General Surgery Flashcards

Question

Hiatal hernia

Answer 1

Eti: obesity, aging, generally weakening of musculofascial structures. Sx: dysphagia, epigastric discomfort, anemia, heartburn, regurg, post-prandial bloating, resp sympt Dx: Barium swallow, EGD Tx: surgery if symptomatic (nissen fundoplication)

Answer 2

Eti: Iatrogenic, severe vomiting, external trauma Sx: cervical: neck pain, crepitus, dysphagia, signs of infection - thoracic: tachycardia, tachypnea, dyspnea, hypotension... Dx: Xray, esophagogram, CT chest, thoracentesis Tx: Broad spectrum abx, surgery within 24 hours,

Answer 3

Eti: associated with GERD and hiatal hernias Sx: dysphagia to solid food, especially large boluses - intermittent, not progressive Dx: barium esophogram is more sensitive than EGD Tx: endoscopic dilation, or endoscopic electrosurgical incision

Answer 4

Eti: hematogenous or lymphogenous spread, or from the gut or fallopian tubes... Presentation: abrupt onset of fever, abdominal pain, distention, rebound tenderness Dx: fluid from paracentesis: used for gram stain, culture, serum ascities albumin gradient, ect. Tx: empiric, third gen ceph

Answer 5

Eti: GI perforation, ischemic bowel, IBD, appendicitis, trauma, PID, peritoneal dialysis Sx: abdominal pain and rigidity, N/V, anorexia, fever, rebound tenderness. Changes in bowel function, character of pain, location, etc. depend on cause Dx: paracentesis eval... Tx: abx with anaerobic coverage

Answer 6

Eti: GI perforations, postop complications, penetrating injuries, sequela of peritonitis Sx: fever, tachycardia, pain, prolonged ileus after surgery or peritonitis Dx: CT is best Tx: abx and drainage Surgical: operative drainage if no improvement after percutaneous

Answer 7

Eti: injury or infection of adjacent structures Pres: fever, abdominal pain, flank pain, anorexia, N/V, weight loss. May have thigh and back pain. + iliopsoas sign if located near psoas muscle Dx: CT is best Tx: abx and drainage

Answer 8

Eti: disease of the peritoneum, or CHF, cirrhosis, Budd-chiari, et. Pres: fluid wave, scrotal edema, umbilica or inguinal hernia, plural effusion, peri-umbilical nodule (sister mary joseph, or supraclavicular nodule (malignancy). Dx: US or CT, paracentesis

Answer 9

Eti: decrease of the mucosa in gastric ulcers, increase in acid or pepsin in duodenal ulcers. Major causes: H. pylori, NSAIDs, Sx: gnawing dull ache, hunger like pain DU: better after meal, worse on empty stomach GU: worse after meal Complications: “coffee ground” emesis, hematemesis, melena Dx: EGD

Answer 10

Eti: gastrin-secreting gut neuroendocrine tumors (gastrinomas), which result in hypergastrinemia and acid hypersecretion Sx: multiple ulcers, "kissing ulcers" Dx: fasting serum gastrin, Secretin stimulation test

Answer 11

Eti: cough, vomiting, heavy lifting, seizures sx: history of non-blooding vomiting followed by hematemesis, melena, epigastric pain radiating to the back Dx: EGD Tx: Endoscopic therapy

Answer 12

Eti: H pylori; also salted, cured, smoked, or pickled foods containing nitrites Sx: Indigestion, weight loss, early satiety, abdominal pain/fullness, nausea, post-prandial vomiting, dysphagia, melena, hematemesis, anemia Dx: EGD, CEA (carcinoembryoic antigen) elevated TX: preop chemo, surgery

Answer 13

Eti: hypertrophy & hyperplasia of the muscular layers of the pylorus, causing a functional outlet obstruction Epi: most often first 3-12 weeks of life Sx: non-bilious, projectile vomiting Dx: abdominal US,

Answer 14

Eti: Blunt or penetrating trauma S/sx: Hypovolemic shock, hypotension, decreased uriniary output, low central venus pressure, sometimes abdominal pressure Dx: FAST exam, high res CT with contrast, may have leukocytosis, coagulopathy, acidosis... Tx: Ensure hemodynamic stability, often requires surgical management.

Answer 15

Eti: hepatocellular carcinoma, cancer arising from hepatocytes, or intrahepatic cholangiocarcinoma, cancer arising from biliary epithelial cells. Risk: Hep B and C Eval: AST and ALT may be elevated, but are non-specific, may have elevated alk phos. Image.

Answer 16

Eti: 80% of acute from obstruction of the cystic duct by a gallstone. S/sx: Acute RUQ pain, fever and Eval: US with sonographyic murphy sign, PMNs and leukocytosis. Tx: most cases resolve spontaneously

Answer 17

Eti: Bacterial infection of biliary ducts, always as sign of biliary obstruction, often caused by choledocholithiasis, biliary stricture and neoplasm. S/sx: Charcot's triad: biliary colic, jaundice, chills and fever Eval: US, may also need ERCP Manage: IV abx, often: cefazolin, cefoxitin, surgical if severe or unremitting.

Answer 18

Eti: gallstone in common bile duct S/sx: Biliary type pain. Dx: Labs (AST/ALT, serum bilirubin, alk phos, GGT), transabdominal US, MRCP, ERCP Tx: Removal of stone

Answer 19

Eti: non-bacterial inflammatory disease, caused by activation, interstitial liveration, autodigestion of pancrease by its own enzymes. Most is caused by gallstones and ETOHism. S/sx: acute sudden, super abdominal pain, nausea, vomiting and elevated serum amylase. Dx: Can have elevated Hct with edematous pancreas, serum amylase 3x normal. (lipase is specfic to pancreas). Tx: Reduce pancreatic secretory stimuli, correct electrolyte balance. Surgical: Endoscopic sphincterotomy, surgery C/I in acute pancreatitis

Answer 20

Defined fibrous wall but lacks epithelial lining. Eti: encapsulated collection of fluid with high enzyme concentrations arising from pancreas. S/sx: Epigastric mass and pain, mild fever, persistant serum amylase. Should be considered when acute pancreatits last more than a week. Tx: Expectant management is reasonable, spontaneous resolution in about 40% of cases.

Answer 21

Fatal if not treated surgically. Eti: Develops in severe cases of pancreatitis w/ hypovolemic shock and pancreatic necrosis. Often seen in post-op pancreatitis. S/sx: rising fever, lack of improvement of severe acute pancreatitis. Can have some vomiting or jaundice. Often just fever. Eval: Serum amylase may be elevated, leukocytosis. Tx: Infected fluid must be drained by percutaneous catheter drainage. Post-op abx to cover for E. coli, staph, klebsiella, proteus, candida albicans.

Answer 22

``` Estimates mortality of patients with pancreatitis based on 48 hour lab values. (0-11 points, 7 points = 100% mortality. On admin: - WBC greater than 16k - Age greater than 55 - Glucose greater than 200 - LDH greater than 250 48 hours into admin: - HCT drop >20% - BUN increase >5mg/dL - Ca<8mg/dL - Arterial pO2 <60mmgH ```

Answer 23

Eti: Obstruction of the appendix by a fecalith, inflammation, foreign body, or neoplasm S/sx: vague/colicky periumbilical pain, N/V, anorexia, fever, constipation Dx: leukocytosis w/ neutrophilia, microscopic hematuria and pyruria, CT abdomen/pelvis Tx: peroperative broad-spectrum abx w/ gram neg and anaerobic coverage

Answer 24

aka: small intestine bacterial overgrowth Eti: failure to limit bacterial growth. Structural lesions causing stasis, IBD, scleroderma S/sx: diarrhea, steatorrhea, distention, abd discomfort, weight loss, dyspepsia Dx: culture and breath test Tx; augmentin or flagyl

Answer 25

Most common after after large resection due to AMI. Usually occurs in patients with less than 100cm of bowel remaining. S/sx: diarrhea, steatorrhea, dehydration, weakness, fatigue.

Answer 26

Eti: Most often due to adhesions related to prior abd. surgery. Hernia, neoplasm, IBD. ABCs: adhesions, bulge (hernia), cancer S/sx: N/V, colicky abd. pain, obstipation, abdominal distension ...

Answer 27

Eti: Colon cancer, diverticulitis, volvulus Pathophys: Obstruction = mucosal edema = impaired venous and arterial blood flow to bowel. S/sx: Obstipation, vomiting, deep visceral cramping Dx: abdominal XR, CT w/ rectal contrast, contrast enema Tx: Hydration, TPN Surgery: Removal of necrotic bowel, or obstructing lesion

Answer 28

Eti: Sudden decrease of mesenteric blood supply, inadequate perfusion, most commonly by embolus Epi: CVD greatest risk S/sx: Severe abdominal pain out of proportion of physical findings, poorly localized. N/V/D Dx: Urgent CTA, mesenteric arteriography Labs: WBC, metabolic acidosis, elevated lactate

Answer 29

Eti: adenomatous polyp into malignancy, 3rd leading cause of cancer death. Epi: Lynch syndrome S/sx: Fe def anemia, rectal bleeding, abdominal pain, change in bowel habits, obstruction, majority asymp. Dx: colonoscopy, barium enema, CT cap, elevated CEA

Answer 30

Eti: weakness in bowel wall Epi: 50-60% of adults by 60. M=W S/sx: uninflammed diverticula, usually asymp, LLQ tender, palpable left colon, sigmoid most common site.

Answer 31

Eti: micro or macroscopic perforation/ obstruction of a diverticulum = inflam response Epi: avg age: 62 S/sx: fever, LLQ pain, N/V, constipation or diarrhea, flatulence, bloating Dx: CT abd pelv., elevated WBC, colonoscopy Tx: clear liquid diet, broad spectrum abx (cipro + flagyl or augmentin

Answer 32

Eti: rotation of segment of the LI S/sx: colicky pain V, obstipation Dx: XR: coffee bean sign, birds beak sign Tx: fluid, electrolytes, surgical emergency

Answer 33

Eti: infection in cryptoglandular epithelium lining the anal canal S/sx: perirectal pain worse with movement or sitting

Answer 34

Eti: can develop from perirectal abscess | ...

Answer 35

Eti: hair containing cyst located just below the coccyx S/sx: painful swollen lesion in sacrococcygeal region Tx: I&D, if abscess = abx

Answer 36

UC: Limited to the colon, rectum always involved. C: any where from mouth to anus, TERMINAL ILEUM mc. Urgency, tenesmus, incontinence, 4 stools per day to 10 severe. C: healthy areas between inflamed areas. UC: Continuous inflam of colon. UC: only effects innermost lining of bowel C: Can have symptoms for many years before dx. UC: Usually gradual onset of symptoms over a couple of weeks. UC: Bloody stool in more common, bloody diarrhea

Answer 37

MSK:arthritis, large joints, ankylosing spondylitis, osteoporosis, Eye: uveitits and episcleritis Skin: erythema nodosum, pyoderma gangrenosum Hepatobiliary: primary sclerosingcolagnitis, fatty liver,autoimmune liver disease Hematopoietic/coag: venous and arterial thromboembolism Pulmonary: rare

Answer 38

fatigue, weight loss, MSK: arthritis, Eye: uvetitis Skin: erythema nodosum, pyoderma gangrenosum Hepatobiliary: primary sclerosising cholagitits renal stones, VTE, ATE

Answer 39

CBC for anemia Elevated ESR Low albumin Electrolyte abnormalities (due to dehyrdation from diarrhea) Abdominal radiography: "thumbprinting" secondary to edema and colonic dilation Avoid barium enema for risk of ileus with toxic megacolon

Answer 40

Colonoscopy: UC: ulceration in rectum, sandpaper appearance. C: Skip lesions, cobblestone appearance. Barium studies: UC: Stove pipe sign (loss of haustral markings) C: String sign: narrowed due to transmural stricutres

Answer 41

UC: - primary sclerosing cholangitis, colon CA, toxic megacolon. (smoking decreases risk for UC) C: Perianal dz: fistulas, stricture, aabscess, granulomas

Answer 42

Endoscopic Retrograde Cholangiopancreatography

Answer 43

Pseudopolyps: due to IBD (non-cancerous) Hyperplastic: low risk, 90% of all polpys Adenomatous polyps: 10% of polyps, 10-20 years before becoming cancerous - Tubulous adenoma: nonpedunculated - Tubulovillous (mixture) - Villous adenoma: (highest risk) tend to be sessile

Answer 44

Risk: more common in women, multiple pregnancy, ascites, obesity Findings: bulge at umbilicus, can have patient sit up, or valsalva to elicit popping out.

Answer 45

``` TNM: T: Primary tumor: size and if in situ or moved N: lymph nodes: regional involvement M: metastatsis Stage 0: T in situ, N0, M0 Stage 1: T1 (<5 cm big), N0, M0 Stage IIA: T0-T2, N1, M0 Stage IV: includes M1 ```

General Surgery Flashcards

(69 cards)