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EOR General Surgery > Gastrointestinal (50%) > Flashcards

Gastrointestinal (50%) Flashcards

1
Q

Most common causes of gastritis

A 
H. pylori infection
Autoimmune causes (pernicious anemia)
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2
Q

Most common causes of gastropathy

A

NSAIDs
Alcohol
Bile reflux

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3
Q

Treatment for gastritis

A

Treat underlying cause and give PPI

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4
Q

What two causes predispose a patient to peptic ulcers?

A

H. pylori

NSAIDs

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5
Q

Symptoms of peptic ulcers

A

Duodenal Ulcers: improve with meals
Gastric Ulcers: worsen with meals
Coffee ground emesis

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6
Q

Diagnostic modality for peptic ulcers

A

Endoscopy

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7
Q

Treatment for peptic ulcers

A

Treat underlying cause and give PPI

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8
Q

Most common form of gastric cancer

A

Adenocarcinoma

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9
Q

Risk factors for gastric cancer

A

> 50 y/o
H pylori
Smoking
Alcohol consumption

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10
Q

Treatment for H pylori

A

Two weeks of:
BID PPI
BID Clarithromycin
BID Metronidazole or amoxicillin

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11
Q

Second line treatment for H pylori

A

BID PPI
QID Bismuth
BID Metronidazole
BID Tetracycline

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12
Q

Preferred antiemetics for postoperative N/V

A

Ondansetron
Metoclopramide
Scopolamine

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13
Q

Symptoms of esophageal cancer

A

Dysphagia to solids progressing to dysphagia to liquids
Weight loss
Anorexia
GI bleed

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14
Q

Risk factors for esophageal cancer

A

Alcohol use
Tobacco use
Prolonged untreated GERD

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15
Q

Diagnostic modality for esophageal cancer

A

Endoscopy

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16
Q

Most common type of hiatal hernia

A

Sliding hernia

GE junction and stomach slide into the mediastinum

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17
Q

Predominant symptom of hiatal hernia

A

Reflux

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18
Q

Management of hiatal hernia

A

Similar to GERD treatment

If a rolling hernia, must surgically repair - can lead to strangulation

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19
Q

Most common cause of intestinal obstruction in infancy

A

Pyloric Stenosis

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20
Q

Pyloric stenosis has an increased incidence with __________ use

A

Erythromycin

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21
Q

Erythromycin leads to an increased incidence of ______ _________

A

Pyloric Stenosis

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22
Q

Electrolyte abnormality seen in pyloric stenosis

A

Hypochloremic metabolic alkalosis

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23
Q

Diagnostic modalities for pyloric stenosis

A
  1. Ultrasound

2. Upper GI Contrast - string sign

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24
Q

Management of pyloric stenosis

A

Initially: IV fluids, potassium repletion if hypokalemic from vomiting
Pyloromyotomy is definitive management

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25
Q

Most common bacterial etiologies of acute cholecystitis

A

E. coli

Klebsiella

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26
Q

Diagnosis of cholecystitis

A
  1. Ultrasound
  2. CT Scan
  3. Labs: leukocytosis w/ left shift, high bilirubin, high LFTs
  4. HIDA scan: gold standard
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27
Q

Management of cholecystitis

A
  1. NPO, IV fluids, abx
  2. Cholecystectomy
  3. Pain control with NSAIDs or narcotics
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28
Q

Premalignant condition of the gallbladder

A

Porcelain gallbladder

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29
Q

Acute cholecystitis without evidence of stones

A

Acalculous Cholecystitis

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30
Q

Acalculous cholecystitis may result from an absence of ___________ stimulation

A

Cholecystokinin

Contracts the gallbladder

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31
Q

Risk factors for acalculous cholecystitis

A

Prolonged fasting
TPN
Trauma
Prolonged postoperative or ICU setting

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32
Q

Diagnostic modalities for acalculous cholecystitis

A
  1. Ultrasound: sludge and inflammation

2. HIDA scan

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33
Q

Risk factors for cholelithiasis

A

Female
Fat
Forty
Fertile

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34
Q

Most common types of gallbladder stones

A

75% Cholesterol

25% Pigment (calcium bilirubinate, assoc. with biliary tract infxn)

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35
Q

Boas Sign

A

Referred right subscapular pain from cholelithaisis

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36
Q

Diagnostic modality of cholelithiasis

A
  1. Ultrasound
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37
Q

Major Complications of cholelithiasis (5)

A
  1. Acute cholecystitis
  2. Choledocholithiasis
  3. Gallstone pancreatitis
  4. Gallstone ileus
  5. Cholangitis
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38
Q

Complications of choledocholithiasis (2)

A
  1. Acute pancreatitis

2. Cholangitis

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39
Q

Diagnostic modalities for choledocholithasis:

A
  1. Ultrasound: often comes back negative

2. ERCP: both diagnostic and therapeutic

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40
Q

Bacterial infection of the biliary tract from obstruction

A

Cholangitis

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41
Q

Most common causes of cholangitis

A

Choledocholithiasis (MC)
Neoplasm
Stricture

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42
Q

Most common organisms in cholangitis

A

E. Coli (MC)

Klebsiella

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43
Q

Charcot’s Triad

A

Seen in cholangitis

  1. RUQ pain
  2. Fever
  3. Jaundice
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44
Q

Reynold’s Pentad

A

Seen in cholangitis
1,2,3. Charcot’s Triad
4. Shock / Sepsis
5. AMS

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45
Q

Diagnostic modalities for cholangitis:

A
  1. Labs: leukocytosis, high bilirubin, high ALT, AST
  2. Ultrasound, CT Scan
  3. Cholangiography: gold standard via ERCP
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46
Q

Management of cholangitis

A 
ABX:
1. Ampicillin/sulbactam or Piperacillin/tazobactam
OR
2. Ceftriaxone + metronidazole
OR
3. flouroquinnolone + metronidazole

Stone extraction via ERCP

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47
Q

Risk factors for hepatic carcinoma

A

Chronic viral hepatitis (B, C, & D)

Cirrhosis

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48
Q

Signs/symptoms of hepatic carcinoma

A
  1. Malaise
  2. Weight loss
  3. Jaundice
  4. Abd pain
  5. Hepatosplenomegaly
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49
Q

Diagnostic modalities of hepatic carcinoma

A
  1. Ultrasound, CT, MRI, hepatic angiogram

2. High alpha-fetoprotein

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50
Q

Treatment for hepatic carcinoma

A

Surgical resection if:

  1. Confined to a lobe
  2. Not associated with cirrhosis
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51
Q

2 most common etiologies for acute pancreatitis

A 
Gallstones
EtOH abuse
Malignancy
Scorpion bite
Mumps in children
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52
Q

Intracellular activation of pancreatic enzymes that causes autodigestion of the pancreas

A

Acute pancreatitis

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53
Q

Pain exacerbated if supine, eating, or walking. Relieved with leaning forward or sitting.

A

Acute pancreatitis

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54
Q

Signs/symptoms of acute pancreatitis

A
  1. Epigastric pain (radiates to back)
  2. N/V and Fever
  3. Epigastric tenderness and tachycardia
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55
Q

Cullen’s Sign and Grey Turner Sign

A

Acute Pancreatitis if necrotizing / hemorrhagic
Cullen’s: periumbilical ecchymosis
Grey Turner: flank ecchymosis

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56
Q

Diagnostic studies for pancreatitis

A
  1. Labs: leukocytosis, lipase, amylase, high glucose
  2. CT: diagnostic test of choice
  3. Ultrasound
  4. XRay - colon cutoff sign
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57
Q

Colon cutoff sign

A

Abrupt collapse of the colon near the pancreas

Acute pancreatitis

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58
Q

Management of pancreatitis

A

90% recover without complications in 3-7 days

  1. Supportive - NPO, IV fluid resuscitation, analgesia with meperidine/demerol
  2. ABX not used routinely
  3. If necrotizing pancreatitis - imipenem
  4. ERCP - only effective for obstructive jaundice
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59
Q

Ranson’s Criteria

A

Used to determine prognosis for pancreatitis
Glucose, Age, LDH, AST, WBC
Calcium, Hematocrit fall, Oxygen, BUN, Base deficit, Sequestration of fluid

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60
Q

Chronic inflammation that results is loss of exocrine and sometimes endocrine function

A

Chronic Pancreatitis

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61
Q

Most common cause of chronic pancreatitis

A

Alcohol abuse

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62
Q

Most common cause of chronic pancreatitis in children

A

Cystic fibrosis

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63
Q

Triad of chronic pancreatitis

A
  1. Calcifications
  2. Steatorrhea
  3. Diabetes mellitus
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64
Q

Diagnosis for chronic pancreatitis

A
  1. AXR: calcified pancreas

2. Endoscopic US

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65
Q

Management of chronic pancreatitis

A

Oral pancreatic enzyme replacement
EtOH abstinence
Pain control

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66
Q

Encapsulated, mature fluid collections occurring outside the pancreas - have a well-defined wall with minimal or no necrosis

A

Pancreatic Pseudocyst

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67
Q

Risk factors for pancreatic pseudocysts

A

Chronic pancreatitis

Blunt or penetrating pancreatic trauma

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68
Q

Diagnostic for pancreatic pseudocysts

A
  1. Ultrasound

2. CT or MRI - differentiate walled-of necrosis of pancreas

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69
Q

Management of pseudocysts

A

Clinical observation w/ f/u imaging for pts with minimal or no sx

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70
Q

Risk factors for pancreatic carcinoma

A 
Smoking
> 60 y/o
Chronic pancreatitis
EtOH
DM
Male
Obesity
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71
Q

Most common type of pancreatis carcinoma

A

Adenocarcinoma: ductal

70% found in the head

72
Q

Signs/symptoms of pancreatic carcinoma

A 
Abdominal pain radiating to back
New onset DM
Painless jaundice (classic)
Weight loss
Pruritus, acholic stools, dark urine
73
Q

Trousseau’s Malignancy Sign

A

Seen in pancreatic carcinoma

Migratory phlebitis associated with malignancy

74
Q

Courvoisier’s Sign

A

Palpable, nontender, distended gallbladder, associated with jaundice
Seen in pancreatic carcinoma

75
Q

Diagnosis of pancreatic carcinoma

A
  1. CT scan - test of choice
  2. ERCP
  3. Labs: increased tumor markers, CEA, CA 19-9
76
Q

Treatment for pancreatic carcinoma

A

Whipple Procedure: radical pancreaticoduodenal resection

Advanced/Inoperative: ERCP w/ stent placement to tx intractable itching

77
Q

Most common causes of appendicitis

A

Fecalith (MC)
Inflammation
Malignancy
Foreign body

78
Q

Vomiting usually occurs _____ pain in appendicitis

A

After

79
Q

RLQ pain with LLQ palpation

A

Rovsing Sign

Appendicitis

80
Q

RLQ pain with internal and external hip rotation with flexed knee

A

Obturator Sign

Appendicitis

81
Q

RLQ pain with right hip flexion/extension (raise leg against resistance)

A

Psoas Sign

Appendicitis

82
Q

Diagnosis for appendicitis

A
  1. CT scan
  2. Ultrasound
  3. Leukocytosis
83
Q

Increased risk of CA in both when there is colonic involvement

A

Inflammatory Bowel Disease - UC and Crohn’s

84
Q

Signs/Symptoms of inflammatory bowel disease

A
  1. abdominal pain
  2. weight loss
  3. bloody diarrhea
  4. fever
85
Q

Extraintestinal manifestations of inflammatory bowel disease (5)

A
  1. Erythema nodosum
  2. Arthritis
  3. Uveitis
  4. Primary sclerosing cholangitis
  5. Pyoderma gangrenosum
86
Q

Characteristics of ulcerative colitis

A

Involves colon
Continuous involvement
pANCA positive

87
Q

Characteristics of crohn’s disease

A 
Skip lesions
Entire GI tract involvement (mouth to anus)
Transmural inflammation
Cobblestone appearance
Fistulas may be seen
ASCA positive
88
Q

Treatment for inflammatory bowel disease

A
  1. Steroids for acute exacerbations
  2. Sulfasalazine or mesalamine
  3. If no response to sulfa or mesalamine, ABX are used for Crohn’s only
  4. Colectomy or proctocolectomy is offered to those with extensive dz refractory to medication
89
Q

Most common malignant neoplasma of the small intestine

A
  1. Adenocarcinomas
  2. Carcinoid Tumors
  3. Lymphoma
  4. GI stromal tumors (GIST)
90
Q

Diagnosis of small bowel carcinoma

A
  1. Contrast examination is test of choice
  2. Enteroclysis
  3. CT
  4. Endoscopy
91
Q

Treatment for tumors found in the periampullary region of the small intestine

A

Pancreaticoduodenectomy

92
Q

Treatment for tumors found in remainder of small intestine (after ampullary region)

A

Poorer prognosis

Rarely amenable to curative resection

93
Q

Manifestations of carcinoid syndrome

A

Type of small intestine cancer
Diarrhea, flushing, hypotension, tachycardia
Fibrosis of the endocardium and valves of right heart
Treat with octreotide

94
Q

Etiologies of toxic megacolon

A

UC
Crohn’s
Pseudomembranous colitis
Infectious

95
Q

Signs/Symptoms of toxic megacolon

A 
Fever
Abdominal pain
N/V/D
Rectal bleeding
Tenesmus (cramping rectal pain)
Electrolyte disorders
96
Q

Physical exam findings for toxic megacolon

A 
Abdominal tenderness
Rigidity
Tachycardia
Dehydration
Hypotension
AMS
97
Q

Diagnosis of toxic megacolon

A
  1. AXR: large dilated colon > 6 cm
98
Q

Management of toxic megacolon

A 
Bowel decompression
Bowel rest
NG tube
Broad-spectrum abx
Electrolyte repletion
99
Q

3rd most common cause of cancer related death in US

A

Colorectal carcinoma

100
Q

Most common site of metastatic spread from colorectal CA

A

Liver
Lungs
Lymph nodes

101
Q

Risk factors for colorectal cancer

A
  1. APC gene
  2. Lynch syndrome
  3. Peutz Jeghers
  4. Age > 50 y/o
  5. Ulcerative colitis
  6. diet
  7. Smoking, EtOH
102
Q

Signs/Symptoms of colorectal cancer

A

Iron deficiency anemia
Rectal bleeding
Abdominal pain

103
Q

Most common cause of large bowel obstruction in adults

A

Colorectal cancer

104
Q

Right-sided (proximal) colorectal CA presents with ________ and ________

A

Bleeding

Diarrhea

105
Q

Left-sided (distal) colorectal CA presents with __________ and _______

A

Bowel obstruction

Changes in stool diameter

106
Q

Diagnosis for colorectal cancer

A
  1. Colonoscopy with biopsy
  2. Barium enema - apple core lesion
  3. Increased CEA
  4. CBC (iron deficiency anemia)
107
Q

Management of colorectal cancer

A

Localized (Stages I-III): surgical resection

Stage III & metastatic: chemotherapy is mainstay (fluorouracil)

108
Q

Guidelines for colorectal CA screening

A
  1. Occult blood test annually
  2. colonoscopy every 10 years ages 50-75 y/o
  3. flex sig every 5 years with occult every 3 years
109
Q

Meckel’s Diverticulum is a persistent portion of embryonic _________ ______ (_____ ____)

A

Vitelline duct (yolk sac)

110
Q

Meckel’s Diverticulum rule of two’s:

A 
2% of population
2% asymptomatic
2 feet from ileocecal valve
2 inches in length
2x more common in boys
2 years most common age of presentation
111
Q

Signs/Symptoms of meckel’s diverticulum

A

Usually asymptomatic
Painless rectal bleeding (periumbilical pain that may radiate to RLQ)
May cause intussusception, volvulus or obstruction

112
Q

Diagnosis of Meckel’s diverticulum

A

Meckel’s scan - looks for ectopic gastric tissue in ileal area

113
Q

Treatment of meckel’s diverticulum

A

Surgical excision if symptomatic

114
Q

Most common area of diverticular disease due to intraluminal pressure

A

Sigmoid colon

115
Q

Diverticulosis is associated with: (3)

A

Low fiber diet
Constipation
Obesity

116
Q

Most common cause of acute lower GI bleeding

A

Diverticulosis

117
Q

Signs/Symptoms of diverticulitis

A

Fever
LLQ abdominal pain
N/V/D/C

118
Q

Diagnosis of diverticulitis

A

CT is test of choice

Labs: WBCs increased, + guiac

119
Q

Management of diverticulitis

A

Clear liquid diet

ABX (ciprofloxacin or bactrim + metronidazole)

120
Q

Most common causes of small bowel obstruction

A
  1. Adhesions
  2. Incarcerated hernia
  3. Crohn’s dz
  4. Malignancy
121
Q

Signs/Symptoms of small bowel obstruction

A 
CAVO
Cramping abdominal pain
Abdominal distention
Vomiting - may be bilious if proximal
Obstipation - usually late finding (diarrhea early)
122
Q

Physical exam for small bowel obstruction

A

Abdominal distention
Hyperactive bowel sounds in early obstruction
Hypoactive bowel sounds in late obstruction

123
Q

Diagnosis of small bowel obstruction

A
  1. AXR - air fluid levels in step ladder pattern, dilated bowel loops
124
Q

Management of small bowel obstruction

A

Nonstrangulated: NPO, IV fluids, NG tube
Strangulated: surgical intervention

125
Q

Decreased peristalsis without structural obstruction

A

Paralytic (Adynamic) Ileus

126
Q

Etiologies of paralytic ileus

A

Postoperative state (abdominal surgery)
Medications (opiates)
Metabolic (hypokalemia)
Metabolic (hypothyroidism, diabetes)

127
Q

Signs/Symptoms of paralytic ileus

A

N/V, abdominal pain, obstipation, abdominal distention

Decreased/absent bowel sounds

128
Q

Diagnosis of paralytic ileus

A
  1. AXR: first line - uniformly distended loops of small and large bowel (due to air)
  2. CT or Upper GI series if high suspicion after negative AXR
129
Q

Treatment for paralytic ileus

A
  1. NPO or dietary restriction
  2. NG suction if moderate vomiting
  3. Electrolyte and fluid replacement
  4. Treat underlying cause
130
Q

Acute colon dilation with severe inflammation

Acute colon dilation without no inflammation

A

Toxic Megacolon

Ogilvie’s Syndrome

131
Q

Acute dilation of the colon in the absence of any mechanical obstruction

A

Ogilvie’s Syndrome

132
Q

Most common location for Ogilvie’s Syndrome to occur

A

Cecum and right hemicolon

133
Q

Ogilvie’s syndrome is more common in ______ (men/women)

A

Men > 60 y/o

134
Q

Causes of Ogilvie’s Syndrome

A 
Post-surgical
Elderly
Severely ill pts
Non-operative trauma
Medications
135
Q

Signs/Symptoms of Ogilvie’s Syndrome

A 
Abdominal distention (hallmark)
Abdominal pain
N/V
Constipation
Will have positive tympany with normal bowel sounds
136
Q

Diagnosis of Ogilvie’s Syndrome

A
  1. AXR - dilated right colon w/ cutoff at splenic flexure

2. CT or contrast enema

137
Q

Management of Ogilvie’s Syndrome if colon dilation < 12 cm and absence of severe sx

A

IV fluid and electrolyte repletion

138
Q

Management of Ogilvie’s Syndrome if colon dilation > 12 cm or if failed conservative therapy after 48 hours

A

Neostigmine

139
Q

Management of Ogilvie’s Syndrome if fail conservative and medical treatment

A 
Decompression initially with NG suction of enemas
Surgical decompression (colostomy) used if all other therapies fail
140
Q

Twisting of any part of the bowel at its mesenteric attachment site

A

Volvulus

141
Q

Most common areas for volvulus’ to occur

A

Sigmoid colon and cecum

142
Q

Signs/Symptoms of volvulus

A 
Obstructive symptoms
Abdominal pain
Distention
N/V
Fever
Tachycardia
143
Q

Management of volvulus

A

Endoscopic decompression

Surgical correction is 2nd line

144
Q

Causes of anal fissures

A

Low-fiber diets
Passage of large, hard stools
Other anal trauma

145
Q

Signs/Symptoms of anal fissures

A

Severe rectal pain
Painful bowel movements causing patient to refrain from having BM
Leads to constipation
BRBPR

146
Q

Where is the most common location of anal fissures

A

90% posterior midline

147
Q

Treatment of anal fissures

A 
80% resolve spontaneously
Supportive measures: warm sitz baths
High fiber diet
Analgesic
Increased water intake
Stool softeners
148
Q

Second line treatment for anal fissures

A

Topical vasodilators: nitroglycerin

149
Q

Most common bacterial etiologies of anorectal abscesses

A

Staph aureus

E. coli

150
Q

Most common location of anorectal abscesses

A

Posterior rectal wall

151
Q

Open tract between two epithelial-lined areas

A

Fistula

Seen commonly with anorectal abscesses

152
Q

Symptoms of anorectal abscess

A

Swelling
Rectal pain that is worse with sitting, coughing, and defecation
May have anal discharge if fistula present

153
Q

Management of anorectal abscesses

A 
I&amp;D followed by WASH
Warm water cleaning
Analgesics
Sitz baths
High-fiber diets
154
Q

Internal hemorrhoids result from engorgement of which venous plexus

A

Superior hemorrhoidal vein

155
Q

External hemorrhoids result from engorgement of which venous plexus

A

Internal hemorrhoidal vein

156
Q

Risk factors for hemorrhoids

A 
Increased venous pressure
Straining during defecation (constipation)
Pregnancy
Obesity
Prolonged sitting
Cirrhosis with portal hypertension
157
Q

Symptoms of internal hemorrhoids

A 
Rectal bleeding (intermittent)
Hematochezia 
Rectal itching and fullness
Mucous discharge
Rectal pain suggests complications
158
Q

Symptoms of external hemorrhoids

A

Perianal pain - aggravated with defecation

+/- tender palpable mass

159
Q

Diagnosis of hemorrhoids

A 
Visual inspection
Digital rectal exam 
Fecal occult blood testing
Proctosigmoidoscopy
Colonoscopy in pts with hematochezia to r/o proximal sigmoid disease
160
Q

Management of hemorrhoids

A

Conservative tx - high fiber diet, increased fluids, warm sitz bath, topical rectal corticosteroids for pruritus and discomfort
If failed conservative therapy or debilitating pain:
Rubber band ligation
Sclerotherapy
Infrared coagulation
Hemorrhoidectomy (for all stage IV)

161
Q

Hernia that occurs lateral to the inferior epigastric artery

A

Indirect inguinal hernia

162
Q

Indirect hernias are often congenital and occur due to a __________ __________ __________

A

Persistent patent process vaginalis

163
Q

Most common overall type of hernias in men and women

A

Indirect inguinal hernia

164
Q

Hernia that occurs medial to the inferior epigastric arteries within Hesselbach’s triangle

A

Direct inguinal hernia

165
Q

Borders of Hesselbach’s Triangle

A

RIP
Rectus abdominis
Inferior epigastric arteries
Poupart’s Ligament

166
Q

Signs/symptoms of a strangulated hernia

A

Incarcerated hernia with systemic toxicity
Compromised blood supply - ischemic
Severe painful bowel movement

167
Q

Management of inguinal hernias

A

Often require surgical repair

Strangulated are surgical emergencies

168
Q

Hernia that is most commonly seen in women

A

Femoral hernia

169
Q

Often become incarcerated or strangulated compared to an inguinal hernia so surgical repair is often done

A

Femoral hernia

170
Q

Management of umbilical hernias

A

Observation, will usually resolve by 2 years old

Surgical repair if still persistent in children > 5 y/o

171
Q

Incision hernias occur most commonly with _____________ and in ___________

A

Vertical incisions

Obese patients

172
Q

Indications for bariatric surgery

A

Pt between 21-55 y/o with BMI of 40
BMI > 35 w/ life-threatening comorbidities
Pts for whom supervised weight-reducing programs have failed

173
Q

Two most common bariatric urgeries

A

Roux-En-Y gastric bypass (RYGB)

AGB (Adjustable gastric banding)

174
Q

RYGB creates a gastric pouch of approximately _____ mL capacity, and attaches a limb of proximal _______ to this gastric pouch

A

30 mL

Jejunum

175
Q

Dumping Syndrome

A

Seen in post Roux-En-Y surgeries
Occurs due to intestines being bypassed in surgery
Abdominal cramps, nausea, vomiting, flushing
Occurs especially with consumption of highly concentrated sweets

176
Q

Roux-En-Y surgeries are associated with resolution of:

A

DM
HTN
Obstructive sleep apnea

177
Q

Important nutritional complications of post-bariatric surgical patients

A 
Anemia (iron and B12 based)
Calcium deficiency
Electrolyte deficiencies
Dehydration
Protein malnutrition

EOR General Surgery (10 decks)

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