General Surgery Flashcards
(49 cards)
What are the indications for a Nissen Fundoplication?
- longstanding, medicine resistant GERD
- GERD complications
- dysplasia
What is the classic motility issue seen with achlasia?
More difficulty swallowing liquids than solid food
Esophageal cancer generally presents with these symptoms?
Dysphagia, weight loss, alcohol or smoking history (SCC), longstanding GERD ( adenocarcinoma)
How is the diagnosis made for a Mallory-Weiss test? For Boerhaave Syndrome?
Mallory Weiss: EGD with photocoagulation
Bowrhaave: gastrografin contrast study
How are each of the following gastric cancers treated:
- Adenocarcinoma
- Lymphoma
- Maltoma
- Surgery
- Chemotherapy or radiation
- Eradication of H. Pylori
What is the number one cause of small bowel obstruction? How is it treated?
Adhesions
Try NG tube decompression while NPO. If this fails after 24 hours, surgery is needed.
In a patient suspected of SBO with fever, leukocytosis, and peritoneal pain, what should be suspected?
Strangulated obstruction
A patient with a carcinoid tumor and liver metastasis will present with these defining symptoms?
Diarrhea, flushing, wheezing, right sided heart failure
*do a 24 hour urine 5HIAA
Colon cancer will present in what way if right sided? Left sided?
Right: anemia in elderly
Left: bloody bowel movements and narrow caliber stools
What are the indications for colostomy in a patient with ulcerative colitis?
- disease >20 years
- severe nutritional depletion
- multiple hospitalizations or multiple high dose steroid packs
- toxic megacolon
What are the two most common antibiotic classes associated with C. Difficile?
Clindamycin and cephalosporins
What is the cause of anal fissure?
Tight sphincter
What will help healing of a fistula in a patient with Crohn’s disease?
Remicade
What patient population would likely present with SCC of the anus? How do you treat?
HIV+
Nigro chemoradiation
In a patient with blood in the stool, how should this be evaluated?
Rule out upper bleeds first with a NG aspirate and EGD. Than perform an angiogram for large amounts of lower GI bleeding or a colonoscopy if the blood stops.
Blood per rectum in a child is likely? What scan should you do? What does it look for?
Meckel diverticulum
Technetium scan for ectopic gastric mucosa
A 54-year-old male is brought into the ED with extreme pain radiating to the back and extreme nausea and vomiting. He’s still retching when you go to examine him. He’s stable, so you order a stat CT to rule out AAA. His daughter pulls you aside to tell you that her father has a history of alcohol abuse and was drinking heavily last night. How do you diagnose and treat?
Diagnose with serum amylase and lipase. Treat with GI rest.
What is the diagnostic imaging modality for elderly patients with volvulus? Treatment?
X-ray: shows “parrot’s beak” bowel
Rectal tube decompression
An acute abdomen in a patient with a recent MI or constant A-fib is likely due to?
Acute mesenteric ischemia
HCC can be detected via this blood marker?
AFP
What patient population will likely have a hepatic adenoma? Why do these patients need emergent surgery?
Females on long term OTC’s. They have a tendency to rupture and bleed.
How could you differentiate between hepatocellular jaundice and obstructive jaundice?
Hepatocellular is due to hepatitis and will have highly elevated transaminases, but low APP.
Obstructive is usually due to stones or cancer and will have highly elevated APP.
Obstructive jaundice due to stones should be treated with?
ERCP to do sphincterotomy and remove stone
Colicky, RUQ Abdominal pain that is easily aborted by anti-cholinergics is likely?
Biliary colic
