Abdominal Surgery

Question 1

GERD symptoms (6)

Answer 1

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

Question 2

how to diagnose ?

Answer 2

EGD and/or barium swallow

Question 3

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

Answer 3

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

Question 4

Tx of GERD (2)

Answer 4

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

Question 5

Tx of ulcers

Answer 5

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

Question 6

tx for ulcer perforation

Answer 6

urgent open surgery

Question 7

tx for H pylori

Answer 7

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

*ABX depends on patient

Question 8

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

Answer 8

those with increased intra-abdominal pressure

Question 9

what are the 3 types of hiatal hernias?

Answer 9

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

Question 10

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

Answer 10

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

Question 11

type 2 hernia is prone to? tx of it?

Answer 11

prone to incarceration or strangulation; repair

Question 12

how to diagnose hiatal hernia?

Answer 12

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

Question 13

type of surgery for hiatal hernia?

Answer 13

thoracotomy or laparotomy

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

Question 14

what are the two types of cholecystitis?

Answer 14

gallstones and acalculous

Question 15

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

Answer 15

• cholesterol

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

Question 16

acalculous cholecystitis is more common in what pt pop?

Answer 16

critically ill (think of random fever with no source)

Question 17

acalculous cholecystitis has an increased incidence of ______ __________ and _________

Answer 17

infection, gangrene, and perforation

Question 18

sign of cholecystitis? how to diagnose?

Answer 18

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

Question 19

whats biliary dyskinesia?

Answer 19

if the gallbladder ejects less than 30%

Question 20

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

Answer 20

obstruction of a stone and alcoholism; NO

Question 21

lab values to test for pancreatitis? treatment?

Answer 21

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

Question 22

three causes of biliary obstruction?

Answer 22

CBD stones, pancreaticobiliary malignancy, benign inflammation

Question 23

two presentations of biliary obstruction?

Answer 23

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

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

Question 24

management of biliary obstruction?

Answer 24

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

if malignancy or stricture= CT or MRI and then ERCP

Question 25

Appendicitis pain location

Answer 25

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

Question 26

appendicitis symptoms?

Answer 26

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

Question 27

appendicitis dx gold standard for adults VS kids

Answer 27

``` adults = CT abdomen (IV and oral contrast) kids = US if possible ```

Question 28

TX for appendicitis

Answer 28

ABX to cover gram - and anaerobic bacteria prior to or | AND laparoscopic removal (maybe opened if perforation)

Question 29

what is the key symptoms for acute mesenteric ischemia?

Answer 29

pain out of proportion to physical exam

Question 30

associated risk factors with AMI? (4) KNOW

Answer 30

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

Question 31

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

Answer 31

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

Question 32

what do pressers do?

Answer 32

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

Question 33

four types of AMI?

Answer 33

arterial embolism arterial thrombosis non occlusive mesenteric venous thrombosis

Question 34

arterial thrombosis AMI is usually due to?

Answer 34

mesenteric atherosclerosis

Question 35

non occlusive AMI is usually due to?

Answer 35

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

Question 36

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

Answer 36

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

Question 37

how to diagnose AMI? tx for embolic AMI?

Answer 37

CT/CTA | tx- resection of necrotic tissue and reperfusion (might require bypass grafting)

Question 38

abdominal surgical conditions specific to elderly (KNOW) 2

Answer 38

AMI and hollow viscus perforation

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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

Question 41

TX for partial vs complete SBO

Answer 41

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

Question 42

how to diagnose SBO?

Answer 42

CT or MRI

Question 43

where is diverticulitis most commonly found?

Answer 43

sigmoid colon (highest pressure area with small diameter)

Question 44

what is right colon diverticuli most often due to?

Answer 44

congenital process (usually involve all layers of the wall)

Question 45

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

Answer 45

feces; PREVENTION: have regular BMs

Question 46

how to diagnose diverticulitis?

Answer 46

CT abd/pelvis

Question 47

how to tx diverticulitis (management and surgically)

Answer 47

ABX- anaerobes and E coli, strep | surgical- resection, hartman's (resection with end colostomy)

Question 48

how to treat colitis?

Answer 48

treat underlying cause of inflammation

Question 49

perforation of colon is ________ than perf of small bowel

Answer 49

WORSE (less sterile, more feces/bacteria)

Question 50

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

Answer 50

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

Question 51

how to diagnose and tx hollow viscus perf?

Answer 51

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

Question 52

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

Answer 52

colon mass; emergent surgery

Question 53

symptoms of colonic obstruction? diagnose? tx?

Answer 53

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

Question 54

how to diagnose a hernia? tx for it?

Answer 54

Dx: US or CT (also, recreate hernia by increasing intraabdominal pressure) Tx: strangulated = emergent repair if necrotic bowel reducible or incarcerated = elective repair