Surgery p426-434

Question 1

Esophageal Perforation presentation?

Answer 1

Retrosternal chest pain, odynophagia, positive hamman sign, pain that radiates to L shoulder.

Question 2

What is Boerhaave Syndrome? Causes?

Answer 2

Full thickness tear. #1 cause is iatrogenic (Endoscopy). #2 secondary to retching and vomiting.

Question 3

Symptoms of Boerhaave Syndrome?

Answer 3

Retrosternal chest pain (acute onset), Radiates to L shoulder, Subcutanous emphysema

Question 4

Most common location of Boerhaave Syndrome?

Answer 4

left posterolateral -distal esophogus.

Question 5

Dx of Boerhaave Syndrome?

Answer 5

Gastrofin Esophagogram with leakage.

Question 6

Tx of Boerhaave Syndrome? Cx? Mortality rate?

Answer 6

Emergent surgery. Cx: Acute mediastinitis (high mortality) 25%

Question 7

What is Mallory Weiss Syndrome?

Answer 7

Mucosal tear, due to vomiting in alcoholics.

Question 8

Symptoms of Mallory Weiss Syndrome?

Answer 8

Hematomesis, Odynophagia

Question 9

Most common location of Mallory Weiss Syndrome?

Answer 9

GE junction

Question 10

Dx of Mallory Weiss Syndrome?

Answer 10

Gastrofin Esophagogram without leakage.

Question 11

Tx of Mallory Weiss Syndrome? Cx?

Answer 11

Supportive. cauterization if necessary. Rare

Question 12

Gastric perforation is most commonly seen secondary to ?

Answer 12

Ulcer disease

Question 13

Risk factors for Gastric perforation?

Answer 13

Helicobacter Pylori, NSAID abuse, burns, head injury, trauma, cancer

Question 14

Gastric perforation -> leakage of gastric acid -> peritonitis or pancreatitis. Presentation?

Answer 14

Abdominal pain that radiates to right shoulder (phrenic nerve irritation). Peritonitis - guarding, rebound tenderness, abdominal rigidity

Question 15

Dx test for gastric perforation? Initial test? Accurate test?

Answer 15

Initial: Upright chest X-ray (free air under diaphragm)

Accurate test: CT scan

Question 16

Tx of gastric perforation?

Answer 16

1. NPO
2. NG tube
3. Medical management (broad spectrum antibiotics, IV fluids in preparation for surgery)
4. Emergent surgery (explorative laparotomy and repair of the perforation)

Question 17

Most common Cx of Diverticulitis ?

Answer 17

Abscess formation

Question 18

________ and ______ contraindicated in Diverticulitis due to increased incidence of perforation?

Answer 18

Barium enema and Colonoscopy

Question 19

Diverticulitis Tx ?

Answer 19

Make NPO, place NG tube. Broad spectrum antibiotics.

Question 20

Abdominal abscess Dx & Therapy?

Answer 20

CT scan. Incision and drainage. Antibiotics

Question 21

Appendicitis Dx, Tx & Cx

Answer 21

CT scan, Laparoscopic Surgery, Abscess formation and gangrene perforation

Question 22

Acute Pancreatitis Dx, Tx, & Cx

Answer 22

Dx: CT scan, amylase is sensitive, and lipase is specific. Tx: Aggressive IV fluids and NPO until symptoms resolve. Cx: Hemorrhage pancreatitis and pseudocyst formation.

Question 23

Diverticulitis Dx, Tx, & Cx

Answer 23

Dx: Ct scan Tx: antibiotics, surgical resection if it recurs or perforates. Cx: Abscess formation. No endoscopy due to risk of perforation.

Question 24

Cholecystitis Dx, Tx, & Cx

Answer 24

Dx: Ultrasound (pericholecystic fluid, gallbladder wall thickening, and stones in the gallbladder), Tx: Laparoscopic surgery or open surgery Cx: Perforation of the gallbladder

Question 25

Signs of Appendicitis

Answer 25

Rovsing Sign: LLQ –> RLQ pain
Psoas Sign: Pain on extension of the hip
Obturator Sign: Pain with internal rotations of the right thigh

Question 26

Hallmark signs of Small bowel obstruction

Answer 26

Abdominal pain, Nausea, vomiting, fever, hyperactive bowel sounds, high pitched tinkling sounds, hypovolemia

Question 27

Most common cause of small bowel obstruction

Answer 27

Previous abdominal surgeries

Question 28

Dx for small bowel obstruction

Answer 28

Dx: elevated WBC, lactate with marked acidosis. Initial test: AXR (multiple air fluid levels with dilated loops of small bowel). Accurate test: CT scan of the abdomen, transformation zone

Question 29

Tx for small bowel obstruction

Answer 29

NPO, NG tube with suction, Medical: IV fluids to replace volume, Surgical decompression indicated if (complete obstruction - emergent), (lack of improvement with medical management)

Question 30

What is fecal incontinence ?

Answer 30

Continuous or recurrent passage of fecal material for at least 1 month in age >3

Question 31

Fecal incontinence Dx

Answer 31

Clinical hx + flexible sigmoidoscopy or anoscopy. Accurate: anorectal manometry. If there is a history of anatomic injury –> best test = endorectal manometry

Question 32

Fecal incontinence Tx

Answer 32

Medical therapy - bulking agents (fiber)
Biofeedback - control exercises and muscle strengthening exercises
Injection - dextranomer/hyaluronic acid which decreases incontinence by 50%
Surgery - colorectal surgery

Question 33

RLQ pain in female patient of child bearing, ectopic pregnancy, cysts, and torsion. Dx?

Answer 33

Beta- HCG, pelvic sonogram
If pelvic sonogram, emergent surgery
Never X-ray and CT