Surgery GI

Question 1

acute epigastric pain ddx

Answer 1

pancreatitis, peptic ulcer dz, gastroenteritis, GERD, gallstone

Question 2

acute epigastric pain screening studies (i..e labs/imaging)

Answer 2

CBC, UA, amylase, lipase, LFTS, CXR, abdominal US (to r/o gallstone). EGD is also appropriate (and get bx to r/o malignancy/H pylori)

Question 3

Patient with acute epigastric pain has neg US for gallstone. Empiric tx with?

Answer 3

H2 blocker or PPI to tx GERD/ulcer/gastritis

Question 4

what’s necessary for surgical intervention for GERD patient?

Answer 4

EGD with biopsy and manometry (to show intact esophageal peristalsis before surgery…ensures pt can swallow normally postop). may need 24 hr pH test of see normal LES tone/coughing/asthma

Question 5

T/F: Most patients with GERD have a hiatal hernia

Answer 5

True…about 80%!!

but most patients with hiatal hernia don’t necessarily have GERD

Question 6

In Barrets esophages, what metaplasia (and possibly dysplasia) occurs?

Answer 6

Squamous cell –> columnar. Increased risk of adenocarcinoma.

Question 7

what is the risk with a type 2 hiatal hernia aka paraesophageal (portion of stomach herniates into chest)

Answer 7

Really dangerous because stomach can necrose and become strangulated (gastric volvulus)

Question 8

sliding vs paraesophageal hernia

Answer 8

Sliding (type 1) stomach just slides up into esophagus, the GE j(x) moves/slides up into chest. medical mgmt of reflux;

para (type 2): GE j(x) normal place but stomach herniates through phrenoesophageal membrane into the chest

Question 9

procedure of choice for uncomplicated PUD that is refractory to medical therapy

Answer 9

Highly selective vagotomy (HSV)

Question 10

Why do you measure gastrin levels in a patient with PUD refractory to medical therapy?

Answer 10

r/o Zollinger Ellison syndrome

Question 11

T/F: All gastric ulcers are related to excess acid output

Answer 11

false. Those on lesser curvature are associated with low gastric acid…ask about NSAID or steroid use

Question 12

T/F: All gastric ulcers should be bx

Answer 12

True, to r/o malignancy. If +, would do CT to assess for mets

Question 13

standard operation for benign, nonhealed gastric ulcers

Answer 13

partial gastrectomy, usually an antrectomy. Do it earlier on giant ulcers (>5cm) b/c higher risk of bleeding and failutre of healing. For type 2 and 3 ulcers, also do the vagotomy.

Question 14

Why does misoprostol help in a patient with coffee-ground material and blood streaks in her NG drainage?

Answer 14

synthetic PGE1 with gastric mucosal protective properties and inhibits gastric acid secretion with coffee-ground bleeding

Question 15

conditions that put individs at high risk for upper GI bleeding

Answer 15

duodenal/gastric ulcer, diffuse erosive gastritis, varices, mallory-weiss tear, gastric carcinoma, AV malformations

Question 16

mgmt of patient with Upper GI bleeding

Answer 16

Resuscitation. 2 large bore IVS with a blood draw for type and match, lavage of NG tube until blood stops coming, IV fluids are esential and monitoring for signs of hypotension, admin of H2 blockers and monitoring of gastric pH. Once stablized, upper endoscopy