surgery- pestanos

Question 1

signs of mechanical intestinal obstruction

Answer 1

high pitched bowel sounds

distended loops of small bowel with air fluid levels

Question 2

signs of strangulation

Answer 2

fever
leukcystosis
constant pain
peritoneal irritation

Question 3

signs of strangulated hernia

Answer 3

hernia that was once reducible is no longer so

Question 4

presentation/treatment for R colon cancer

Answer 4

hypochromic Fe deficiency anemia, 4+ occult blood

R hemicolectomy

Question 5

presentation of L colon cancer

Answer 5

bloody stool, narrow stool caliber

Question 6

when do you surgically treat crohns

Answer 6

complications such as bleeding/ stricture/ fistula

Question 7

proper surgical treatment for UC

Answer 7

removal of rectal mucosa –> need stoma or ileoanal anastomosis

Question 8

medical therapy for anal fissure

Answer 8

diltiazem topical ointment TID for 6 weeks

higher success rate than botulinum toxin

Question 9

most common causes of GI bleeding

Answer 9

angiodysplasia
polyps
diverticulosis
cancer

Question 10

origin of GI bleed is always ______ when there is hemoptysis or blood recovered by NG tube

Answer 10

upper

Question 11

approach to lower GI bleed

Answer 11

1) EXCLUDE HEMORRHOIDS
Next:
-angiogram --> agnioembolization
-wait to stop, --> colonoscopy
-tagged red cell study

Question 12

blood per rectum in a child

Answer 12

meckel divertic –> technetium scan looking for ectopic gastric mucosa

Question 13

causes of acute abdomen

Answer 13

perf
obstruction
inflammation
ischemia

Question 14

acute abdomen: perf

Answer 14

sx: diffuse/ generalized pain, guarding, rebound, PT DOESN’T MOVE
dx: free air under diaphragm

ex: perf peptic ulcer

Question 15

acute abdomen: obstruction

Answer 15

think of a duct

sx: PT MOVES CONSTANTLY SEEKING COMFORT, typlica location of pain and radiation

Question 16

things to rule out in generalized acute abdomen before doing ex lap

Answer 16

MI
PE
lower lobe PNA
pancreatitis

Question 17

findings on xray for sigmoid volvulus

Answer 17

“parrot’s beak sign”

giant air filled loop from RUQ to LLQ

Question 18

hepatic adenoma

Answer 18

complication of birth controls pills?

can rupture and bleed into abdomen

Question 19

labs associated with obstructive jaundice

Answer 19

elevations of direct and indirect bili, inc AST/ALT,

INC ALP!!!!

Question 20

courvoisier terrier sign

Answer 20

malignant biliary duct obstruction (large and THIN WALLED with distended galbladder)

Question 21

MRCP vs ERCP

Answer 21

MR cholangiopancreatogram
Endoscopic retrograde “

MR is noninvase, only imaging
ERCP is functional

Question 22

cancers that cause obstructive jaundice

Answer 22

adeno of head of panc
adeno of ampulla of Vater
cholangocarcinoma of common duct

Question 23

surgical managment of acute cholecystitis

Answer 23

NPO, NG suction, IVF, abx –> elective chole

Question 24

option in non surgical patient needed emergent chole?

Answer 24

percutaneous transhepatic cholecystOSTOMY

Question 25

ranson's criteria for acute hemorrhagic pancreatitis

Answer 25

inc WBC, bG dec serum Ca, HCT

Question 26

hesselbachs triangle

Answer 26

inguinal lig= inferior inf epigastric= lateral rectus abdominus = medial

Question 27

excessive salivation after birth, or choking after first feeds

Answer 27

esophageal atresia

Question 28

what should you check for if you note esophageal atresia?

Answer 28

VACTER- vertebral, anal, cardiac, tracheal, esophageal, renal and radial check for imperforate anus, echo for heart, xray for spine

Question 29

congenital diaphragmatic hernia

Answer 29

LEFT - -> hypoplastic lung with fetal type circulation - req intubation/sedation/low pressure vent/ NG suction

Question 30

when do you repair congenital diaphragmatic hernia

Answer 30

3-4 days after birth to allow lung maturation

Question 31

how do you fix large omphaloceles

Answer 31

construction of "silo" to protect bowel --> contents squeezed into belly piece wise over a week --> closure

Question 32

do babies with gastroschisis require nutrition?

Answer 32

yes, parenteral for ~1 month because bowel will not work

Question 33

gastroschisis vs omphalocele

Answer 33

gastro --> defect to RIGHT of cord, no covering | omphaloSEAL--> cord goes to defect, thing protective membrane

Question 34

differential for billious vomiting and "double bouble"

Answer 34

duodenal atresia annular pancreas malrotation

Question 35

how can you distinguish malrotation from duodenal atresia and annular pancreas? how do you dx it?

Answer 35

double bubble with minimal normal gas pattern beyond surgical emergency! dx with contrast enema, upper GI

Question 36

bililous vomiting, multiple air fluid levels, no double bubble

Answer 36

intestinal atresia "vascular accident" in utero

Question 37

necrotizing enterocolitis: signs and tx

Answer 37

- feeding intol, abd distention, rapid drop in plt | - stop feeds, IV abx, IV nutrition

Question 38

meconium ileus

Answer 38

CF - multiple dilated SB loops + ground glass appearance in low abd - gastrograffin= dx and tx

Question 39

nonbilious projectile vomiting after feeds in newborn

Answer 39

pyloric stenosis - olive mass - FIRST rehydrate, correct hypochloremic, hypokalemic metabolic alkalosis

Question 40

tx for pyloric stenosis (after electrolyte correction)

Answer 40

ramstedt pyloromyotomy | balloon dilation

Question 41

biliary atresia

Answer 41

6-8wk with progressive jaundice - stimulate with phenobarbital - liver transplant is definitive

Question 42

hirschprung (aganglionic megacolon) --> sx

Answer 42

chronic constipation | -explosive expulsion of stool and flatus on DRE --> relief of abdominal distention

Question 43

hirschprung on xray, dx

Answer 43

distended proximal colon (normal) --> "normal" distal colon (aganglionic) dx with full thickness biopsy of rectal mucosa

Question 44

intussussception

Answer 44

colicky abd pain currant jelly stools RLQ barium/air enema= dx and tx

Question 45

how do you tell appy from intussussception in kids

Answer 45

appy > age 3

Question 46

pediatric lower GI bleed

Answer 46

meckel's radioisotope scan to look for gastric mucosa

Question 47

three complications of GI fistula when draining freely (stable pt)

Answer 47

1. fluidand lyte loss 2. nutritional depletion 3. erosion/digestion of abdominal wall **feed past fistula + ostomy

Question 48

fistula FETID mnemonic (fistula will heal unless these are present)

Answer 48

``` Foreign body Epithelialization Tumor Infection/Irradiation/IBD Distal obstruction ```

Question 49

t/f steroids prevent fistula healing

Answer 49

TRUE | also remember FETID

Question 50

how to manage traumatic pelvic fracture

Answer 50

External fixation give blood look for urethral injury ***if CT shows bleeding only in pelvis. If its expanding to peritoneum --> OR