Surgery GI/Nutrition Flashcards
Etiology of cholecystitis
Gallstones
S/S of cholecystitis
RUQ pain
Radiate to shoulder
Precipitated by fatty meals
Murphy sign
Diagnosis of acute cholecystitis
US showing wall thickening, stones may be visualized
Treatment of cholecystitis
Lap chole
Etiology of acute pancreatitis
Gallstones
Alcohol
S/S of acute pancreatitis
Epigastric pain that radiates to back
N/V
Improves when leaning forward
Grey Turner sign
Cullens sign
Diagnosis of acute pancreatitis
Elevated amylase and lipase
CT
Ranson’s criteria
Treatment of acute pancreatitis
NPO
Fluids
Pain meds
Etiology of chronic pancreatitis
Alcoholism
S/S of chronic pancreatitis
LUQ pain that radiates to back
Malabsorption
Diabetes
Diagnosis of chronic pancreatitis
Normal amylase and lipase
CT showing calcifications
Treatment of chronic pancreatitis
Avoid alcohol
Pain management
Digestive enzymes
Puestow procedure
Whipple procedure
Puestow procedure
Side-to-side anastomosis of the pancreas and jejunum (pancreatic duct is filleted open)
Whipple procedure
A procedure in which the head of the pancreas and duodenum are removed
Etiology of anal fissures
Constipation and straining
S/S of anal fissures
Posterior midline
Pain with defecation
Bleeding
Treatment of anal fissures
Proper toileting
S/S of perianal abscess
Throbbing
Pain
Erythema
Swelling
Fluctuant
Treatment of perianal abscess
I&D
S/S of perianal fistula
Discharge
Itching
Pain
Treatment of perianal fistula
Fistulotomy
Etiology of appendicitis
Fecalith
S/S of appendicitis
Periumbilical pain that migrates to teh RLQ
McBurney’s point tenderness
Diagnosis of appendicitis
CT
Treatment of appendicitis
Lap appendectomy
Unasyn or cefoxitin pre-op
Bariatric surgical candidates
BMI > 40
BMI > 35 with obesity-related complications
Age 18-65
Roux-en-Y gastric bypass
Bariatric surgery that involves stapling the stomach to decrease its size and then shortening the jejunum and connecting it to the small stomach pouch, causing the base of the duodenum leading from the nonfunctioning portion of the stomach to form a Y configuration, which decreases the pathway of food through the intestine
Characteristics of roux-en-Y bypass
Restrictive and malabsorptive
Sleeve gastrectomy
Removal of the greater curvature of the stomach leading to a tubular-shaped stomach
Characteristics of sleeve gastrectomy
Restrictive
Laparoscopic adjustable gastric banding
Placement of a restrictive band on the upper portion of the stomach
Characteristics of laparoscopic adjustable gastric banding
Restrictive
Etiology of volvulus
Torsion of a segment of the bowel (MC sigmoid)
S/S of sigmoid volvulus
Slowly progressive abdominal pain, nausea, abdominal distention, and constipation
Vomiting several days after onset of pain
Diagnosis of sigmoid volvulus
CT
Whirl pattern
Management of sigmoid volvulus
Detorsion with rigid sigmoidoscopy
S/S of cecal volvulus
Abdominal pain
N/V
Diffusely distended
Tender to palpation
Diagnosis of cecal volvulus
X-ray: coffee bean and comma sign
CT: whirlwind
Treatment of cecal volvulus
Surgery
Etiology of small bowel obstruction
Post-surgical adhesions
S/S of small bowel obstruction
N/V
Colicky abdominal pain
Dehydration
Hyperactive bowel sounds early on, then hypoactive bowel sounds
Diagnosis of SBO
Ladder-like appearance of dilated bowel loops on X-ray
Treatment of SBO
GI decompression with NG tube
Surgery
Etiology of cholangitis
CBD obstruction of e. coli
S/S of cholangitis
RUQ pain
Fever
Jaundice
Hypotension
Mental status change
Diagnosis of cholangitis
ERCP
Treatment of cholangitis
ERCP with stone extraction and sphincterotomy
Lap chole after ERCP
Cipro and Flagyl
Etiology of cholelithiasis
Cholesterol
S/S of cholelithiasis
RUQ pain (biliary colic)
Diagnosis of cholelithiasis
Ultrasound
Treatment of cholelithiasis
NSAIDs for pain
Lap chole
Etiology of choledocholithiasis
Stone in the CBD
S/S of choledocholithiasis
Biliary colic
Jaundice
Diagnosis of choledocholithiasis
Elevated liver enzymes
US
Treatment of choledocholithiasis
ERCP with stone extraction and sphincterotomy
Colon polyp
Fleshy lesion protruding into intestinal lumen
What type of colon polyp are most likely to be cancerous?
Flat
Diagnosis/treatment of colon polyp
Colonoscopy with removal
Risk factors for colon cancer
Family hx
Age
Diet
Smoking
Obesity
S/S of colon cancer
Asymptomatic
Bowel changes
Diagnosis of colon cancer
Colonoscopy with biopsy
Treatment of colon cancer
Surgical resection
Chemo/radiation
Screening for colon cancer
Colonoscopy q10y
CT colonography q5y
Flexible sigmoidoscopy q5y
Flexible sigmoidoscopy with FIT q10 years plus FIT q1y
FIT-DNA q1-3y
FOBT q1y
FIT q1y
from ROSH
Etiology of diverticular disease
Chronic constipation
S/S of uncomplicated diverticulosis
Asymptomatic
Treatment of uncomplicated diverticulosis
High fiber diet
S/S of diverticulitis
LLQ pain
Fever
Bowel changes
Blood in stool
Palpable mass
Diagnosis of diverticulitis
CT
Treatment of diverticulitis
Clear liquid diet x 2-3d
Cipro + Flagyl, Bactrim + Flagyl, Augmentin, Zosyn
High fiber diet
Colonoscopy 4-8 weeks after resolution of symptoms
Risk factors for esophageal cancer
Smoking
Alcohol
Barrett esophagus
S/S of esophageal cancer
Weight loss
Dysphagia
Diagnosis of esophageal cancer
Endoscopy with biopsy
Treatment of esophageal cancer
Surgery, chemo, radiation
MC gastric cancer
Adenocarcinoma
S/S of gastric cancer
Dyspepsia
Vague epigastric pain
Weight loss
Anorexia
Masses
Signs of metastasis of gastric cancer
Virchow’s node: left supraclavicular lymph node
Sister mary joseph nodule: umbilical nodule
Blumer shelf: rigid rectal shelf
Diagnosis of gastric cancer
EGD
Treatment of gastric cancer
Surgical resection, chemo, radiation
GERD treatment
Lifestyle modifications
Mild: H2 blockers
Severe or failed H2: PPI
Etiology of hemorrhoids
Increased venous pressure
S/S of hemorrhoids
Asymptomatic
Bleeding
Staging of hemorrhoids
I: confined to anal canal
II: protrude from anal canal, but redicable
III: require manual reduction after bowel movement
IV: chronically protruding and risk strangulation
Treatment of hemorrhoids
Stage 1-2: proper toileting
More severe or failure of conservative treatment: band ligation or injection sclerotherapy
Stage 4: hemorrhoidectomy
Etiology of liver cancer
Cirrhosis
S/S of liver cancer
Constitutional symptoms
Tender hepatomegaly
Diagnosis of liver cancer
Elevated liver enzymes
AFP
CT and MRI to identify mass
Biopsy to confirm
Patients that should be screened for liver cancer
Patients with cirrhosis or chronic HBV or HCV
Liver US and AFP q6m
Treatment of liver cancer
Resection of tumor
Liver transplant
Risk factors for umbilical hernia
Anything that increases the intra-abdominal pressure:
- Pregnancy
- Ascites
- Obesity
- Large abdominal tumor
S/S of umbilical hernia
Soft swelling covered by skin herniated area protrudes with coughing, crying, or straining
Treatment of umbilical hernia
Small: mesh repair laparoscopically
Large: open repair
Incisional hernia
Result of breakdown own fascial closure
Hernia patients that are not surgical candidates
Not urgent
Unwilling
Poor surgical risk
Indirect vs. direct vs. femoral inguinal hernia
Indirect: patient inguinal canal, above inguinal ligament, internal inguinal ring
Direct: external inguinal ring only, rarely into the scrotum
Femoral: below the inguinal ligament, inguinal canal is empty
S/S of hiatal hernia
Asymptomatic
GERD
Treatment of hiatal hernia
Lifestyle modifications
NISSEN fundoplication
Magnetic sphincter
MC location of Crohn’s
Terminal ileum
S/S of Crohn’s
RLQ pain
Nonbloody diarrhea
Malabsorption
Erythema nodosum
Pyoderma gangrenosum
Fistula formation
Diagnosis of Crohn’s
Colonoscopy with biopsy
Skip lesions
Cobblestoning
Treatment of Crohn’s
Steroids
Immunomodulators
TNF blockers
MC area of ulcerative colitis
Rectum and sigmoid colon
S/S of UC
Bloody diarrhea
Crampy lower abdominal pain
Diagnosis of UC
Sigmoidoscopy
Management of UC
Mild: topical mesalamine
Severe: oral mesalamine, steroids, or immunomodulators
Curative: proctocolectomy with placement of ileostomy
Mild vs. severe UC
Mild: mostly distal
Severe: extends past the sigmoid
MC type of pancreatic cancer
Adenocarcinoma of the pancreatic head
Greatest risk factor of pancreatic cancer
Smoking
S/S of pancreatic cancer
Vague epigastric pain with radiation to the back
Constitutional sx
Courvoisier sign
Courvoisier sign
Painless jaundice with palpable gallbladder
Diagnosis of pancreatic cancer
CT
ERCP if CT is inconclusive
Treatment of pancreatic cancer
Whipple
Resection of tumor
Pancreatic pseudocyst
Encapsulated collection of fluid with well-defined inflammatory wall
Occurs as a complication of acute pancreatitis
Treatment of pancreatic pseudocyst
If asx - nothing
If sx - drain
Etiology of PUD
H. pylori and NSAIDs
S/S of PUD
Dull, gnawing epigastric pain
Relief by eating
Nocturnal pain
Diagnosis of PUD
EGD
Treatment of H. pylori PUD
Omeprazole
Amoxicillin
Clarithromycin
EGD or breath test 4 weeks later
S/S of pyloric stenosis
Postprandial N/V
Epigastric pain
Distention
Olive-shaped mass
Diagnosis of pyloric stenosis
EGD for adults
US for kids
Management of pyloric stenosis
Conservative treatment first
Pyloromyotomy
Etiology of toxic megacolon
IBD (UC)
Infectious colitis
S/S of toxic megacolon
Bloody diarrhea
Abdominal pain and distention
Toxic
Diagnosis of toxic megacolon
CT
Treatment of toxic megacolon
IV steroids
Colectomy with ileorectal anastomosis
