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Clin Med- P > Abdominal Surgery > Flashcards

Abdominal Surgery Flashcards

1
Q

GERD symptoms (6)

A

burning, chest pain, pain radiating to jaw, occult blood (ulcer), dysphagia, odynophagia

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2
Q

how to diagnose ?

A

EGD and/or barium swallow

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3
Q

what is barrett’s esophagus? what does this make people at risk for?

A

esophageal epithelium is injured by reflux and “healed” with the wrong cell type: COLUMNAR
makes people at risk for CA and need more frequent follow-up

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4
Q

Tx of GERD (2)

A

patient education: fix diet, reduce constricting garments, elevate HOB, weight loss
meds: OTC antacids, H2 blockersl PPI, reglan

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5
Q

Tx of ulcers

A

PPI BID for at least two weeks (see if meds need to be continued after depending on pt’s symptoms)

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6
Q

tx for ulcer perforation

A

urgent open surgery

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7
Q

tx for H pylori

A

two ABX, PPI 2x daily, and bismuth (pepto)

*ABX depends on patient

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8
Q

what type of pt do you see a hiatal hernia in?

A

those with increased intra-abdominal pressure

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9
Q

what are the 3 types of hiatal hernias?

A 
type 1: retro-peritoneal portion of proximal stomach slides up through the diaphragm
type 2 (paraesophageal): herniated gastric fundus rolls up through the esophageal hiatus
type 3: type 1 and type 2 combo
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10
Q

which hernia type is most common? type 1 is worse in what position? what is significant about type 1 vs type 2?

A

type 1; worse when supine or bending over; reflux into lower esophagus during type 1

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11
Q

type 2 hernia is prone to? tx of it?

A

prone to incarceration or strangulation; repair

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12
Q

how to diagnose hiatal hernia?

A

barium swallow w fluro- continuous xray taken of esophagus after barium’s swallowed OR
EGD w biopsy (specialist’s office)

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13
Q

type of surgery for hiatal hernia?

A

thoracotomy or laparotomy

usually preserve vagal nerve (unless want to reduce reflux); use mesh

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14
Q

what are the two types of cholecystitis?

A

gallstones and acalculous

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15
Q

gallstones are most commonly formed from what? what type of people are they commonly found in?

A
  • cholesterol

- female, fertile, fat, rapid weight loss, hypertriglyceride, western diet, DM

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16
Q

acalculous cholecystitis is more common in what pt pop?

A

critically ill (think of random fever with no source)

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17
Q

acalculous cholecystitis has an increased incidence of ______ __________ and _________

A

infection, gangrene, and perforation

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18
Q

sign of cholecystitis? how to diagnose?

A

murphy’s sign; US of RUQ, HIDA scan, or MRCP

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19
Q

whats biliary dyskinesia?

A

if the gallbladder ejects less than 30%

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20
Q

what two things are pancreatitis likely from? is pancreatitis always a surgical problem?

A

obstruction of a stone and alcoholism; NO

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21
Q

lab values to test for pancreatitis? treatment?

A

Lipase and amylase (lipase more important tho bc amylase can decrease during the course)
-tx: treat the cause of it, as symptoms resolve try food challenges

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22
Q

three causes of biliary obstruction?

A

CBD stones, pancreaticobiliary malignancy, benign inflammation

23
Q

two presentations of biliary obstruction?

A

1) . RUQ pain to charcot’s triad (jaundice, fever, RUQ pain)

2) . Reynold’s pentad (charcot’s + shock and AMS)>

24
Q

management of biliary obstruction?

A

if a gallstone = MRCP, ERCP, lap chole with CBDE

if malignancy or stricture= CT or MRI and then ERCP

25
Q

Appendicitis pain location

A

pain that starts at umbilicus and migrates to RLQ (McBurney’s point)

26
Q

appendicitis symptoms?

A

anorexia, N/V, diarrhea, low-grade fever

27
Q

appendicitis dx gold standard for adults VS kids

A 
adults = CT abdomen (IV and oral contrast)
kids = US if possible
28
Q

TX for appendicitis

A

ABX to cover gram - and anaerobic bacteria prior to or

AND laparoscopic removal (maybe opened if perforation)

29
Q

what is the key symptoms for acute mesenteric ischemia?

A

pain out of proportion to physical exam

30
Q

associated risk factors with AMI? (4) KNOW

A

1) . age > 70
2) . heart disease
3) . smoking and HTN in >50% of pts
4) . COPD in >1/3

31
Q

most cases of AMI is due to? what mesentary is affected?

A

arterial embolism (50%); typically SMA (bc secondary to high flow rate and more open anatomic angle)

32
Q

what do pressers do?

A

they vasoconstrict all blood vessels (so affects the flow to the gut as well- pts might not be fed while taking these meds)

33
Q

four types of AMI?

A

arterial embolism
arterial thrombosis
non occlusive
mesenteric venous thrombosis

34
Q

arterial thrombosis AMI is usually due to?

A

mesenteric atherosclerosis

35
Q

non occlusive AMI is usually due to?

A

flow is low in the vessels, such as in shockk or vasoconstricting agents (digoxin or cocaine)

36
Q

mesenteric venous thrombosis usually affects what vessel? what happens in this type of AMI?

A

usually affects SMV
outflow occlusion leads to bowel wall edema, which leads to microvascular hypoperfusion, and then infarct occurs
(hypercoagulable states)

37
Q

how to diagnose AMI? tx for embolic AMI?

A

CT/CTA

tx- resection of necrotic tissue and reperfusion (might require bypass grafting)

38
Q

abdominal surgical conditions specific to elderly (KNOW) 2

A

AMI and hollow viscus perforation

39
Q

elderly patients with abdomen pain post-operatively might have that pain because of what things we do to them perioperatively? (5) KNOW

A

1) . any surgery near abdomen causes adhesions…can lead to small bowel obstruction
2) . post-op fecal impaction
3) . giving pain meds can cause constipation
4) . post-op ileus from anesthesia
5) . incisions- risk of hernia

40
Q

Causes of small bowel obstruction? (7) most common?

A

1). ADHESIONS
2). maligancy
3). inflammatory strictures
4). incarcerated hernias
less common: congenital lesions, volvulus, intussusception

41
Q

TX for partial vs complete SBO

A

partial: mostly no surgery, NG tube placement to decompress, hydrate and moniotr volume status
complete: usually need surgery

42
Q

how to diagnose SBO?

A

CT or MRI

43
Q

where is diverticulitis most commonly found?

A

sigmoid colon (highest pressure area with small diameter)

44
Q

what is right colon diverticuli most often due to?

A

congenital process (usually involve all layers of the wall)

45
Q

what usually gets stuck in diverticuli pockets to cause inflammation? Most important to prevent this?

A

feces; PREVENTION: have regular BMs

46
Q

how to diagnose diverticulitis?

A

CT abd/pelvis

47
Q

how to tx diverticulitis (management and surgically)

A

ABX- anaerobes and E coli, strep

surgical- resection, hartman’s (resection with end colostomy)

48
Q

how to treat colitis?

A

treat underlying cause of inflammation

49
Q

perforation of colon is ________ than perf of small bowel

A

WORSE (less sterile, more feces/bacteria)

50
Q

what is a hollow viscus perf? where does pain present?

A

intraluminal contents leak into sterile peritoneal cavity; pain presents near site of perf

51
Q

how to diagnose and tx hollow viscus perf?

A

diagnose: plain film (free air >1ml) or CT
tx: emergent surgery

52
Q

what is the leading cause of colonic obstruction? if you have a competent ileocecal valve, how do you tx?

A

colon mass; emergent surgery

53
Q

symptoms of colonic obstruction? diagnose? tx?

A

s/s: melena, weight loss, abd distention
diagnose with CT
tx: perfed? then resect w/ ostomy and then delayed anastomosis
non perf? resection or stent

54
Q

how to diagnose a hernia? tx for it?

A

Dx: US or CT (also, recreate hernia by increasing intraabdominal pressure)

Tx: strangulated = emergent repair if necrotic bowel
reducible or incarcerated = elective repair

Clin Med- P (124 decks)

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