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Alimentary Flashcards

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1
Q

FAP screening recs

gene

A

APC

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2
Q

Lynch screening

A
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3
Q

MC area for FBs to impact

A

Esoph

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4
Q

What is the most common type of CBD injury

A

complete transection

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5
Q

When should stricturoplasty be performed for crohns

A

When concerned for short gut

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6
Q

Small bowel tumor with liver mets think…..

watch out for this during resection

Tx for 2nd line?

A

carcinoid

serotonin syndrome

octrotide

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7
Q
A
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8
Q

2 PE findings for obturator hernia

A

medial thigh paraesthesias and romberg—knees tucked

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9
Q

Ideal Wetzel location on small bowel

A

40 cm distal to LOT

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10
Q

Expected weight loss of excess weight at 2 years follow up?

What is excess weight calculated as

A

excess weight is current weight - IBW

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11
Q

First important SMA branch

Next?

A

pancreaticoduodenal

middle colic

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12
Q

3 possible origins of the right colic artery

A

SMA MCA, nothing

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13
Q

superior rectal artery collateralizes with …

A

hypogastric arteries

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14
Q

what is the collateral flow of the colon?

artery of Moskowitz?

A

Marginal artery

Arc of riolan

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15
Q

distal sma thrombus will show what effect pattern

A

jejunal sparing

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16
Q

3 types of mesenteric ischemia

A

arterial, venous and nomi

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17
Q

non emergent pneumatosis intestinalis

when is PI concerning

A

Nonemergent etiologies include asthma, chronic obstructive pulmonary disease, inflammatory bowel disease, peptic ulcer disease, bacterial and viral infections, immunosuppressive medications, collagen vascular disease, and iatrogenic causes

acute abdomen

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18
Q

3 findings in all mesenteric ischemia types

A

pain out of proportion, acute abdominal pain, metabolic acidosis

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19
Q

3 s/s of chronic mesenteric ischemia

A

food fear, postprandial pain, weight loss

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20
Q

Given critical CV patient, look for these 4 signs when considering NOMI

A

Diagnostic symptoms: high suspicion if three of four are present

Ileus or abdominal pain
Catecholamine requirement
Episode of hypotension
Gradual rise in serum transaminase level

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21
Q

usual suspect for NOMI

A

Sick CV patient

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22
Q

First thing to do if patient presents with Mesenteric ischemia concerns

A

hep ggt

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23
Q

4 pos prognosticators for spontaneous fistula closure

A

free distal flow, 2cm tract length, <1cm bowel involv, healthy surrounding bowel

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24
Q

at what duration does surgical intervention need to be discussed for fistula

A

8 weeks, but generally optimize until 6 months

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25
MC overall cause of ECF
iatrogenic
26
3 imaging studies for ECF
fistulogram CT PO CT rectal(distal obstruction or hollwo viscus rectal connection suspected)
27
3 output grades for ECF
<200, 200-500, >500
28
agents to begin to decrease fistula out put what helps in crohns
h2 or ppi; octreotide infliximab
29
What metric do we look at for ECF considering PO vs TPN
fistula daily output, needs to be under 500cc/d
30
What are the basic principles of fistula management in the subacute setting
wound care(pouches?), PO v tpn, electrolyte/fluid resus
31
what artery supplies meckels 2 meckels tissue types
vitelline gastric and panc
32
meckels scan?
technitium 99 binds to gastric mucosa
33
3 meckels concerning features, how does this guide us
fibrous bands, >2cm, palpable abnormalitiy resect or not
34
segmental meckels removal in bleeding cases if these characteristics are present
2cm neck, narrow lumen, palp abnorm, unhealthy appearing tissues
35
when to consider removal of incidental meckels why
age younger than 50 years, male sex, diverticulum length >2 cm, and ectopic tissue or palpable abnormalities. Ca risk vs resection complication risk
36
what can be used for diarrhea with radiation enteriitis
Cholestyramine is commonly used to bind bile acid that is not absorbed in the ileum due to radiation damage of the small bowel, making the bile acid insoluble and osmotically inactive.
37
MC benign sb tumor MC location
adenomas, Brunner gland, villous adenomas ileum
38
carcinoid tumor now known as.... cell type location in GI tract in descending order of prevalence
net enterochromafin like appendix>small int> colon> stomach> rectum
39
Mc site of SB adenoca
duo and prox j
40
where is malignant SB lymphoma found and why?
ileum, all the peyers patchers
41
2 worrisome sb adenomas and their backgrounds
villous - 50% mal risk familial in duo -- FAP
42
hamartomas in SB are associated with ...
PJS --- melanin defects
43
adenoca of SB accounts for __% of mal sb tumors assoc with ... MC site
50 crohns in young age ileum
44
SB lymphoma make up __% of sb malig risk factors MC intestinal neoplasm in this population
25 celiac and aids younger than 10
45
2 mc presentations of small bowel adenomas
obstruction and bleeding
46
ct findings indicative of SB NET
A diagnosis of a NET of the small intestine can be confidently made based on the classic appearance of a solid mass with spiculated borders that is associated with linear strands within the mesenteric fat and kinking of the bowel on abdominal CT scan.
47
what imaging modality can help with identifying SB NETs Tx for lymphoma?
dotatate resection if symptomatic!! then systemic
48
SB adenoca mets to liver, tx?
Folfox
49
SB NET with carcinoid syndrome tx?
octreotide
50
how can duodenal adenomas be conservatively managed depending on location and anatomy
endoscopy
51
3 genes for colon cancer What are the MMR genes?
KRAS APC TP53 MLH1, MSH2/6, PMS2
52
CPG island mutations for colon ca due to .....
loss of BRAF and MLH1
53
age of screening for colon ca
45
54
is a high MMR or low MMR assoc with poor colon ca prog
low
55
6 genetic syndromes for colon ca
FAP, HNPCC, JPS, PJS, li fraumeni, cowden
56
who is high risk for colon cancer when to screen
1st degree fam hx of adv adenoma or colon ca 40 or 10 y prior to dg
57
screening time and finding: 5-10 5 3 then 5 8 y after onset
2ad 1cm 2 serr 1cm 3-10ad >1cm HGD IBD
58
T staging for adenoca of colon
59
Stage 2 colon cancer T N M who gets adjuvant?
T2-4 n0 High risk: LVI poorly diff T4 <12LN onstruction Pos margins
60
S3 colon ca adjuvant reg and duration
6 months FOLFOX or CAPOX
61
5y survival for all colonc ca stages
90 75 50 5
62
surveillance schedule for all stages of colon ca
1 - 1y colonoscopy 2/3/4 - hnp and cea 6m x2 year, then 6m x 5 CT CAP 12m x 5 Colon 1 3 5
63
HNPCC inh pattern gene type 7 cancers
AD MMR colon, endom, ovary, stomach, biliary, sb, urothelial
64
Op choice for HNPCC
segment or total --- no diff in survivial
65
who needs lynch screening
3 relatives, 2 gens, 1 crc prior to 50
66
2 weird HNPCC skin things
sebacious adenoma and keratocanthomas
67
all screening for FAP
68
3 weird specific FAP pathologies non cancer
desmoids, jaw osteoma, epidermal cysts
69
who has hamartomatous disease, colon cancer syndromes
PJS, JPS
70
Op choice for FAP
total with end v pouch dont leave rectum
71
risk of colon ca with FAP by 45yo
90%
72
2 dietary risk factors for diverticulosis
red meat and low fiber
73
what type of diverticula is a colonic diverticula mech?
false, weak point where arteriole inserts into muscle
74
6 at risk populations for diverticular disease
obese, poor activity, nsaids, opiates, steroids, smoking
75
ideal number of attacks before colectomy for diverticulitis
4
76
Percent of patients with recurrent diverticular disease after first attack
20-40
77
Layers involved in acute ischemic colitis
mucosa and sm
78
dg test of choice for ischemic colitis
colonoscopy unprepped
79
one big long term sequelae of ischemic colitis
strictures
80
describe avms and their role in LGIB
With age, low-grade obstruction of submucosal veins from chronic colonic contraction can lead to arteriovenous communication and dilation in the form of angiodysplasias. As the veins become tortuous and precapillary valves become incompetent, the resulting arteriovenous malformations (AVMs) may cause slow blood loss that frequently presents as melena or subacute anemia. AVMs represent 5% to 10% of lower GI bleeds.
81
The most common causes of lower GI bleeding
The most common causes of lower GI bleeding are diverticulosis (30%-65%), ischemic colitis (5%-20%), hemorrhoids (5%-20%), polyp/neoplasm (2%-15%), and angioectasias (5%-10%).
82
LGIB accounts for __% of all GIB
20
83
first step in evaluating for UGIB Neg pred value?
NGT only 645%
84
Initial dg test for LGIB
prepped colonoscopy within 24h and for reccurrence
85
Thoracic duct anatomy
86
where does the thoracic duct originate
L2 at cirstena chyli
87
pathophys of chylothorax
Chylothorax can cause significant systemic protein loss, which lowers oncotic pressure and can result in high-volume pleural effusions.
88
MCC of non trauma chylo
malig
89
TG level to dg chylo what if it is indeterminate? what is the indet value?
110 50-110, chylomicron by lipoprotein elctrophereses
90
duration of cons mng for chylo? poor surgical candidate next step
5-7d embol
91
what cause for chylo has highest fail rate for intervention? what extra step is taken?
malign pleurodesis
92
what dietary change is made for chylo leak
medium chain avoid long chain
93

Written Boards - Final (21 decks)

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