Absite review (2) Flashcards
(321 cards)
1
Q
Arterial supply and vascular drainage of adrenal gland
A
- Superior adrenal – inferior phrenic artery
- Middle adrenal – aorta
- Inferior adrenal – renal artery
- Left adrenal vein goes to left renal vein.
- Right adrenal vein goes to inferior vena cava
2
Q
Lymphatic drainage of adrenal medulla
A
Lymphatics drain to subdiaphragmatic and renal lymph nodes.
3
Q
GFR zones of adrenal cortex
A
SALT, SUGAR and SEX STEROIDS
4
Q
cortisol effect
A
inotropic, chronotropic, and increases vascular resistance; proteolysis and
gluconeogenesis; decreases inflammation, glycogenolysis
5
Q
Aldosterone secretion is stimulated by
A
1.angiotensin 2
2. hyperkalmeia
3. to some extent ACTH
6
Q
which CAH is salt wasting
A
21-hydroxylase deficiency
7
Q
which CAH has low testesterone
A
17-hydroxylase deficiency
8
Q
MC cause of primary hyperaldosteronism (Conn’s syndrome)
A
bilateral idiopathic adrenal hyperplasia
(Renin is low)
9
Q
Causes of secondary adrenal hyperplasia
A
CHF, Renal artery stenosis, Renin secreting tumor…etc
(Renin is high)
10
Q
patient with HTN and hypokalemia u think of
A
Hyperaldosternism (Conn’s syndrome)
11
Q
Dx for primary hyperaldosteronism
A
- Salt-load suppression test (best, urine aldosterone will stay high)
- Aldosterone:renin ratio > 25
12
Q
MCC of hypocortisolism (addison disease)
A
withdrawal of exogenous steroids
13
Q
Cosyntropin test
A
give ACTH and measure cortisol level
14
Q
hypotension not responding to fluids or pressors think of
A
Acute adrenal insufficiency
15
Q
MC cause of hypercortisolism (cushing’s syndrome)
A
Exogeneous steroid intake
16
Q
best test to diagnose cushing syndrome
A
24- hour urinary cortisol level (best) , ACTH
17
Q
high dose dexamethasone suppression test effect on ectopic producer of ACTH
A
does not suppress
18
Q
cushing’s disease (not syndrome) refers to
A
pituitary adenoma
19
Q
MC noniatrogenic cause of hypercortisolism
A
pituitary adenoma
20
Q
rate limiting enzyme in catecholamines production
A
tyrosine hydroxylase
21
Q
enzymes that converts norepinephrine into epinephrine is only found in
A
adrenal medulla
22
Q
MC location of extraadrenal neural crest tissue
A
usually in the retroperitoneum,
most notably in the organ of Zuckerkandl at the aortic bifurcation.
23
Q
10% rule of pheochromocytoma
A
malignant, bilateral, in children, familial, extra-adrenal
24
Q
preoperative management in pheochromocytoma
A
good volume resuscitation
give alpha blocker before beta blocker
25
Most common extramedullary tissue site for pheochromocytoma
organ of Zuckerkandl
26
superior and middle thyroid veins drain
internal jugular vein
27
inferior thyroid vein drain
innominate (brachiocephalic vein)
28
MC injured nerve following thyroidectomy
superior laryngeal nerve
29
Tubercles of Zuckerkandl of thyroid
most posterio-lateral extension of thyroid gland
30
thyroglobulin function
stores T3 and T4 in colloid within follicular cells
31
Thyroxine binding protein function
transport protein that binds most of T3 and T4 in plasma
32
Wolf-Chaikoff effect
patient given high doses of iodine
(Lugol’s solution, potassium iodide) ihbit T3 and T4 release
(used in Thyroid Storm)
33
Most thyroid nodules are benign (T or F)
true
34
best initial test for thyroid nodules
FNA and TFT
35
nodules that warrant FNA (according to size)
nodules 5mm or more
36
colloid tissue on thyroid nodule FNA, whats next
most likely colloid goiter; low chance of malignancy (< 1%)
* Tx: thyroxine; lobectomy if it enlarges
37
normal thyroid tissue on FNA with elevated TFT most likely
solitary toxic nodule
38
MCC of goiter worldwide
iodine deficiency
39
Most important aspect before removal of a lingual thyroid
Is the only thyroid tissue in 70% of patients who have it
40
what hyperthyroid medication is safe in pregnancy
PTU
41
methimazole and PTU MOA
Inhibits peroxidases and prevents iodine–tyrosine coupling
42
causes of hyperthyroidism
1. Graves disease (MC)
2. Toxi multinodular goiter
3.single toxic nodule
43
symptoms that are specific to graves disease
exopthalmous
peritibial edema
44
Graves disease pathogenesis
IgG antibodies (LATS, TSI) to TSH receptor / Type 2 Hypersens. reaction
45
MC indication for thyroidectomy in graves disease
suspicious nodule
46
Preop preparation thyroidectomy in graves disease
methimazole until euthyroid, β-blocker, Lugol’s solution for 14
days
47
preferred initial treatment for toxic multinodular goiter
surgery
48
Causes of Thyroiditis
1. Hashimoto's thyroiditis
2. De Quervain’s thyroiditis (subacute granulomatous thyroiditis)
3. Bacterial Thyroiditis
4. Riedel's fibrous struma
49
pathogenesis of hashimotos
both cellular and humoral immune mediated
50
cause of goiter in hashimotos
lack of organification of trapped iodide inside gland
51
Reidel's fibrous struma thyroiditis
Woody, fibrous component that can involve adjacent strap muscles and carotid sheath
Disease commonly cause hypothyroidism and compressive syx
52
Types of thyroid cancer
1. papillary
2. follicular
3. medullary
4. hurthle cell thyroid ca
5. anaplastic
53
features worrisome for thyroid malignancy
solid solitary cold nodule
Men
age >50
previous XRT
MEN2a MEN2b
voice change
54
MC type of thyroid ca
papillary
55
route of spread of papillary thyroid CA
lymphatic
56
prognosis of papillary thyroid CA based on
local invasion
57
histopathology of papillary CA
psammoma bodies
orphan Annie nuclei
58
Risk Factors for thyroid CA recurrence/metastasis
X-GAMES
– previous XRT, high
grade, age (< 20 or > 50), males, extrathyroidal disease, and size (> 1 cm)
59
worse prognosis of medullary thyroid CA
sporadic type
MEN2b
60
medullary thyroid CA tumor arises from which cells
parafollicular c cells
61
1st manifestation of MEN IIa and IIb
Diarrhea (due to calcitonin release from medullary thyroid CA
62
Age for prophylactic thyroidectomy and central node dissection is determined by
specific RET proto-oncogene codon mutation risk:
* Level A codon – before age 10 or earlier if lacks low-risk criteria
* Level B codon – before age 5 or later if low-risk criteria
* Level C codon – before age 5
* Level D codon – first year of life
(Low-risk criteria : normal calcitonin level, normal neck U/S, less aggressive MTC
family history)
63
iodine ablation therapy is only effective for which types of thyroid CA
papillary
follicular
64
how to monitor for recurrence after surgery
for papillary, follicular and medullary thyroid CA
papillary and follicular thyroglobulin level
Medullary : clacitonin level
65
Most important factor before initiating iodine ablation therapy
Make sure TSH is high to facilitate uptake of radioactive iodine
66
superior parathyroid are formed embryologically
4th pharyngeal pouch
67
inferior parathyroid are formed embryologically
3rd pharyngeal pouch
68
anatomy of superior parathyroid gland
found lateral to the RLN and superior to the inferior thyroid artery
69
anatomy of the inferior parathyroid gland
below inferior thyroid artery
medial to the RLN
70
MC location of ectopic parathyroid gland
tail of thymus
71
Osteitis fibrosa cystica
(brown tumors) – bone lesions from Ca
resorption; characteristic of hyperparathyroidism
72
labs in primary hyperparathyrodism
↑ PTH and ↑ Ca; ↓ PO4−; Cl− to PO4− ratio > 33; ↑ renal cAMP;
high urinary Ca (24-hour urine collection)
73
secondary hyperparathyroidism is seen in
renal failure patients
74
“Synchronous” tumors
Cases in which the second primary cancer is diagnosed within 6 months of the primary cancer
75
Metachronous tumors
Cases in which a second primary tumor is diagnosed (develops) more than 6 months after the primary cancer
76
sestamibi scan
Best for trying to pick up missing / ectopic parathyroid glands and for reops
77
Familial hypercalcemic hypocalciuria pathogensis
Caused by defect in PTH receptor in distal convoluted tubule of the
kidney that causes ↑ resorption of Ca
78
pseudohypoparathyroid
pathogenesis
defect in PTH receptor in the kidney, does not respond to PTH
79
Diarrhea is often the presenting symptom in what MEN syndromes
MEN2a
MEN2b
(due to increased calcitonin from medullary thyroid CA)
80
MEN1(MENIN gene)
(3Ps)
pituitary adenoma
parathyroid hyperplasia
pancreatic neuroendocrine tumor
81
MEN2a (RET proto-onco gene)
(2Ps,1M)
Parathyroid hyperplasia
Medullary thyroid CA
pheochromocytoma
82
MEN2b (RET proto-onco gene)
(1P,2Ms)
pheochromocytoma
Medullary thyroid CA
mucosal neuromas
marfinoid habitus
83
PTHrP secreted by which CA
squamous cell lung CA
Breast CA
84
Long thoracic nerve innervates
innervates serratus anterior; injury results in winged scapula
85
Lateral thoracic artery supply
supplies serratus anterior
86
Thoracodorsal nerve innervated
innervates latissimus dorsi; injury results in weak arm pull-ups
and adduction
87
Thoracodorsal artery supply
supplies latissimus dorsi
88
Medial pectoral nerve innervate
innervates pectoralis major and pectoralis minor
89
Lateral pectoral nerve innervates
pectoralis major only
90
Intercostobrachial nerve
lateral cutaneous branch of the 2nd intercostal nerve;
provides sensation to medial arm and axilla
91
breast arterial supply
Branches of internal thoracic (mammary) artery, intercostal arteries, thoracoacromial
artery, and lateral thoracic artery supply breast.
92
Mondor’s disease
superficial vein thrombophlebitis of breast
93
green/yellow/brown nipple discharge consistent with
fibrocystic disease of the breast
94
fibrocystic disease of the breast types
sclerosing adenosis, apocrine metaplasia, duct adenosis,
epithelial hyperplasia, ductal hyperplasia, and lobular hyperplasia
95
DCIS subtypes and the most aggressive of them all
comedo, papillary, cribriform, solid
comedo most aggressive
96
screening for breast cancer has decreased mortality by
25%
97
screening for breast CA age
* Average risk – annual mammogram starting at age 40
* High-risk – annual mammogram and MRI starting age 25-40
98
BRCA screening
* Yearly mammogram and breast MRI starting at age 25
* Yearly pelvic exam + U/S and CA-125 starting at age 25
99
Lung CA screening
yearly low dose CT chest
Indicated for patients 50–80 years old with > 20 pack-year smoking
history and are currently smoking or who have quit within last 15
years
100
MC solitary pulmonary nodule
Granuloma, hamartoma
101
persistant air leaks occurs after which type of thoracic surgeries
wedge
segmentectomy
102
lung cancer prognosis based on
nodal invlovement
103
types of lung cancer
Non–small cell carcinoma:
1.squamous cell ca
2.adenocarcinoma
Small cell carcinoma
104
Small cell CA paraneoplastic syndrome
ACTH and ADH
105
MC paraneoplastic syndrome ever
ACTH secreting small lung CA
106
unresectable lung disease according to stag
N2, N3 or M disease
107
how does lung hamartomas appear on
CT
calcification appear as popcorn lesion
108
Anterior mediastinal tumors
Ts
Thymoma
Thyroid CA or goiter
T-cell lymphoma
Teratoma
paraThyroid adenoma
109
posterior mediastinal tumors
Enteric cysts
neurogenic tumors
lymphoma
110
phases of empyema development
Exudative phase (1st week)
Fibro-proliferative phase (2nd week)
Organized phase (3rd–4th week)
111
Massive hemoptysis
>600cc/24hr
112
spontaneous pneumothorax occurs more at which side
Right
113
surgery for pneumothorax
VATS apical blebectomy and mechanical pleurodesis
114
Catamenial pneumothorax
occurs in temporal relation to
menstruation
* Caused by endometrial implants in the visceral lung pleura
115
Ductus arteriosus
connection between descending aorta and left pulmonary artery (PA)
116
Ductus venosum
connection between portal vein and IVC; blood shunted away from liver
in utero
117
MC ASD type
ostium secundum
118
TOF components
1. VSD
2. Pulmonary stenosis
3. RV hypertrophy
4. Overriding aorta
119
medication used to close a PDA
indomethacin
120
Left main coronary branches
Left anterior descending
circumflex
121
Organisms responsible for endocarditis
staph aureus (50% of cases)
122
Stages of atherosclerosis
1st foam cells
2nd smooth muscle proliferation
3rd intimal disruption
123
carotid sheath contains
carotid artery, internal jugular vein, vagus nerve
124
MC site of carotid artery stenosis
bifurcation
125
first branch of internal carotid artery
ophthalmic artery
126
Gastrin produced by
G cells in stomach antrum
127
secretion of gastrin is stimulated by
amino acids, vagal input (acetylcholine),
calcium, ETOH, antral distention, pH > 3.0
128
secretion of gastrin is inhibited by
pH < 3.0, somatostatin, secretin, CCK
129
Target cells for gastrin
parietal cells and chief cells
130
effect of gastrin
↑ HCl, intrinsic factor, and pepsinogen secretion (gastrin
is the strongest stimulator for all)
131
somatostatin produced by
mainly produced by D (somatostatin) cells in stomach
antrum
132
secretion of somatostatin is stimulated by
acid in the duodenum
133
target cells of somatostatin
Many cells !!
it is the great INHIBITOR
134
effect of somatostatin
inhibits gastrin and HCl release (primary role); inhibits
release of insulin, glucagon, secretin, CCK, and motilin; ↓ pancreatic
and biliary output; slows gastric emptying
135
octreotide MOA
somatostatin analogue
136
CCK produced by
produced by I cells of duodenum
137
secretion of CCK stimulated by
amino acids and fatty acid chains
138
effect of CCK
gallbladder contraction, relaxation of sphincter of Oddi, ↑
pancreatic enzyme (exocrine) secretion (acinar cells)
139
Secretin is produced by
S cells of duodenum
140
secretion of secretin is stimulated by
fat, bile, pH < 4.0
141
secretion of secretin is inhibited by
pH > 4.0, gastrin
142
effect of secretin
↑ pancreatic HCO3− release (ductal cells), inhibits
gastrin release (this is reversed in patients with gastrinoma), and
inhibits HCl release
143
Vasoactive intestinal peptide produced by
pancreas and gut
144
secretion of VIP is stimulated by
fat, acetylcholine
145
effect of VIP hormone
increase water and electrolyte intestinal secretion
increase gut motility
146
glucagon is secreted by
alpha cells of the pancreas
147
glucagon release is stimulated by (starvation state)
↓ glucose, ↑ amino acids, acetylcholine
148
glucagon release is inhibited by
↑ glucose, ↑ insulin, somatostatin
149
effect of glucagon
glycogenolysis, gluconeogenesis, ↓ gastric acid secretion,
↓ gastrointestinal motility, relaxes sphincter of Oddi, ↓ pancreatic
secretion
150
insulin is secreted by
beta cells of the pancreas
151
secretion of insulin is stimulated by (fed state)
glucose, glucagons, CCK
152
secretion of insulin is inhibited by
somatostatin
153
Motilin is produced by
Mo cells in the upper small bowel
154
bowel recovery in order
* Small bowel 24 hours
* Stomach 48 hours
* Large bowel 3–5 days
155
Peristalsis phases of bowel
* I – resting
* II – accelerating
* III – peristalsis
* IV – decelerating
156
esophageal lining is made up of
non-keratinized squamous cell epithelium
157
muscle types of the esophagus
● Upper ⅓ esophagus – striated muscle
● Middle ⅓ and lower ⅓ esophagus – smooth muscle
158
arterial supply of the esophagus
● Thoracic esophagus – vessels directly off the aorta are the major blood supply
● Cervical esophagus – supplied by inferior thyroid artery
● Abdominal esophagus – supplied by left gastric and inferior phrenic arteries
159
venous drainage of the esophagus
hemi-azygous and azygous veins in the chest
160
left vagus travels
anteriorly
161
right vagus travels
posteriorly
162
length of esophagus
around 25 cm
163
length between the incisors and lower esophageal sphincter
around 40 cm
164
Anatomic areas of esophageal narrowing
* Cricopharyngeus muscle
* Compression by the left mainstem bronchus and aortic arch
* Diaphragm (near lower esophageal sphincter)
165
in pharyngeoesophageal disorders patients have more trouble with liquid or solid foods
liquid
166
plummer vinson syndrome
esophageal web, iron deficiency anemia
167
zenkers diverticulum is what type of diverticulum
False diverticulum
168
where is zenker's diverticulum located
located posteriorly;
Occurs between superior pharyngeal constrictors and inferior cricopharyngeus
(Killian’s triangle)
169
causes of zenker's diverticulum
failure of UES to relax leading to an increase in pressure
170
Traction esophageal diverticulum is true or false
True
171
epiphrenic diverticulum is true or false
false
172
pathogenesis of achalasia
Secondary to destruction of inhibitory neuronal ganglion cells in muscle wall (autoimmune
[#1], infectious, genetic)
173
difference between diffuse esophageal spasm and nutcracker esophagus
manometry for DES high amplitude NON-peristaltic movements
for nutcracker high amplitude peristaltic movements
174
scleroderma of the esophagus pathogenesis
● Fibrous replacement of esophageal smooth muscle
● Causes dysphagia and loss of LES tone with massive reflux and strictures
175
best test to diagnose GERD
24 hour pH probe
176
Most common cause of dysphagia following Nissen
wrap is too tight (generally resolves
on its own; give clears for 1st week; can dilate after 1 week)
177
types of hiatal hernia
● Type I – sliding hernia from dilation of hiatus (most common type)
● Type II – paraesophageal
● Type III – combined
● Type IV – sliding with entire stomach in the chest plus another organ
178
Needs barrett's surveillance for lifetime even after Tx why ?
Barrett’s CA risk is not reversed with PPI or fundoplication.
179
risk factors for esophageal adenocarcinoma
GERD, obesity, Barrett’s
180
MC esophageal CA
adenocarcinoma
181
degrees of esophageal caustic injuries
* Primary burn – hyperemia
Secondary burn – ulcerations, exudates, and sloughing
Tertiary burn- Deep ulcer, charring, lumen narrowing
182
epidermis is subdivided into 5 layers
the
stratum basale (deepest), the stratum spinosum, the stratum
granulosum, the stratum lucidum and the stratum corneum
(superificial)
183
TIVA (total intravenous anaesthesia) advantage
reduce postoperative nausea and vomiting
184
ligasure can seal vessels up to
7mm in diameter
185
harmonic scalpel vs ligasure
harmonic scalpel uses ultrasound vibration
ligasure uses thermal energy
186
MC hepatic artery variant
right hepatic artery comes off SMA
187
line that divides liver into right and left lobe
Cantlie's line
188
line that divides left lobe of the liver into medial and lateral
falciform ligament
189
portal triad and gallbladder are found in which liver segments
IV, V
190
kupffer cells
liver macrophages
191
Foramen of Winslow borders
* Anterior – portal triad
* Posterior – IVC
* Inferior – duodenum
* Superior – liver (caudate lobe)
192
Most primary and secondary liver tumors are supplied by
hepatic artery
193
usual energy source for liver
ketones
194
the only water-soluble vitamin stored in the liver
b12
195
primary bile acids (cholic and chenodeoxycholic) are made by
Bile salts are conjugated to taurine or glycine
196
deficiency in storage ability; high conjugated bilirubin
Rotor’s syndrome
197
deficiency in secretion ability; high conjugated bilirubin
Dubin–Johnson syndrome
198
urgent liver TXP listing if
King’s College criteria are met.
199
Budd–Chiari syndrome
hepatic vein occlusive disease (a cause of postsinusoidal portal HTN)
200
Child-Pugh Score depends on what parameters
Albumin
Bilirubin
INR
Encephalopathy
Ascites
201
MELD score depends on what parameter
uses INR, creatinine, and total bilirubin
202
splenic vein thrombosis can lead to what type of varices
Gastric varices
203
MC organism causing pyogenic abscess
Ecoli
204
preop ERCP done in liver hydatid cyst to
check for communication with the biliary system
205
Most common benign hepatic tumor
Hemangioma
206
sulfur colloid scan for hepatic mass
no uptake for adenoma because no kupffer cells
positive uptake for Focal nodular hyperplasia because there are kupffer cells
207
Metastasis:primary ratio of malignant liver tumors
20:1
208
MC malignant liver cancer
HCC
209
MC risk factor for HCC
hep B
210
tumor marker for HCC
AFP
211
calot triangle border
superior liver
medial common hep duct
lateral cystic duct
212
cystic artery is a branch off
right hepatic artery
213
gallbladder has no
submucosa
214
histopathology with cholecystitis
Rokitansky–Aschoff sinuses
215
bile leak after cholecystectomy u think off
cystic duct stump
CBD injury
ducts of luschka GB fossa
216
types of GB stones
cholesterol stones
black stones
brown stones
217
risk factors for black GB stone
hemolytic disorders, cirrhosis, chronic TPN
218
MC location and cause for brown biliary stones
CBD
caused by infection in biliary tree
219
Most sensitive test for cholecystitis
cholecystokinin cholescintigraphy
220
ACALCULOUS CHOLECYSTITIS risk factors
severe burns, prolonged TPN, trauma, or major surgery
221
PRIMARY SCLEROSING CHOLANGITIS is assocaited with
ulcerative colitis
222
Adenomyomatosis
thickened nodule of mucosa and muscle associated with
Rokitansky–Aschoff sinus
223
pancreatic blood supply
* Head – superior (off GDA) and inferior (off SMA) pancreaticoduodenal arteries (anterior
and posterior branches for each)
* Body – great, inferior, and dorsal pancreatic arteries (all off splenic artery)
* Tail – splenic, gastroepiploic, and caudal pancreatic arteries
224
only pancreatic enzymes secreted in its active form
amylase
225
pathway of activation of pancreatic enzymes
trypsinogen is activated to trypsin by enterokinase secreted by the duodenum
Then trypsin activates EVERYTHING
226
major pancreatic duct that merges with CBD before entering duodenum
Duct of Wirsung
227
small accessory pancreatic duct that drains directly into duodenum
Duct of Santorini
(s for small duct)
228
Failed fusion of the pancreatic ducts is called
PANCREAS DIVISUM
229
MCC death in pancreatitis
sepsis
230
Ranson’s criteria
* On admission → age > 55, WBC > 16, glucose > 200, AST > 250, LDH > 350
* After 48 hours: Hct ↓ 10%, BUN ↑ of 5, Ca < 8, PaO2 < 60, base deficit > 4, fluid
sequestration > 6 L
231
best antibiotic to be given when needed for pancreatitis
imipenem
232
ARDS in pancreatitis is related to the release
phospholipases
233
Coagulopathy in pancreatitis is related to the release of
proteases
234
mnemonic for ON admission ranson criteria
WAGAL
wbc>16
age>55
glucose>200
AST>250
LDH>350
235
PANCREATIC PSEUDOCYSTS not associated with pancreatitis or known trauma u need to r/o
pancreatic CA
236
MC cause of chronic pancreatitis
Alcohol
237
number 1 risk factor for pancreatic adenocarcinoma
smoking
238
Pancreatic neuroendocrine tumors are divided into
non-functional (MC)
functional
239
MC functional PNET
insulinoma
240
symptoms of insulinoma
Whipple’s triad – fasting hypoglycemia (< 55), symptoms of hypoglycemia
, and relief with glucose
241
c-peptide in insulinoma is
increased
242
MC PNET in MEN-1
gastrinoma
243
MC location of gastrinoma
Gastrinoma triangle
244
gastrinoma triangle
common bile duct, neck of pancreas, third portion of the
duodenum
245
symptoms of glucagonoma
Symptoms (4 D’s): Diabetes, Dermatitis (rash – necrolytic migratory erythema),
Depression, DVT
246
symptoms of vipoma
watery diarrhea, hypokalemia, and achlorhydria (WDHA)
247
congenital lack of ligaments holding spleen in place is called
wandering spleen
248
ITP pathogenesis
anti-platelet antibodies (IgG to GpIIb/IIIa and Gp Ia/IIa) –
bind platelets; results in decreased platelets
249
THROMBOTIC THROMBOCYTOPENIC PURPURA
(TTP) pathogenesis
Due to ADAMTS13 defect (metalloproteinase that normally cleaves
vWF)
platelets go crazy and aggregates
250
Vaccines needed before splenectomy
Pneumococcus, Meningococcus,
H. influenzae
251
when to give vaccine in splenectomy
Give vaccines at least 14 days before elective surgery or 14 days after
emergency surgery
252
Most common congenital hemolytic anemia requiring splenectomy
spherocytosis
253
spherocytosis pathogenesis
Spectrin deficit (membrane protein, autosomal dominant) leads to
less deformable RBCs and splenic culling/sequestration
(hypersplenism).
254
which portions of the duodenum are retroperitoneal
2nd and 3rd
255
B12 and folate absorption occurn in
terminal ileum
256
iron absorption occurs in
duodenum
257
both jejunum and ileum are supplied by
SMA
258
Arcades and vasa recta difference between ileum and jejunum
for jejunum larger fewer arcades with longer vasa recta
259
jejunum and ileum arterial supply
SMA
260
non conjugated bile acids are absorbed by
passive diffusion
261
how much bowel u need to survive off TPN
Probably need at least 75 cm to survive off TPN; 50 cm with competent ileocecal valve
262
MCC of large bowel obstruction whether there history of surgery or no
colon Ca
263
failure of closure of the omphalomesenteric duct
MECKEL’S DIVERTICULUM
264
most common tissue found in Meckel’s
pancreatic tissue
265
when do u remove an incidentally found meckel's diverticulum
gastric mucosa suspected (diverticulum feels
thick) or has a very narrow neck
266
which IBD is more associated with bloody diarrhea
UC
267
age of presentation for crohn's disease
bimodal distribution
20–30s, 50–60s
268
extraintestinal manifestations of crohn's disease
1.arthritis
2.uveitis
3.pyoderma gangrenosum
4.megaloblastic anemia
269
MC involved bowel segment in crohn's
terminal ileum
270
histopathology for crohn's disease
transmural inflammation
noncaseating granuloma
cobblestoning
creeping fat
skip lesions
narrow deep ulcers
271
why do crohn's disease patients get calcium oxalate kidney stones
↓ oxalate binding to calcium secondary to ↑ intraluminal fat (fat binds Ca) →
oxalate then gets absorbed in colon → released in urine→hyperoxaluria
272
best for localizing carcinoid tumor not seen on CT scan
Octreotide scan
273
Most sensitive tumor marker for carcinoid tumor
chromogranin A
274
Peutz–Jeghers syndrome gene mutation
STK11 gene mutation; autosomal dominant
275
most common stomal infection
candida
276
parastomal hernias is mc associated with
colostomies
277
most common cause of stenosis of stoma
ischemia
278
FAP+osteomas called
Gardner's syndrome
279
FAP+brain tumors
Turcot's syndrome
280
Peutz–Jeghers syndrome
*benign hamartomas
*mucocutaneous pigmentation
*increase risk of breast Ca
281
GIST tumors arise from
intestinal calls of cajal
282
ckit mutation of GIST tumors allows which drug to work
Gleevec(imatinib)
283
MC location for GIST
gastric
284
Anal canal borders
extends from anorectal ring (puborectalis) to anal verge (squamous mucosa
and perianal skin junction)
285
Anal margin border
from squamous mucocutaneous junction to 5 cm out radially
286
Ascending and ⅔ of transverse colon blood supply
supplied by SMA (ileocolic, right and middle
colic arteries)
287
⅓ transverse, descending colon, sigmoid colon, and upper portion of the rectum blood supply
IMA (left colic, sigmoid branches, superior rectal artery)
288
Marginal artery
runs along colon margin, connecting SMA to IMA (provides
collateral flow)
289
Arc of Riolan
short direct collateral connection
between SMA and IMA
290
percentage of GI blood flow that supplies mucosa and submucosa
80%
291
Middle rectal artery is a branch of
internal iliac artery
292
inferior rectal artery is a branch of
internal pudendal artery (which is a branch of the internal iliac artery)
293
Superior rectal vein drain into
IMV and eventually the portal vein
294
Middle and inferior rectal veins drain into
internal iliac veins and eventually the IVC.
295
Watershed areas of large bowel
* Splenic flexure (Griffith’s point) – SMA and IMA junction
* Rectum (Sudeck’s point) – superior rectal and middle rectal junction
296
innervation of the external sphincter muscle
internal pudendal nerve
297
Stump pouchitis pathogenesis
lack of short chain fatty acids
298
Denonvilliers’ fascia (anterior)
rectovesicular and rectoprostatic fascia in men;
rectovaginal fascia in women
299
Waldeyer’s fascia (posterior)
rectosacral fascia
300
most common colon polyp
hyperplastic
301
risk factors for potentially cancerous polyps
> 2 cm, sessile, or villous
302
most important prognostic factor for colon CA
nodal status
303
FAMILIAL ADENOMATOUS POLYPOSIS (FAP) is associated with what gene mutation
APC
autosomal dominant
304
LYNCH SYNDROMES gene mutation
DNA mismatch repair gene
also called(hereditary nonpolyposis colon Ca)
autosomal dominant
305
Amsterdam criteria for Lynch syndrome
“3, 2, 1” → at least 3 first-degree relatives,
over 2 generations, 1 with cancer before age 50
306
histopathology of Ulcerative colitis
chronic inflammation involving the mucosa and submucosa
CRYPT ABSCSESS
307
complications of U.C
Toxic colitis
toxic megacolon
308
Toxic colitis criteria
>6 bloody diarrhea/day
tachycardia
fever
leukocytosis
309
Toxic megacolon criteria
Toxic colitis criteria +
>6 cm large bowel
abdominal distention, pain and tenderness
310
Large bowel perforation with obstruction most likely to occur in
cecum
311
Spermatic cord structures rule of 3
Rule of 3s for the spermatic cord:
- 3 layers: External spermatic fascia, cremasteric fascia and internal spermatic fascia.
- 3 arteries: Artery to vas deferens, testicular artery and cremasteric artery.
- 3 nerves: Genital branch of genitofemoral nerve, ilioinguinal nerve and sympathetics.
- 3 other structures: Pampiniform plexus, vas deferens and testicular lymphatics.
312
name spermatic cord structures
testicular artery, pampiniform plexus, cremasteric
muscle, vas deferens, ilioinguinal nerve, genital branch of the genitofemoral nerve
313
Pantaloon hernia
direct and indirect components
314
most common early complication following hernia repair
Urinary retention
315
most common cause of hernia recurrence
Wound infection
316
Recurrence rate of hernia
2%
317
Most commonly injured nerve with open inguinal hernia repair
ilioinguinal nerve
318
Most commonly injured nerve with laparoscopic hernia repair
Lateral femoral cutaneous nerve
319
Femoral canal boundaries
Cooper’s ligament (pectineal, posterior), inguinal ligament
(anterior), femoral vein (lateral), and lacunar ligament (medial)
320
loss of cremasteric reflex; numbness on ipsilateral penis,
scrotum, and thigh after hernia surgery... nerve injured?
Ilioinguinal nerve injury
321
