Surgery Rotation 15 Flashcards
Pre-op management of pt with high risk of coagulation
Prophylactic low-dose heparin
Hormones that can be produced by squamous cell carcinoma of the lung
PTH = hypercalcemia
THINK: s(Ca)mous cell
Hormones that can be produced by small cell carcinoma of the lung
ADH, ACTH (Cushings), antibodies against post-synaptic Ca2+ channels (Lambert Eaton)
Tx of acute pancreatitis
Fluid resuscitation
What causes flank pain that radiates to the groin?
Kidney stones
Ddx of LLQ pain in old men
Sigmoid volvulus
Mesenteric ischemia
Biliary disease associated with ulcerative colitis
Primary sclerosing cholangitis
Antibody associated with primary sclerosing cholangitis
p-ANCA
Antibody associated with primary biliary cirrhosis
anti-mitochondiral antibodies
Classic imaging associated with PSC
“beaded” appearance due to contrasting dilation and narrowing
Diagnose: episodes of dysphagia, regurgitation, and/or chest pain precipitated by emotional stress and hot/cold foods
Diffuse esophageal spasm
Test used to diagnose diffuse esophageal spasm
Manometry
What will you see on endoscopy with a gastrinoma
Multiple ulcers and thickened gastric folds
Presentation of colovesical fistula
Connection between colon and bladder
Presents with pneumaturia (air in urine), fecaluria (stool in urine), recurrent UTI (mixed flora)
How do you diagnose colovesical fistula
Abd CT with oral or rectal (not IV) contrast - will show contrast in the bladder
Colonoscopy to exclude colonic malignancy
Describe management of dysphagia when it is difficulty initiating swallowing; with cough, choking or nasal regurg
Probably oropharyngeal dysphagia
Evaluation with barium swallow
Evaluation of dysphagia with solids progressing to liquids
Mechanical obstruction
Barium swallow or upper GI
Evaluation of dysphagia with solids and liquids at onset
Motility disorder
Barium swallow followed by manometry
Next step in management after US if suspected cancer causing biliary obstruction?
Abd CT
Do not do ERCP immediately because it is invasive
Diagnose: bleeding in women on long term OCP
Hepatic adenoma
Most common cause of liver mass
Metastatic disease
Tx of acute pancreatitis
Supportive (fluids, bowel rest)
Diagnosis of chronic pancreatitis
CT
Tx of acute ascending cholangitis
Emergency ERCP to drain duct. Or can use percutaneous transhepatic drainage
Fluids, abx
Tx of pulmonary contusion
Fluid restriction and diuretics
Contused lungs are sensitive to fluid overload
Cause and presentation of primary biliary cirrhosis
Autoimmune destruction of intra-hepatic bile ducts
–Associated with other autoimmune conditions
Presentation:
–Cholestasis – due to destruction of bile ducts
–Jaundince, hepatomegaly, steatorhhea, portal HTN
–Hyperlipidemia (with xanthelasma)
–Metaboalic bone disease
- Lymphocytic infiltrate + -
granulomas
- Mostly occurs in women around age 40
- (+) anti-mitochondrial antibody (AMA)
- Cirrhosis is a late complication
Cause and presentation of primary sclerosing cholangitis
- Unknown cause
- Concentric fibrosis of the intra- and extra-hepatic bile ducts
- Contrast imaging will show “beaded” appearance due to alternating fibrotic and dilated regions
- Mostly occurs in men around age 40
- Associated with (+) pANCA and Ulcerative colitis
- Increased risk for cholangiocarcinoma
Tx of sigmoid volvulus
sigmoidoscopy-guided placement of rectal tube
Ulcers associated with autoimmune disorders such as IBD
Pyoderma gangrenosum
What are the effects of hypomagnesemia on calcium?
Mg is needed for the production and release of PTH. So low Mg = low PTH = hypocalcemia
Contraindications to mammography
Age < 20. Breast tissue too dense
Lactating women
NO contraindication in pregnancy
Tx of sigmoid volvulus
sigmoidoscopy-guided placement of rectal tube
Ulcers associated with autoimmune disorders such as IBD
Pyoderma gangrenosum
What are the effects of hypomagnesemia on calcium?
Mg is needed for the production and release of PTH. So low Mg = low PTH = hypocalcemia
What is decerebrate posturing?
Causes hyper extension (away from core, vs. decorticate posturing)
Caused by ICP
