Surgery Rotation 12 Flashcards
What is the tx for immune thrombocytopenia
Splenectomy
Spleen is what is producing the antibodies and also what is consuming the antibody-bound platelets
What are the two important medications to give to a post-op splenectomy
Aspirin - can have post-op thrombocytosis
Prophylactic penicillin
What is Kehr sign
L shoulder pain to due irritation of the diaphragm
When do you go to surgery in a pt with appendicitis
Always if we think they have appendicitis
Do not need imaging if there is a good clinical picture
How does management of appendicitis change if there is perforation or abscess
Drain abscess and give abx first, then appendectomy once stabilized
1 site for carcinoid tumor
appendix
Sx of carcinoid symdrome
BFDR
Bronchospasm
Flushing
Diarrhea
R-heart lesions
What else should you look for in a pt with carcinoid syndrome
Niacin (B3) deficiency
Because serotonin and niacin are both made from tryptophan; so if all tryptophan is being used for 5HT, none is used for Niacin
Presentation of Niacin deficiency
Pellagra = diarrhea, dermatitis, dementia
Tx of carcinoid tumor of appendix if >2cm, at base of appendix, or with + nodes
Hemicolectomy
Otherwise appendectomy is good enough
1st step in management of possible SBO
Upright CXR to look for free air
CT can show point of obstruction
Tx of SBO
IVF, NG tube
When do you do surgery for SBO
If peritoneal signs, increased WBC, or no improvements within 48 hr
Diagnose: dilation of both small and large bowel on XR
Post-op ileus
Most common location of Crohn’s
Terminal ileum
Tx of diverticulitis
NPO, NG suction, IVF, broad spectrum abx
When is surgery indicated for diverticulitis
Multiple episodes, age < 50
Sx of R-sided vs L-sided colon cancer
R-sided = bleeding
L-sided = obstruction
When is surgery indicated in AAA
> 5 cm
1 cause of death post-op AAA
MI
Post-op diarrhea after AAA repair
Ischemic colitis
Post-op weakness and decreased pain/sensation after AAA repair
ASA syndrome
Post-op AAA repair 1-2 yrs later if have brisk GI bleeding
Aortoenteric fistula
Diagnose: severe mid-epigastric pain after eating, food fear, weight loss
Pain out of proportion to exam
Mesenteric ischemia
Work up of suspected acute mesenteric ischemia
Angiography (aorta and SMA/IMA)
Tx of acute mesenteric ischemia
Surgical emergency!
Embolectomy
Cause of chronic mesenteric ischemia
Slow progressing stenosis
Tx of chronic mesenteric ischemia
Aortomesenteric bypass or transaortic mesenteric endarterectomy
Best test for peripheral artery claudication
Ankle-brachial index
Normal >1
Tx of acute arterial occlusion
Immediate heparin + prepare for surgery
When would you use thrombolytics in acute arterial occlusion
No surg in <2 weeks
Hemorrhagic stroke
Common complication of tx of acute arterial occlusion
Compartment syndrome during reperfusion period
Do fasciotomy + watch for myoglobinuria
Tx of DVT
Heparin bridge to Warfarin, continue Warfarin 3-6 months
Work-up of suspected PE
Give Heparin 1st! Then work up with V/Q scan, then spiral CT
Pulmonary agiography is gold standard
Tx of PE
Heparin Warfarin overlap
Use thrombolytics if severe but NOT if s/p surgery or hemorrhagic stroke
Surgical thrombectomy if life threatening
1st step in assessing thyroid nodule
Check TSH
Next step in thyroid nodule if TSH is low
Do RAIU to find the “hot nodule”
Excise or radioactive iodine
Next step in thyroid nodule if TSH is normal
FNA
Next step in thyroid nodule if normal TSH and benign FNA
Leave it alone
Next step in thyroid nodule if normal TSH and malignant FNA
Excise and check pathology
Next step in thyroid nodule if normal TSH and malignant FNA with indeterminate pathology
Re-biopsy or check RAIU
Next step of cold thyroid nodule
Surgically excise and check pathology
How do you differentiate amide anesthetics from ester anesthetics
Amides have an “I” other than the I in “caine”
E.g. Lidocaine, Bupivacaine, Prilocaine
Vs. Procaine, Chlorprocaine, Tetracaine
Are amide or ester anesthetics longer acting
Most amides are intermediate to long acting
Esters are short acting except for tetracaine
