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Surgery GI/GU Flashcards

1
Q

RENAL ABD PAIN

  • CC sounds like?
  • work up
  • ddx
A

CC: colicky right sided flank pain, n, v, hematuria, CVA tenderness
WU: UA, BUN/Cr, CT abdomen, renal US, KUB, blood cultures
DDx: nephrolithiasis, renal cell carcinoma, pyelnephritis, GI etiology, glomerulonephritis, splenic rupture

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2
Q

PANCREAS ABD PAIN

  • cc
  • wu
  • ddx
A

CC: dull epigastric pain that rad to back
WU: Ct abd, CBC, electrolytes, amylase, lipsae, AST, ALT, bilirubin, alk phosh, US Abd
DDX: pancreatitis, pancreatic CA, PUD, cholecystitis/cholechodo

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3
Q

GALLBLADDER ABD PAIN

  • cc
  • wu
  • ddx
A

CC: RUQ
WU: RUQ US, CBC, CMP, HIDA scan, MRCP/ERCP, Amylase/lipase, alk phosp, bili
ddx: cholecystitis, choledoco, hepatitis, asending cholangiitis, fitz-hugh-curtis syndrome, acute subhepatic appendicitis

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4
Q

LIVER ABD PAIN

  • cc
  • wu
  • ddx
A

CC: RUQ pain, fever, anorexia, nausea, vom, dark urine, clay stool
WU: CBC, amylase, lipase, liver enzymes, viral hepatitis serologies, UA, US Abd, ERCP, MRCP
ddx: acute hep, acute chole, asend cholangitis, choledocho, pancreatitis, primary sclerosing cholangitis, primary biliary cirrhosis, glomerulonephritis

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5
Q

SPLEEN ABD PAIN

  • cc
  • wu
  • ddx
A

CC: severe LUQ pain +rad to left scapula with hx of infectious mono

wu: CBC, CXR, CT/US abd
ddx: splenic rupture, splenic infarct, kidney stone, rib fx, pneumoina, perf peptic ulcer

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6
Q

STOMACH ABD PAIN

  • cc
  • wu
  • ddx
A

CC: burning epigastric pain after meals
WU: rectal exam–occult blood in stool, amylase, lipase, lactate, AST, ALT, bili, alk phosph, upper endoscopy (H. Pylori biopsies), upper GI series
ddx: PUD, perf PUD, gastritis, GERD, cholecystitis, mesenteric ischemia, chronica pancreatitis

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7
Q

INTESTINES ABD PAIN

  • cc
  • wu
  • ddx
A

CC: crampy abd pain, v, abd distention, inability to pass flatus
workup: rectal exam, CBC, electrolytes, CT abd/pelvis, colonoscopy
DDX: obstruction, SB or colon CA, volvulus, gastroenteritis, food poisoning, ileus, hernia, mes ischemia/infarction, diverticulitis, UC, Crohns, IBS, celiac,

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8
Q

Boas sign

A

ref pain to subscapular area due to phrenic nerve irritation
-cholecystitis

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9
Q

TOC for cholecystitis

-findings?

A

US

  • thickened GB >3mm
  • distention
  • sludge
  • stones
  • pericholecystic fluid
  • sonographic murphys sign
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10
Q

gold standard test for cholecystitis

A

HIDA scan–>shows GB ej fraction and if stones are present in cystic ducts
**if pt is fasting… scan can show false decr ejcection fraction—– inject with morphine or CCK (Cholecystokinin)

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11
Q

TX options for acute chole

A

Conservative: NPO, IV ABX (third gen ceph + metronidazole)

Cholecystectomy

Meperidine preff to Morphine (causes contraction of spincter of oddi)

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12
Q

what patient population does acalculous cholecystitis occur in

A

very ill pt–hospitalized

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13
Q

lab findings for acute chole

A
  • evelv WBC
  • elev lipase, AST/ALT
  • elev Total Bili: direct&raquo_space;»indirct
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14
Q

most specific test for acute chole

A

HIDA

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15
Q

what can chronic cholecysttis lead to

A

porcelin GB—premalignant condition

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16
Q

List Charcot’s triad

A

RUQ + Jaundice + fever =cholangitis

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17
Q

List Reynold’s pentard

A

RUQ + Fever +Jaundice +AMS + hypotension

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18
Q

RUQ + Fever +Jaundice +AMS + hypotension

A

Reynold’s pentad

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19
Q

RUQ + fever + jaundice

A

Charcot’s triad

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20
Q

define cholangitis

A

omplication of gallstones with symptoms secondary to an infected obstruction of the common bile duct (E.coli is the #1 cause)

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21
Q

Pruritis + jaundice=?

A

primary sclerosing cholangitis
-chronic liver dz characterized by a progressive course of cholestasis with inflammation and fibrosis of intrahepatic and extrahepatic bile ducts

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22
Q

Primary Sclerosing Cholangitis MC ocurs in who

A

UC patients

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23
Q

what does an elevated alk–phosphate mean

A

obstruction to bile flow—- cholestasis in ANY part of the biliary tree
-normal levels make cholestasis unlikely

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24
Q

what is GGT

A

used to confirm that the ALK-P elevation is of hepatic origin ***enzyme found in liver

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25
Q

Pancreatitis

  • mcc acute
  • chronic mcc?
  • other causes
A

Gallstones (mc acute)
ETOH (MC chronic)
Trauma

Steroids
Mumps
Autoimmune
Scorpion
Hypercalcemia/hypertrigs 
ERCP
Drugs
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26
Q

what does pancrease secrete

A

glucagon
amylase
insulin

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27
Q

pain assoc with pancreatitis lessens when?

A

pt leans forward or sits in fetal position

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28
Q

Triad for chronic pancreatitis

A

DM
Steatorrhea
Calcifications

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29
Q

diagnostic findings for pancreatitis acute and crhonic

  • labs
  • toc for acute and crhonic
A

-prandial epigastric pain

LABS:
*incr lipase –>more sensitive and specific vs amylase—>but has to be elev 3x
*amylase: transient, can go back to normal 24-72 hrs
*incr WBC
*liver enzyes +/- increase
*mild hyperbilirubinemia
*hyperglycemia
*hypocalcemia
*
CHRONIC: calcifications on US/gallstones, amylase and lipase NOT elevated

TOC acute= abd CT
TOC chronic= MRCP

Abd XRL sentinel loop–>look for diminished bowel sounds in exam question

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30
Q

TX for pancreatitis

A

MAINSTAY=supportive: NPO, IVF**, analgesics, bowel rest
**inadeaute IVF resustication in first 48 hours–>can lead to severe pancreatiits

*ERCP if biliary sepsis suspected

CHRONIC= addresss underling cause: most commonly is ETOH abuse

  • stop drinking
  • low fat diet
  • enzyme replacement
  • surgical removal of damaged part
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31
Q

Dysphagia with liquids AND solids suggest?

A

Achalaisa

-motility disorder

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32
Q

dysphagia with only solid food suggestive of? (3)

A
  • stricture
  • ring
  • tumor
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33
Q

upper endoscopy

  • another name?
  • proceudre
  • what is seen?
  • good for?
  • not helpful for ??
A

esophagogastroduodenoscopy (EGD)

  • put fiberoptic camera down into esophagus to visualize problem
  • SEE: high quality color imaging of esoph, gastric and duodenal LUMENS
  • can also do biopsies, injection catheters for delivery of drugs, balloon dilators or hemostatic devices

GOOD FOR: mucosal lesions, biopsies or interventional procedures are required (dilation, banding)

minimally invasive**

NOT GOOD FOR: looking at motion.. aka mobility disorders

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34
Q

Esophagram

  • name the two types
  • what is needed with these tests?
  • Good for?
  • cons?
  • high sensitivtiy for?
A
  1. XR — still
  2. Fluoroscopy—real time/moving XR

*contrast PO is needed so it illuminates inside esophagus “BARIUM SWALLOW”

GOOD FOR: function and morphology: strictures, compression and altered anatomy: reflux, hiatal hernias, mucosal granulairty, erosions, ulcerations, strictures

high sensitiity for detecting strictures vs endoscopy
CON:
-not good for looking at mucosa
-not fully diagnostic and PT will eventually need endoscopy—even if the esophagram study is negative …why???? because next step would be to obtain biopsies, provide tx, or clarify any abnormal findings in case of + exam OR to add certainty to a - exam

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35
Q

two types of contrast used for esophagrams

A

brium

gastrografin

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36
Q

what is the most useful test for evaluation of proximal gasotrintestinal tract

A

endoscopy

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37
Q

list advantages of endoscopy vs barium esophgram

list the disadvantage

A

ADV

  1. increased sensitivity for detection of mucosal lesions
  2. increased sensitivity for detection of abnormalities like Barretts esophagus or vascular lesions
  3. ability to obtain biopsies
  4. ability to dilate strictures DURING exam

DISADV

  1. expensive
  2. low sensitivity for detection of non-focal esophageal strictures
  3. sedatives or anesthetics are req
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38
Q

what is quad therapy

-triple?

A

quad therapy (metronidazole, tetracycline, pepto, PPI)

proton pump inhibitor, clarithromycin and amoxicillin or an imidazole)

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39
Q

air under diaphgram on CXR

A

perf peptic ulcer

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40
Q

sudden onset of severe abdominal pain–may radiate to the shoulder blade with + peritonitis s/s

A

perf ulcer

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41
Q

MC site for anal fissure

A

posterior midline

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42
Q

severe tearing pain on defecation accomp with hematochezia

*bright red stool on TP

A

anal fissure

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43
Q

throbbing rectcal pain worse with sitting, couhging and defication

A

anorectal abscess/fistual

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44
Q

sentinel pile on PE

A

aka fissure

***anorectal abscess, fissure

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45
Q

severe rectal pain when he defecates. He has a fever of 39 C. On exam a palpable mass is felt at the anal verge.

A

anorectal abscess

*****result of an infection

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46
Q

fistula is what?

A

result of chronic abscess

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47
Q

perianal drainage, perirectal abscess, recurrent perirectal abscess, “diaper rash,” itching

A

fistula

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48
Q

What disease should be considered with fistula in ano?

A

chrons dz

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49
Q

How do you find the internal rectal opening of an anorectal fistula in the O.R.

A

Inject H2 O2 (or methylene blue) in external opening—then look for bubbles (or blue dye) coming out of internal opening

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50
Q

sudden onset of severe colicky flank pain associated with nausea and vomiting as well as the absence of rebound or direct testicular tenderness
+microscopic hematuria

A

nephrolithiasis

  • pain will radiate into testicles for men
  • afebrile too
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51
Q

phren sign
(+)= ?
(-) = ?

A

if it is + seen with epididymitis
*pain is relieved with elevation of the scrotum

  • sign is seen with testicular torsion
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52
Q

Marfans syndrome PE findings

A

Ectopia lentis, aortic root dilation and aortic dissection are major criteria for the diagnosis of the disease.
particularly long arms and fingers and a pectus excavatum

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53
Q

what is adjuvant therapy of choice in post-menopausal estrogen receptor positive axillary node negative breast cancer?

A

Tamoxifen

-estrogen modulator

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54
Q

when is chemotherapy indicated with BC?

A

tumors > 1 cm

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55
Q

when is bisphosphonate therapy used in BC

A

if there is METS to the bone

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56
Q

Recurrent nephrolithiasis may be one of the presentations of

A

primary hyperparathyroidism

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57
Q

Measurement of ________levels would be the initial laboratory test for the evaluation of hypercalcemia.

A

parathyroid

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58
Q

____ prophylaxis considered in all burn patients

A

tetanus

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59
Q

when do you use LMW heparin for prophylaxis of venous thromboembolism

A

-ortho neuro trauma surgery with RF for clots

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60
Q

venous thromboembolism prophylaxis for low risk minor procedures in PT under 40

A

early ambulatio n

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61
Q

acute phase of adrenal crisis is treatred with

A

IVF

hydrocortisone

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62
Q

Class I indications for CABG from the American College of Cardiology (ACC) and the American Heart Association (AHA) are as follows

A
  • Over 50% left main coronary artery stenosis
  • Over 70% stenosis of the proximal left anterior descending (LAD) and proximal circumflex arteries
  • Three-vessel disease in asymptomatic patients or those with mild or stable angina
  • Three-vessel disease with proximal LAD stenosis in patients with poor left ventricular (LV) function
  • One- or two-Vessel disease and a large area of viable myocardium in high-risk area in patients with stable angina
  • Over 70% proximal LAD stenosis with either an ejection fraction (EF) below 50% or demonstrable ischemia on noninvasive testing
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63
Q

_______is the treatment of choice in patients with pulmonary embolism with normal ventricular function and no absolute contraindications.

A

anticoagulatio n

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64
Q

_______ is the treatment of choice in a diabetic with two or three vessel disease

A

CABG

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65
Q

indications for Billroth I surgery

A

procedure for gastroduodenostomy is the most physiologic type of gastric resection, since it restores normal continuity

  • gastric ulcers
  • type of reconstruction after a partial gastrectomy in which the stomach is anastomosed to the duodenum
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66
Q

Dumping Syndrome

-what is it

A
  • complication of bariatric surgery
  • s/s due to rapid gastric emptying and rapid fluid shifts when large amts of CHOs are ingested

CM

  • early: bloating, flatus, diarrhea, abd pain, nausea, vasomotor (dizziness, tachypnea, hypotension, flushing)—withint 15 mins
  • late: hypoglycemia, syncope
DX 
-clinical 
-
TX
-decr CHO intake 
-eat more freq with smaller meals,
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67
Q

In patents with diabetic retinopathy, what clinical intervention is most successful in preserving vision?

A

Panretinal laser photocoagulation

-

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68
Q

PTs taking steroid medicine, what should they do to the dose if they become sick?

A

To better mimic the normal physiologic response the baseline dose should be doubled for the duration of the illness. Doses should be increased 5-10 fold with major events such as surgery.

EX: takes 25 mg regulalry…. SICK DOSE= 50…. SURGERY DOSE= 125-250

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69
Q

Intestinal obstruction without complications is suggested by

A

crampy pain, abdominal distention, hyperactive bowel sounds, visible peristalsis, and minimal tenderness.

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70
Q

what is a key feature of duodenal ulcer

A

Epigastric tenderness
**pain is RELIEVED with eating

(gastric ulcer pain is worse with food)

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71
Q

________ represents one of the most common medical and surgical conditions seen during pregnancy.

A

GB disease

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72
Q

SBO xray finding

A

air fluid levels with distended loop of bowel

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73
Q

xray finding for perf duodenal ulcer

A

free air under the diaphragm

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74
Q

complaints of vague epigastric abdominal pain associated with jaundice and generalized pruritus. Physical examination reveals jaundice and a palpable non-tender gallbladder, but is otherwise unremarkable

A

pancreatic CA (head)

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75
Q

Courvoisier’s sign

A

palpable non-tender GB—due to obstruction from pancreatic CA

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76
Q

RF for pancreatic CA (6)

A

age, tobacco use, obesity, chronic pancreatitis, family history and previous abdominal radiation.

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77
Q

MC skin CA

A

Basal

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78
Q

The most serious complication of Barrett’s esophagus is

A

esophageal adenocarcinoma

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79
Q

Drugs to tx MRSA

  • IV
  • PO
A

IV:

  • vanco (pref for hosp acquired)
  • daptomycin

PO

  • clindamycin
  • bactrim
  • doxy
  • minocycline
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80
Q

witin first __ days post op pnma can occur

A

5

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81
Q

Elevated _____levels can help distinguish post op pnma from other causes of fever and infiltrates after surgery

A

procalcitonin

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82
Q

MC bacteria involved with post-op pnemonia

A

Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter species, and Staphylococcus aureus.

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83
Q

triad for DVT and name of it

A

Virchow’s triad

vascular endothelial injury or inflammation, stasis, and hypercoagulable state

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84
Q

specific findings for DVT

A

swelling of the whole leg, > 3 cm difference in circumference between calves, pitting edema, and collateral superficial veins

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85
Q

how is definitive dx of DVT made

A

venography

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86
Q

study of choice for PE

A

CT angiography

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87
Q

tx of choice for dvt

A

Anticoagulation therapy using subcutaneous heparin followed by oral anticoagulant (warfarin or a factor Xa or direct thrombin inhibitor)

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88
Q

What is phlegmasia alba dolens?

A

A rare complication of deep vein thrombosis (DVT) in pregnancy where the leg turns milky white.

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89
Q

Warfarin is contraindicated in

A

pergnancy

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90
Q

Surgeries with high cardiac risk include ? (5)

A

laparoscopic total abdominal colectomy with ileostomy,
breast reconstruction with free flap,
open cholecystectomy,
open ventral hernia repair of incarcerated or strangulated hernia, and
Whipple procedure

91
Q

first line tx for stable angina? also should be given this before surgery since its cardio protective

A

bb

atenolol, propranolol, metoprolol)

Initiation of a beta-blocker prior to elective surgery is an important part of optimizing the patient’s cardiac risk.

92
Q

presence of lung sliding and comet tails on cxr

A

NORMAL findings

absence of those findings indiacte a pnmothorax

93
Q

barcode or stratosphere sign on cxr

A

indicates pneumothorax (means no lung motion)

94
Q

seashore sign on cxr

A

normal lung

-indicates + lung movement

95
Q

emergent large bore needle chest decompression should be followed by what procedure

A

thoracostomy aka chest tube placement

96
Q

What type of pneumothorax occurs in conjunction with menstrual periods?

A

catamenial

97
Q

What is the most appropriate IV fluid for a preoperative patient who is NPO?

98
Q

IV fluid solutions to treat hypernatremia

A
  • half normal saline

- normal saline withD5

99
Q

how long before surgery should ASA be discontinued?

  • metformin or any PO diabetic drug?
  • Long-acting sulfonylureas?
A

1 wk for ASA

Metformin and other PO DM Drugs–> 1 day before

Long-acting sulfonylureas–> 48-72 hrs before

100
Q

What is the best way to manage hyperglycemia during surgery?

A

continuous insulin drip

101
Q

Protein status is often measured by the following three laboratory measures:
-which is used for short term changes and why

A

serum albumin,

serum transferrin,

serum prealbumin–>used for short term–>bc half life is 2-3 days

102
Q

________ is recommended for patients requiring surgery who are at intermediate risk of hypothalamus-pituitary-adrenal axis (HPA axis) suppression aka on steroids for longterm

A

Morning serum cortisol level

103
Q

two most common indiactions for pre-op emergent dyalisys

-other reasons

A

Hyperk >6.5 with EKG changes
fluid overload

OTHER REASONS:

  • acidosis–met acidosis with ph <7.1
  • ingestion of salicylates, lithium, isopropanol, methanoly,
  • uremia—elev BUN with signs of uremia–>uremic bleeding, pericarditis, encephalopathy, neruopathy
104
Q

What should the peak expiratory flow rate be for patients with asthma before elective surgery?

A

> 80% of their predicted value.

105
Q

Which internal jugular vein follows a direct path to the superior vena cava?

A

The right internal jugular vein. The left internal jugular vein drains into the brachiocephalic vein.

106
Q

list the order of highest risk for infection to least likely infection for the central venous access veinsitse

A

FEMORAL—highest risk of infection

INT JUGULAr—double the risk of infectino vs subclavian

subclavian–lowest risk

107
Q

What is the initial imaging modality used to evaluate DVT

A

Compression ultrasound with Doppler

108
Q

What is the reversal agent for apixaban and rivaroxaban?

A

Andexanet alfa

109
Q

parkland formula

A

4 mL/kg x body weight in kg x percent of body surface area burned)

*det fluid resustiation for the firt 24hrs of burn pt

Half of the required fluid is given in the first 8 hours, and the remaining fluid is given over the next 16 hours

110
Q

causes for transudative

A

cirrhosis
HF
Nephrotic syndrome
PE

111
Q

causes for exudative

A

CA
pnma
PE
pancreatitis

112
Q

next step for pt who is HD unstable with a PE

A

Thrombolysis with r-tPA

***stable would get IVC filter

113
Q

low ph low bicarb

A

met acidosis

114
Q

low ph high bicarb

A

resp acidosis

115
Q

high pH high bicarb

A

met alkalosis

116
Q

high ph low bicarb

A

resp alkalosis

117
Q

_______ tx is indicated for patients with an INR > 10 with no significant bleeding present

A

vit K alone

118
Q

______ tx is necessary when INR >10 with LT bleeding

A

Administer vitamin K and fresh frozen plasma

119
Q

hypocapnia (PaCO2 < 35 mm Hg), increased blood pH (> 7.45), and normal bicarbonate (22 to 26 mEq/L)

A

resp alkalsosi

120
Q

increase in pH (> 7.45), normal PaCO2 (35 to 45 mm Hg), and an increase in serum bicarbonate (> 26 mEq/L).

A

met alkalosis

121
Q

What is the most common cause of respiratory alkalosis?

A

hyperventilation

122
Q

Which of the following is the most common cause of hematochezia in a 68-year-old individual
AKA MCC of lower GIB

A

diverticulosis

hematochezia=lgib—>bright red stool per rectum

123
Q

anatomic location for hematocheiza due to LGIB

A

distal to the ligament of Treitz

124
Q

Causes of hematochezia (lower GI bleeding) include : (7)

A
  1. DIVERTICULOSIS— MCC >AGE 60
  2. hemorrhoids (most common cause in patients < 50 years of age),
  3. angiodysplasia,
  4. colitis (infectious, ischemic, inflammatory bowel disease),
  5. colon cancer,
  6. anorectal disorder,
  7. proctitis
125
Q

MCC of UGIB

126
Q

Chronic mesenteric ischemia is secondary to ?

A

atherosclerotic plaque proliferation

127
Q

acute mesenteric ischemia mcc by?

A

arterial embolism or thrombosis

128
Q

_______is the most commonly affected artery in cases of acute mesenteric ischemia.

129
Q

classic triad for mesenteric ischemia (only sometimes pt will present with full triad)

A

abdominal pain, fever, and heme-positive stool

130
Q

what drug to support BP if pt has mesenteric ischemia do we avoid

A

vasopressin

131
Q

anotehr term for HIDA Scan

A

Cholescintigraphy

132
Q

Cholescintigraphy another term

A

HIDA scan

***GS for acute chole

133
Q

For patients with esophageal varices, an ________ is the diagnostic and therapeutic tool of choice

A

esophagogastroduodenoscopy (EGD)

134
Q

acute management for esophageal varices

A
  • hemodynamic resusication
  • OCTREOTIDE
  • banding, sclerotherapy
  • ABX: ex Ceftriaxone
135
Q

chronic management of esophageal varices

A

NS BB

-ligation

136
Q

tumor marker assoc with hepatic CA

A

alpha fetoprotein

137
Q

what tumor marker is assoc with ovairan CA

A

cancer antigen 125 or CA 125

138
Q

which tumor marker is assoc with pancreatic CA

A

cancer antigen 19-9

139
Q

what markers assoc with colorectal CA

A

cancer antigen 19-9
and
carcinoembryonic antigen ***aka CEA

140
Q

first-line therapeutic option for achalasia

A

Laparoscopic Heller myotomy

141
Q

first line tx for esophageal spasm

A

CCB alone
-doesnt work, then try TCA

**can also try botulism inj if medication doesntwork

142
Q

indications for admission for diverticulitis

A

severe pain, inability to tolerate oral intake, sepsis, immunocompromised status, failing outpatient treatment, or the presence of complications.

143
Q

list some PO abx used for tx of OUTPATIENT diverticulitis

A

ciprofloxacin and metronidazole,

trimethoprim-sulfamethoxazole and metronidazole,

or amoxicillin-clavulanate monotherapy

AND CLD

144
Q

INPATIENT IV abx options for uncomplicated diverticulitis

A

piperacillin-tazobactam monotherapy,

a combination of ceftriaxone and metronidazole or ciprofloxacin and metronidazole

145
Q

AB XR finding for perf diverticulitis

A

Free air outside the bowel in the abdomen.

146
Q

abd pain worse when laying down and alleviated with leaning forward

A

acute pancreatitis

147
Q

inguinal hernias are located ______ to the inguinal ligament.

vs femoral hernias are located_____ to the inguinal ligament

A

Inguinal hernias= superior

femoral=inferior

148
Q

age of onset for chrons dz

A

BIMODAL

15-30 and then 60-80

149
Q

imaging modality of choice for chrons

A

MRI with enterography

150
Q

mainstays of medical management for chron dz

A

Sulfasalazine and aminosalicylates

151
Q

primary choledoco can occur due to what kind of diseases

A

cystic fibrosis–causes biliary stasis

152
Q

serum CA-19-9

A

pancreatic CA

-NOT considered appropriate screenig test tho

153
Q

Courvoisier sign

A

palpable GB

-seen with pancreatic CA

154
Q

Whipple procedure

A

pancreaticodudenectomy–used in pancretic CA

155
Q

US finding for cholangitis

A

CBD dilation

156
Q

IV abx of choice for cholangitis

A

BS— like piperacillin-tazobactam

aand ERCP*

157
Q

When should vitamin K be administered to patients with acute cholangitis?

A

If the patient has hypoprothrombinemia as a result of liver damage secondary to cholangitis.

158
Q

hital hernia

  • define
  • list types
  • GS for dx
A

proximal portion of the stomach protrudes thru dia into the esophageal space

TYPES

  1. sliding—more common–95%–present with sx of GERD,
  2. paraesophageal–sx more substernal pain, n/v, aka more signficiant sx than sliding

GS for dx is barium swallow

159
Q

which virus has been assoc with incr risk of gastric CA

160
Q

what does this upright cxr show

A

sx: abd pain sudden in nature, tachy, cool extrems, low temp, marked broad like rigidity, abd distention, hypovolemia, peritonitits

TX

  • NGT
  • IVF
  • IV PPI
  • BS ABX
  • OP vs NON OP management
161
Q

What is Zollinger-Ellison disease?

A

gastrin-secreting cancer that results in acid hypersecretion in the stomach.

162
Q

acute abdominal pain, diarrhea, rectal bleeding, tachycardia, dehydration, and fever.

A

toxic megacolon

-can be compliaction of UC

163
Q

how to dx toxic megacolon

A

radiographic evidence of colonic distention plus at least 3:

  • fever >38 C
  • HR >120
  • WBC > 10.5
  • anemia

PLUS at least one of the following:

  • dehydration
  • ams
  • electro disturb
  • hypotension
164
Q

____is the recommended initial treatment for sigmoid volvulus without signs of perforation or bowel ischemia.

A

sigmoidoscopy—to reduce volvulus

–SURGERY to prevent recurruance

165
Q
A

sigmoid volvulus

bent inner tube apperanceor U shaped

166
Q

RF for sigmoid volvulus

A

nursing home pt
bed bound
elderly
chronic constipation

167
Q

What is the 3-6-9 rule?

A

Bowel is considered dilated when dilation is > 3 cm, 6 cm, and 9 cm for the small bowel, large bowel, and cecum, respectively.

168
Q

Definitive tx for BPH

A

surgical—transurethral resection of the prostate. aka TURP
**remove excess prostate tissue to relieve onstruction

169
Q

enteral nutrition =

A

feeding tube—directly into stomach or SI

<4 weeks= naso tube
>4 weeks =percutaneous tube

170
Q

indication for parenteral nutrition

A
  • if patient does not hve a functional gut or if enteric access not safe AKA A PARTIALLY FUNCTIONING OR NON-FUNCTIONAL GI TRACT IS MAIN INDICATION***
  • burns
  • malabsorption
  • severe malnutrition
  • paralytic ileus
  • sm bowel ischemia
  • necrotizign endocarditis
  • GI surgery

post-liver transplantation, short-bowel syndrome, comatose patients who are critically ill, prolonged ileus, significant gastrointestinal bleeding, significant gastrointestinal ischemia, or a high-output fistula.

171
Q

Which stones are associated with chronic urinary tract infec

A

struvite sotnes

172
Q

what timing post op is a fever greatest concern

-causes?

A

late…. 4-30 days

DVT
drug fever
inflammatory rxns
infectiouns related to surgical procedure itself **abd abscess for ex

173
Q

what is a consistent PE finding for right sided colorectal CA

174
Q

what is consistent PE fidnig for left sided colorectal CA

A

change in bowel haits
hematocheiza
thin stools

175
Q

apple core lesion

A

finding for colorectal CA

176
Q

what is used to prevent gallstone formation in pts with rapid wt loss

A

ursodeoxycholic acid— a bile salt

177
Q

medical management for GERD

A
  1. H2 antagonist
  2. increase dose of H2
  3. trial low dose PPI and stop using H2
  4. fundopliction is indicatd for cases refractory to med management
178
Q

MCC for SBO

LBO–bengin and non-benign causes

A

SBO=adhesions

LBO= CA (non-benign) and volvulus is MC bengin cause

179
Q

mc location for LBO

A

at or below transverse colon

***sigmoid colon

180
Q

What signs are characteristic of volvulus on plain radiography?

A

coffee bean sign

northern exposure sign

181
Q

postprandial pain
fear of eating
weight loss

A

chronic mesenteric ischemia

182
Q

major concern for surgical repair of anal fissure

*when is surgery indicated

A

irreversible fecal incontinence

**surgery reserved for pt who has sx >8 weeks or failed supportive tx

183
Q

________ulcers tend to cause pain shortly after eating, while _______ ulcers tend to cause pain 1–2 hours after meals or during the night

A

gastric

duodenal

184
Q

another word for rapid urease testing

A

campylobacter-like organism test

*this diagnoses H. pylori

185
Q

first line tx for H pylori

A

10-14 days of triple therapy

  • clarithromycin
  • amoxicillin
  • PPI (-azole)

**metronidazole replace for amoxicillin PCN allergy

10-14 days QUAD therapy

  1. bismuth subsalicylate
  2. tetracycline
  3. metronidazole
  4. PPI
186
Q

supraclavicular node

A

virchow node— gastric CA

187
Q

left axillary node

A

irish node

188
Q

periumbilical node

A

sister mary joseph node

189
Q

PE shows Howship-Romberg sign

A

obturator hernia

190
Q

whats in Hsselback triangle

A

dierct hernias

  1. inferior epigastric vessel–>lateral
  2. rectus abdominis muscle–>medial
  3. inguinal ligament–>inferior
191
Q

MC type of stone found in primary choledoco

A

pigmented stone

PRIMARY=stones originat in CBD–result from biliary stasis– why they look brown
SECONDARY=stones originate in GB

192
Q

appropriate diagnostic test to determine if h pylori was eriadicated

A
  1. stool angient test

2. breath urease test

193
Q

mc anatomical site for UC

194
Q

hallmark location for crohn dz

A

terminal ileum

195
Q

screening for colorectal CA with colonscopy done every ____ years

196
Q

screening for colorectcal ca with CT colonography every ____ years

197
Q

what is more specific amylase or lipase

198
Q

anal fistuals are assoc with what dz

199
Q

only complaint is painless hematochezia

A

meckles diverticulum

200
Q

scan of choice after dx of Meckles

A

uclear medicine scan, known as the technetium-99m pertechnetate scan

201
Q

TOC for meckels diverticulum

A

diverticulectomy

202
Q

cause of meckles

A

incomplete obliteration of the vitelline duct

203
Q

__________is needed to confirm the diagnosis of achalasia

A

manometery

204
Q

Heller myotomy

A

An incision of the circular muscle layer of the lower esophageal sphincter aimed at treating achalasia

205
Q

classification for hemrroids

1st-4th

A

1st= does not proture through anus
2nd=prolapse but reduce spontaenously
3rd=prolapse and require manual reduction
4th=cannot be reduced and may strangulate

206
Q

tx for anal fissure

A 
topical nifedipine or nitro 
topical analgesic 
stool softenr 
sitz bath 
incr fiber intake
207
Q

which type of volvulous presents in younger patients

208
Q

Markedly elevated fasting serum gastrin levels are associated with

A

gastrinoma or zollinger-ellison syndrome

209
Q

what type of adenomatous polyp has greatest risk of malignancy

210
Q

history of vomiting, coughing, or retching followed by hematemesis or melena with epigastric abdominal pain or back pain

A

Mallory Weiss syndrome

**forecul retching

211
Q

What makes up the classic triad of chronic pancreatitis?

A

Steatorrhea, diabetes mellitus, and calcifications on imaging.
**only seen in advance dz

212
Q

triad for intusussception

A

colicky abd pain (comes and goes—-comes and goes)
vomiting (sausace shaped mass in abd)
bloody red currant jelly stools

213
Q

_____ grading system is used to eval patients with prostate CA

214
Q

MDs dont LIe

A

Medical to IEA: dierct

Lateral to IEA: indirect

215
Q

internal hemorroids arrise from and are _____ the _____ line

A

superior hemorrhoidal cushion

ABOVE or proximal to dentate line

216
Q

_______ recc surgical procedure for toxic megacolon

A

subtotal colectomy with end-ileostomy

217
Q

target sign with transverse view in RUQ

A

pyloric stenosis

218
Q

mcc LGIB

A

diverticulosis

painless rectal bleeding

219
Q

tx option for pt with recurrent nonsevere CDIFF

A

Fidaxomicin 200 mg PO every 12 hrs

220
Q

3 or 4 unformed stoools in 24 hours

-watery diarrhea

221
Q

colonic ischema MC affects what part of colon

A

watershed areas

  • -spenic flexure
  • rectosigmoid junction
222
Q

CEA stands for

A

carcinoembryonic antigen

**colorectcal ca

223
Q

melena= U or L GIB

EORs (15 decks)

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