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MS3 > Surgery Rotation 11 > Flashcards

Surgery Rotation 11 Flashcards

1
Q

Gastric varices are often caused by what?

A

Splenic vein thrombosis

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2
Q

What should you be concerned about if you treat H. Pylori with triple therapy and pain does not improve?

A

Zollinger Ellison (gastrin-secreting tumor)

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3
Q

Test for Zollinger Ellison

A

Secretin stimulation test = gastrin levels remain high after administration of secretin

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4
Q

Tx of Zollinger Ellison

A

Surgical resection of tumor (most likely in pancreas even though ulcers are in duodenum)

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5
Q

What else should you be looking for with Zollinger Ellison

A

MEN1

  • Pituitary tumors (prolactin or GH)
  • Pancreatic endocrine tumors (Zollinger-Ellison syndrome, insulinomas, VIPomas, glucagonomas)
  • Parathyroid adenomas
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6
Q

Diff in tx of pt with acute onset vs gradual onset hypovolemic hypernatremia

A

acute = D5W

Gradual = D5W 1/2NS (pt has adjusted to hypernatremia so you can’t correct too quickly)

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7
Q

What is SMA syndrome?

A
  • When the 3rd part of the duodenum (transverse section) gets compressed between the SMA and aorta
  • Due to decrease in aortomesenteric angle
  • This blocks food from passing from duodenum to jejunum, causing intestinal obstruction
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8
Q

Tx of SMA syndrome

A

Restore weight and nutrition

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9
Q

How do diagnose pancreatitis

A
  • Increased amylase + lipase

- CT

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10
Q

Tx of pancreatitis

A
  • Mostly supportive

- NG suction if nauseous, NPO for bowel rest, IV hydration, observation

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11
Q

Common complications of pancreatitis

A

Psuedocysts (no cells), hemorrhage, abscess, ARDS

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12
Q

What is Courvoisier’s sign

A

Large, nontender GB, itching and jaundice

Indicative of pancreatic cancer at head of pancreas

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13
Q

What is Trousseau’s sign associated with pancreatic cancer

A

Migratory thrombophlebitis

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14
Q

Diagnosis of pancreatic cancer?

A

Endoscopic US and FNA biopsy

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15
Q

When is a pancreatic tumor deemed “resectable”

A

No mets outside abd, no extension into SMA or portal vein, no liver mets, no peritoneal mets

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16
Q

What is the presentation associated with insulinoma

A

Whipple’s triad:

  • Sxs (sweat, tremor, hunger, seizures)
  • BGL < 45
  • Sx resolve with glucose administration
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17
Q

What labs indicated real insulinoma vs. exogenous insulin administration

A

Labs: elevated insulin, C-peptide, and pro-insulin

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18
Q

Presentation of glucagonoma

A

Hyperglycemia, diarrhea, weight loss

Characteristic rash = necrolytic migratory erythema

19
Q

Presentation of somatostatinoma

A

Malabsorption, steatorrhea

Commonly malignant

20
Q

Presentation of VIPoma

A

WDHA

Watery diarrhea, hypokalemia, achlorhydia

21
Q

Tx of VIPoma

A

Octreotide

22
Q

Best first test if presumed gallbladder problem

23
Q

Diagnose: RUQ pain, high bilirubin, high alkaline phosphotase

A

Thinking obstruction

Choledocholithiasis

24
Q

Tx of choledocholithiasis

A

Chole +/- ERCP to remove stone

25
Q

Diagnose: RUQ pain, fever, jaundice, decreased BP, AMS

A

Ascending cholangitis

26
Q

Tx of ascending cholangitis

A

Abx

Remove stone with ERCP

27
Q

Cause of hepatitis with ALT > AST (with both of them really high)

A

Viral hepatitis

28
Q

Cause of hepatitis with AST = 2x ALT

A

Alcoholic hepatitis

29
Q

Cause of hepatitis with AST and ALT high s/o hemorrhage, surgery, or sepsis

A

Shock liver: Hypotension = liver injury

30
Q

Medical management of cirrhosis and portal HTN

A

Somatostatins for vasoconstriction to decrease portal pressure

Beta blockers to decrease portal pressure

31
Q

What is downside to TIPS

A

Worsens encephalopathy because it bypasses clearance of pneumonia

32
Q

Tx of hepatic encephalopathy

A

Lactulose (will poop it out)

33
Q

Main risk factors for hepatocellular carcinom

A

Chronic HepB carrier > HepC

Cirrhosis

34
Q

Tumor marker associated with hepatocellular carcinoma

35
Q

Diagnose: women on OCP, palpable abd mass or spontaneous rupture, leading to hemorrhagic shock

A

Hepatic adenoma (tumors are fed by estrogen, which is why OCP is a risk factor)

36
Q

Tx of hepatic adenoma

A

Stop OCP

Surgery usually not needed

37
Q

2nd most common benign liver tumor

A

Focal nodular hyperplasia

Less likely to rupture

38
Q

Most common cause of liver bacterial abscess

A

E. Coli, Bacterioides, Enterococcus

39
Q

Tx of bacterial liver absces

A

Drainage + IV abx

40
Q

Tx of amoebic abscess (Entamoeba histolytica - anchovy paste)

A

DO NOT drain

Tx with Metronidazole

41
Q

Diagnose: Pt from south america with RUQ pain and lots of liver cysts

A

Hydatid cysts from Ecchinococcus - transmitted via dog feces

42
Q

Lab findings in Ecchinococcus

A

Eosinophilia, + Casoni skin test

43
Q

Tx of Echinococcus liver cyts

A

Surgery + Albendazole

Be careful of cyst rupture and spread

MS3 (88 decks)

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