Surgery Rotation 14 Flashcards
Management of SBO causes by adhesions from surgery 5 years ago
NG suction, bowel rest, willing to wait about 24hr in complete obstruction, Willis to wait 3-5 day’s in incomplete obstruction
Main concern while waiting out SBO
Strangulation - fever, leukocytosis, pain etc
Management of strangulated obstruction
Emergency surgery
Management of acute appendicitis
Emergency surgery
Tests to diagnose atypical appendicitis
US or CT
US is user dependent
CT os more reliable
Treatment of peripheral artery disease
- Walking program
2. Aspirin
Is it possible to have elevated WBC in urinalysis in appendicitis?
Yes - if the inflammation of appendicitis is great enough, it can spread to the ureter and bladder leading to an abnormal urinalysis
What does an IV pyelography show you?
Will show blood flow to kidney, ureters, and bladder
Provides detailed info about anatomy of calyces and the size and shape kidney
Useful in detecting kidney stones
What is culdocentesis and when is it used
Culdocentesis is a procedure performed in women in which peritoneal fluid is aspirated from the posterior pelvic cul-de-sac (pouch of Douglas) through the posterior vaginal fornix
Historically, it was used to evaluate women for hematoperitoneum secondary to ruptured ectopic pregnancy or ruptured ovarian cyst, or for a pelvic infection
Next step in management of patient with clinically obvious intussusception
Nonoperative reduction using hydrostatic or pneumatic pressure via enema
Hormones secreted by renal cell carcinoma
- Erythropoietin → polycythemia
- ACTH → Cushing
- PTH-related peptide → Hypercalcemia
- Prolactin → hypogonadism, decreased libido, galactorrhea
Describe presentation of Crohn disease
- RLQ pain (ileum is most common location)
- Non-bloody diarrhea
- Strictures (string sign appearance)
Describe presentation of Ulcerative colitis
- LLQ pain (rectum)
- Bloody diarrhea
- Loss of haustra (lead pipe appearance)
Imaging used to diagnose acute cholecystitis
US
What are causes on non-visualization of the gallbladder on US
- Non-distention due to inadequate fasting
- Surgically removed
- Congenitally absent
- Ectopic location
- Filled with stones
Diagnostic test for suspected appendicitis if not clinically obvious
CT
Best first test for suspected acute cholangitis
US
Best imaging test for suspected pancreatitis or pancreatic malignancy
CT
Treatment of appendiceal abscess
Patients can have high complication rate from immediate surgery due to the mass of inflamed and infected debris and adhesions
If stable, these patients should be managed with IV abx, bowel rest, and possible percutaneous drainage of abscess
Can return in 6-8 weeks for elective appendectomy
Structures at risk for damage in a supracondylar fracture?
Brachial artery and median nerve
Scary complication of scaphoid fracture
Osteonecrosis due to disrupted blood flow
Next step in management of suspected renal contusion
CT scan
Only imaging test commonly used in a penile fracture
Retrograde urethrogram for suspected urethral injury
Regardless, penile fracture is a urological emergency
Will mechanical bowel obstruction have hyper or hypoactive bowel sounds
Hyperactive (e.g. gallstone ileus)
Will acute bowel ischemia have hyper or hypoactive bowel sounds
Hypoactive
Tx of small pneumothorax
Observation and oxygen
How do you diagnose C. diff
- Stool culture
- Proctosigmoidoscopic exam
- Identification of toxin in stool (probably best option)
Tx of C. diff
- Stop offending abx
- Do not give anti-diarrheals (it will keep toxin in body)
- Metronidazole (or oral Vancomyin)
Tx of internal hemorrhoids
Rubber band ligation or laser
Remember that internal hemorrhoids have no nerve innervation
Tx of external hemorrhoids
Formal operation with anesthesia because ligation will be too painful
Tx of anal fissures
If pain control doesn’t work, want to loosen anal sphincter (surgical sphincterectomy, botox injections)
What is a fistula-en-ano
Occurs in someone who previously had an ischiorectal abscess drained
Describe metastasis of anal adenocarcinoma vs anal squamous cell carcinoma
Adeno = mets only to abd lymph nodes
SCC = abd lymph nodes + groin lymph nodes
Management of squamous cell carcinoma of the anus
Chemotherapy + radiation to shrink tumor, followed by surgery if necessary
Which thyroid cancer spreads hematogenously (vs. others which spread via lymph)
Follicular
What is melanosis coli
Dark brown discoloration of the colon with pale patches of lymph follicles
Caused by laxative use
Describe primary biliary cirrhosis
-Autoimmune destruction of intra-hepatic bile ducts
o Associated with other autoimmune conditions
-Presentation:
o Cholestasis – due to destruction of bile ducts
o Jaundince, hepatomegaly, steatorhhea, portal HTN
o Hyperlipidemia (with xanthelasma)
o Metaboalic bone disease
Antibody associated with primary biliary cirrhosis
anti-mitochondrial antibody (AMA)
Most common cause of cirrhosis
viral hepatitis (C > B)
Tx of acalculous cholecystitis
- Enteric antibiotic coverage
- Cholecystostomy for initial drainage
- Cholecystectomy once clinically stable
Neoplasms associated with Lynch syndrome
Aka Hereditary Nonpolyposis Colorectal cancer (HNPCC)
Colorectal cancer
Endometrial cancer
Ovarian cancer
Initial treatment of esophageal variceal bleeding
Volume resuscitation, IV octreotide, Abx
Tx of esophageal varices that stop bleeding after fluid and octreotide
Beta blocker (prophylaxis) with endoscopic band ligation in 1-2 weeks
Tx of esophageal varices that continue to bleed after fluid and octreotide
Balloon tamponade (temporary)
Then TIPS or shunt surgery
How do you diagnose meckels diverticulum
Radioactive technichium Study to identify gastric mucosa in the bowel
Tx of stress ulcers
Radiographic ligation of vessels supplying the ulcers
