Surgical Abdomen Flashcards

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1
Q

main reasons for emergent/urgent surgery

A

Obstruction, necrosis, perforation, and exsanguinating hemorrhage

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2
Q

“when I was riding to the hospital, going over the bumps in the car hurt a lot” sign of..

A

peritonitis

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3
Q

types of blockage in GI tract

A

GOO (gastric outlet obstruction), small bowel obstruction, and colonic obstruction

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4
Q

proximal obstruction hallmarks

A

frequent vomitting, non-feculent, less colicky, late obstipation

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5
Q

distal obstruction hallmark

A

late vomitting that smells feculent, MORE colicky, early obstipation

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6
Q

what is GOO caused by

A

pyloric/duodenal pathology- such as foreign body, tumor of antrum/pylorus/duodenum, or pyloric channel ulcer

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7
Q

GOO treatment

A

EGD with dilation or surgery, resection/bypass around tumor, or removal of FB

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8
Q

most common cause of small bowel obstruction

A

adhesion (mechanical cause)

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9
Q

most common cause of colonic obstruction

A

carcinoma (mechanical cause)

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10
Q

workup for SBO includes

A

AXR, SBFT, CT with oral contrast

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11
Q

tx for small bowel obstruction

A

IVF, NG tube for decompression, pain control, abx if indicated, and NPO

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12
Q

when is surgery indicated for SBO

A

if hernia, pain severe, or conservative management failed

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13
Q

preop surgery for SBO

A

NG tube for decompression, correct electrolytes (IVF), abx within 30 min of decompression, NPO, DVT prophylaxis, consent

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14
Q

types of surgery for SBO

A

adhesiolysis, small bowel resection, exploratory laparotomy

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15
Q

functional cause of obstruction

A

SBO- paralytic ileus. LBO- colonic pseudo obstruction or ogilve’s

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16
Q

tx of colonic obstruction

A

preoperative decompression (stent for stricture or tumor), resection of obstructed segment, or end colostomy/loop ileostomy

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17
Q

right sided vs left sided colon cancer

A

right sided- presents with anemia and liquid stood. left sided- presents with obstruction and solid stool

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18
Q

what can diverticulitis look exactly like on radiographic study and grossly?

A

tumor

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19
Q

types of volvulus

A

sigmoid, cecal, transverse, and cecal bascule

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20
Q

tx of volvulus

A

decompression colonoscopy or resection

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21
Q

segmental colon resection

A

diverticulitis, colon cancer, perforation, volvulus

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22
Q

hartman’s procedure

A

surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy.

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23
Q

subtotal colectomy indications (main)

A

pseudomembranous colitis with toxic megacolon, UC, ischemia of colon

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24
Q

total colectomy indications

A

UC

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25
Q

2 finishes of total colectomy

A

end ileostomy and ileoanal anastomosis with j-pouch plus a temporary diverting ileostomy

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26
Q

LAR indications

A

high rectal tumor

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27
Q

LAR removes…

A

sigmoid colon and most of the rectum

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28
Q

abdominoperineal resection

A

removal of rectum and anus + end colostomy

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29
Q

abdominoperineal resection indication

A

low rectal tumor

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30
Q

tx of volvulus

A

decompression with colonoscopy, definitive surgery with sigmoidectomy with end colostomy

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31
Q

“dilated bird beak toward LLQ”

A

sigmoid volvulus

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32
Q

patient presents with noticeable bulge and severe pain in abdomen. Has N/V. Upon palpation, very tender. Bluish discoloration present on skin. Non-reducible bulge. Dx?

A

hernia

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33
Q

When is hernia repair emergent?

A

when there is strangulation of bowel within the hernia sac, otherwise its elective

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34
Q

what type of hernias are at low risk of strangulation?

A

very large hernias

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35
Q

If patient has hernia that causes strangulation of bowel resulting in death of bowel, what is next course of action?

A

emergent surgery- necessitates small bowel resection

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36
Q

landmark for differentiating direct vs indirect hernias?

A

inferior epigastric vessels

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37
Q

borders of hesselbach’s triangle

A

epigastric vessels, rectus sheath, and inguinal ligament

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38
Q

graham patch used in tx of…

A

duodenal perforation

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39
Q

graham patch F/U for duodenal perforation

A

follow up EGD in 6-8 weeks to biopsy

40
Q

perforated ulcer tx

A

broad spectrum abs plus antifungal. EMERGENT

41
Q

gastric perforation tx

A

excision of the ulcer and repair of gastric wall or gastric resection (antrectomy) and reconnection (Billroth I, II, and Roux-en-Y)

42
Q

Patient presents with RUQ pain that is severe, diarrhea, fever, Murphy’s sign. LIpase and LFT normal. US shows thickened gallbladder wall. Suspect..

A

acute cholecystitis

43
Q

If patient with acute cholecystitis but not good candidate for surgery, what are your other options?

A

cholecystostomy tube

44
Q

patient presents with RUQ pain on palpation, jaundice, scleral icterus but no rebound. LFT elevated. suspect

A

choledocholithiasis

45
Q

types of tx in choledocholithiasis

A

MRCP, ERCP, and PTC

46
Q

what can be done at time of surgery to r/o choledocholithiasis?

A

intraoperative cholangiogram

47
Q

patient presents with central abdominal pain that migrates to the RLQ, mild fever, N/V, tenderness at mcburney’s point. suspect

A

acute appendicitis

48
Q

most common causes of pancreatitis

A

alcohol or gallstones (in U.S.)

49
Q

scorpion bite can cause..

A

pancreatitis

50
Q

“sword through stomach” sensation - severe upper abdominal pain that radiates through to the back, N/V, dehydration, tachycardia. Decreased or absent bowel sounds, non-peritoneal tenderness. suspect

A

acute pancreatitis

51
Q

lab findings in acute pancreatitis

A

lipase and amylase

52
Q

criteria for acute pancreatitis

A

ranson’s criteria

53
Q

tx for acute pancreatitis

A

if cause is gallstones, allow pancreatitis to resolve then cholecystectomy. if no cause found, gallbladder removed

54
Q

in which cases would you operate on pancreas itself?

A

pseudocyst, necrosis with infection, chronic pancreatitis, and pancreatic cancer

55
Q

potential complication of pancreatic pseudocyst

A

chronic pancraticocutaneous fistula

56
Q

management of large pancreatic pseudocyst

A

wait until “rind” forms, then do a cystgastrostomy, cystduodenostomy, or cystjejunostomy

57
Q

if pancreatic pseudocyst becomes infected…

A

IR catheter drainage preferred over internal drainage

58
Q

treatmetn of pancreatic necrosis

A

broad spectrum antibiotics. if signs of infection, necrosectomy is indicated

59
Q

unrelenting pain in chronic pancreatitis. tx

A

surgical therapy- drainage procedures or pancreatectomy

60
Q

drainage procedure vs. pancreatectomy in tx of chronic pancreatitis

A

drainage procedure best when duct is dilated (chain of lakes), puestow procedure. pancreatecomy best when duct looks normal

61
Q

whipple procedure

A

pancreaticoduodenectomy

62
Q

total pancreatectomy leads to

A

brittle DM

63
Q

pancreatic cancer is treated surgically ONLY if

A

there is a chance of surgical cure

64
Q

upper abdominal pain, jaundice, high transaminase. Normal gallbladder. NO fever.

A

hepatitis

65
Q

patient presents with acute onset lower abdominal pain, well localized, change in bowel habits, fever

A

diverticulitis

66
Q

what diagnostic test MUST you do if suspect diverticulitis

A

CT

67
Q

3 categories of inpatient diverticulitis

A

unperforated, microperforated/abscess, freely perforated

68
Q

tx of diverticulitis

A

po antibiotics

69
Q

unperforated diverticulitis tx

A

IV abs, NPO, re-CT if worsening

70
Q

microperforated diverticulitis

A

IV abs, NPO, IR drainage of abscess, interval CT’s

71
Q

freely perforated diverticulitis

A

IV abs, sugical management

72
Q

to prevent recurrence of diverticulitis

A

high fiber diet and fiber supplements

73
Q

surgical tx considered for GERD if

A

young patients on maximal medical therapy, patients with poor control of their symptoms, and patients with severe esophagitis

74
Q

does surgical tx cure baretts esophagus?

A

NO, though regresion may occur. these patients still need surveillance every 2 years

75
Q

gold standard for diagnosing GERD

A

ph monitoring using pH probe (obtain deMeester score)

76
Q

GERD surgeries if indicated

A

nissen fudoplication, toupet, belsey mark IV, collis, endoscopic (TIF)

77
Q

distinguish US and HIDA in acute vs. chronic cholecystitis

A

acute- US shows thickened gallbladder wall and pericholecystic fluid. HIDA shows non-filling of gallbladder. chronic- US shows no fluid or GB wall thickening, stones. HIDA- slow filling, low EF

78
Q

what organ most commonly affected in nissen fundoplication in GERD tx?

A

spleen

79
Q

chronic cholecystitis and biliary dyskinesia tx

A

laparoscopic cholecystecomy, intraoperative cholangiogram, possible open

80
Q

if patient with biliary dyskinesia indicated for surgery, what do you warn them/

A

that 10% chance pain will not change after surgery

81
Q

bacterial infection of bile ducts

A

bacterial cholangitis

82
Q

bacterial cholangitis always signifies…

A

obstruction

83
Q

causes of bacterial cholangitis

A

choledocholithiasis (most common), biliary stricture, and neoplasm

84
Q

charcot’s triad

A

biliary colic (RUQ abdominal pain), jaundice, fever/chills in bacterial cholangitis

85
Q

severe form of bacterial cholangitis

A

suppurative cholangitis

86
Q

diagnostic pentad of suppurative cholangitis

A

biliary colic, jaundice, fever, confusion/lethargy, and shock

87
Q

patient presents with painless jaundice

A

pancreatic head cancer

88
Q

tx bacterial cholangitis

A

IV abx, then decompression of the duct

89
Q

common organisms in bacterial cholangitis

A

e. coli, klebsiella, pseudomonas, enterococcus

90
Q

patient presents with anal pain, esp after bowel movment, BRBPR

A

anal fissure

91
Q

patient with anal fissure treated medically with fiber suppleemtns, miralax, hydrocortisone suppositories and cream, sitz baths. no relief. what surgery do you consider/

A

lateral internal sphincterotomy - open, closed, or lateral position

92
Q

types of surgeries in liver

A

wedge resection, hepatic segmentectomy, partial hepatectomy, RFA, needle biopsy, TIPS

93
Q

RFA for liver surgery should not be used near…

A

large vessels (heat sink)

94
Q

patient with cirrhosis with hypervascular mass larger than 2 cm, serum AFP larger than 400 ng/mL diagnostic of

A

hepatocellular carcinoma

95
Q

TIPS =

A

transjugular intrahepatic portosystemic shunt - liver disease