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achalasia

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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treatment for achalasia

medical - CCB, nitrates, Botulinum injection to LES

Balloon dilation – stretch LES

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

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Hiatal Hernia repair

Reduce stomach herniation, close defect, +/- gastropexy

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Anti-reflux Procedures (GERD):

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

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post-op diet for GERD and PEH surgery

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

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what is a subtotal distal gastrectomy?

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

Gastrojejunostomy (Billroth II)

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what is a total gastrectomy?

proximal disease (fundus, cardia) - esophagojejunostomy

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reasons for gastrectomy

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

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Post-gastrectomy syndromes

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

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gastric volvulus

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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small bowel obstruction causes

ABC

adhesions (70%)
bulges (incarcerated hernias)
carcinoma

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SBO treatment

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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Small Bowel Resection

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

presence of stone(s) in GB

cholelithiasis

stone(s) in the CBD

choledocholithiasis

inflammatory state of GB, acute or chronic

cholecystitis

inflammation/infection of biliary tree

cholangitis

acute cholecystitis in absence of gallstones

Acalculous cholecystitis

indications for cholecystectomy

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

Relative CONTRAINDICATIONs for cholecystecomy

Cirrhosis and Portal HTN

intra-op and post-op complications of cholecystectomy

``` 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 ```

Courvoisier law

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

when is pancreatic cancer unresectable?

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

what is a "whipple" procedure

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

whipple complications

``` Delayed gastric emptying Bile leak Pancreatic fistula Dumping, steatorrhea Bile reflux gastritis ```

most common age for appendicitis

10-30

operation for right sided colon cancer

right hemicolectomy

skip lesions are associated with what?

chron's disease

continuous lesions are associated with what?

ulcerative colitis

indication to operate for IBD

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

definitive treatment (cure) for UC

colectomy

treatment for cecal volvulus

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

management for diverticular disease

NPO, antibiotics sx management: sigmoidectomy, diverting ostomy (hartmann's procedure) Post dz diet: low fiber, transition to high fiber usually 4-6 weeks out

three different types of hernias

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

spigelian ventral hernia

at lateral border of rectus at the linea semicircularis

rectus diastasis

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