GI Flashcards
(202 cards)
1
Q
What is GERD
A
Reflux of stomach contents into esophagus
2
Q
What leads to the sx of GERD
A
Breakdown of reflux barrier and poor clearance of aci
3
Q
What causes GERD
A
Incompetent Barrier (LES relaxation, hiatial hernia, scleroderma)
Aggressive reflux
Reduced acid clearance in esophagus
Increased abdominal pressure
4
Q
What are 4 common associated conditions of GERD
A
Sliding Hiatal Hernia
Tobacco and Alcohol
Scleroderma
Decreased Gastrin Production
5
Q
Sx of GERD
A
Pyrosis Regurgitation Water Brash Dysphagia Hoarseness Globus Sensation Chronic Cough Asthma Chest Pain
6
Q
What are common complications of GERD
A
Barrett’s Esophagus
Ulcers or Adenocarcinoma
Dental Caries
7
Q
Dx of GERD
A
Trial of H2 blockers first
Endoscopy
pH Monitoring
8
Q
Tx of GERD
A
Lifestyle Modification
H2 blockers, PPI, Antacids
Fundoplication if no relief
9
Q
What are indications for surgical treatment of GERD
A
Failure of medical management
Esophageal Stricture
Pulmonary Insufficiency (nocturnal aspiration)
Barrett’s Esophagus (squamous epithelium transition to columnar due to reflux)
10
Q
What is an Esophageal Stricture
A
Narrowing or tightness of esophagus causing problems in swallowing
11
Q
What causes Esophageal Stricture
A
Ingesting Lye or caustic substances
12
Q
Dx of Esophageal Stricture
A
EGD within 24 hours of ingestion to assess level of ulceration + contrast to rule out performation
13
Q
Tx of Esophageal Stricture
A
Immediate: NPO + IV fluids + H2 blocker Don't induce emesis Medical: Shallow - Corticosteroids Moderate to deep - Abx (Penicillin or Gentamicin) Endoscopy every 2 years
14
Q
What is surgical tx for Esophageal Stricture
A
Dilation: With Maloney Dilator/Balloon Catheter
Esophagectomy: With Colon interposition or gastric pull up
15
Q
What is a Hiatal Hernia
A
Protrusion of GE junction through hiatus of diaphragm
16
Q
What are 6 causes of Hiatal Hernia
A
Widened Hiatus Esophageal shortening Increased intra-abdominal pressure Autosomal Dominant Congenital Acquired (traumatic)
17
Q
What are the 4 types of Hiatal Hernias
A
Type 1: Sliding Hernia
Type 2: Defect in phrenoesophageal membrane, leads to gastric fundus herniation
Type 3: Both GE junction and fundus herniate through hiatus
Type 4: Omentum/Colon/Small bowel present in hernia sack
18
Q
Sx of Hiatal Hernia
A
Asymptomatic
Reflux symptoms
19
Q
Dx of Hiatal Hernia
A
Upper Endoscopy
20
Q
Tx of Hiatal Hernia
A
Tx for GERD sx
Surgical if severe
21
Q
What is Zenker’s Diverticulum
A
False Pharyngoesophageal Diverticulum
Involves mucosa and submucosa at UES
22
Q
Sx of Zenker’s Diverticulum
A
Dysphagia + Neck Mass + Hilitosis + Food regurgitation + Heartburn
23
Q
Dx of Zenker’s Diverticulum
A
Barium Swallow
24
Q
Tx of Zenker’s Diverticulum
A
Diverticulectomy Cricopharyngeal Myotomy (UES relaxation)
25
What is Leiomyoma
Benign smooth muscle tumor
26
Sx of Leiomyoma in Esophagus
Dysphagia
27
Dx of Leiomyoma in Esophagus
Barium Swallow: Will show filling defect
Esophagoscopy: CONFIRMS Dx
Ultrasound to confirm mass is intramural
28
Tx of Leiomyoma in Esophagus
Surgical Removal
Enucleation: Removal of mass without harm to surrounding tissues
Resection if low grade tumor
29
What are 3 forms of Intraluminal Masses
Mucosal Polyps, Lipomas, Myxofibromas
30
Sx of Intraluminar Masses
Dysphagia + Regurgitation + Weight Loss
31
Dx of Intraluminar Masses
Radiographs and Esophagoscopy
32
Tx of Intraluminar Masses
Esophagotomy and Repair
33
Sx of Esophageal Carcinoma
Dysphagia, first with solids then eventually with liquids
Weight Loss
Hoarseness if laryngeal nerve is damaged
34
Dx of Esophageal Carcinoma
Contrast XRAY
| Upper Endoscopy with Biopsy
35
Tx for Esophageal Carcinoma
Radio Frequency Ablation and Endoscopic Mucosal Resection for low grade
Esophagectomy + Gastric pull-up or colon resection for invasive
36
What population is more likely to get Squamous Cell Carcinoma of Esoaphgus
African Americans and Chinese
Smokers, Alcoholics
Hot foods or bad oral hygiene
37
What population is more likely to get Adenocarcinoma of Esophagus
White men with GERD, usually final stages that eventually lead to Barrett's Esophagus
38
What is Achalasia
Loss of peristalsis in lower esophagus + lower esophageal sphincter remains closed during swallowing
39
What causes Achalasia
Neurologic: Loss of Auerbach's plexus, Vagus Nerve
Infectious: Chagas, but rare
40
Sx of Achalasia
Dysphagia
| Regurgitation
41
Dx of Achalasia
Distal narrowing and proximal dilation of esophagus
Manometry: Motility study shows increased LES pressure thatdoes not relax
Xray with contrast: BIRDS BEAK
42
Tx of Achalasia
Surgical Myotomy
| Bolloon Dilation
43
What is Diffuse Esophageal Spasm
Strong non-peristaltic contractions of esophagus + Normal Sphincters
44
Sx of Diffuse Esophageal Spasms
Chest pain with radiation to back, ears, neck, and jaw
45
Dx of Diffuse Esophageal Spasms
Manometry: Repetitive high-amplitude contractions
Xray with Contrast: Segmented Spasms/CORKSCREW Esophagus
Endoscopy
46
Tx of Diffuse Esophageal Spasms
Medical: Antireflux/CCB/Nitrates
Surgical: Long Esophagomytomy
47
What is Nutcracker Peristalsis
Hypertensive Peristalsis
| Presents like Diffuse Esophageal Spasms but are very strong Peristaltic waves
48
Dx and Tx for Nutcracker Peristalsis
Manometry, Xray with Contrast, Antireflux Meds, Long Esophagomytomy
49
What is Peptic Ulcer Disease
Damage to gastric mucosal barrier causing erosion through submucosa or muscularis propria
50
Causes of PUD
H.Pylori
NSAIDS
Bile Reflux
Gastrinoma (Zollinger-Ellison Syndrome): Neuroendocrine tumor that secretes gastrin, leads to ulcers and diarrhea
51
Sx of PUD
Burning mid-epigastric stomach paid reduced by food or antacids
N/V, Hematemesis, Melena
Usually asymptomatic until severe
52
Dx of PUD
Upper GI Xray: Barim pooling at ulcer
Endoscopy if alarm sx present (weight loss, melena, mass)
H.Pylori Breath Test
53
Tx of PUD
H.Pylori Positive do Triple Therapy: Clarithromycin + PPI + Amoxicillin/Metronidazole if allergic
Triple Therapy usually done for 10-13 days
H.Pylori Negative do PPI or H2 blocker for 4-8 weeks
Sucralfate: binds in ulcer and protects for 6 hours
54
What are 5 surgical indications for PUD
```
Intractability
Uncontrolled Bleeding
Perforation
Gastric Outlet Obstruction
Malignancy
```
55
What is the most common type of Gastric Cancer
Gastric Adenocarcinoma: poor survival 90-95% are malignant
56
What are the 2 types of Gastric Adenocarcinoma
Intestinal Type: Glandular and well-differentiated found in Distal stomach
Diffuse Type: Poorly differentiated small cell infiltrating tumor of proximal stomach
57
What are risk factors for gastric adenocarcinoma
```
Older males
High Salt Intake
Smoked Meats
Low Protein
Vit. A and C
Smoking
```
58
Sx of Gastric Adenocarcinoma
Epigastric Pain + Anorexi + Fatigue + Vomiting and Weight Loss
Palpable Lymph Nodes: Supraclavicular or Periumbilical
59
Dx of Gastric Adenocarcinoma
Upper GI Xray
| Upper Endoscopy + Biopsy
60
Tx of Gastric Adenocarcinoma
Subtotal or Total Gastrectomy
Resection or Bypass + Radiotherapy
Adjuvant Chemotherapy: 5-FU/Leukovorin + Radiation
61
What is a Gastric Lymphoma
Uncommon with good prognosis
62
Sx of Gastric Lymphoma
Abdominal Pain + Early Satiety + Fatigue + Constitutional B Sx (Fevers, night sweats, weight loss)
63
Dx of Gastric Lymphoma
Endoscopy and Biopsy with Endoscopic US for staging
64
Tx for Gastric Lymphoma
Medical: Chemo + Radiation (CHOP: Cyclophosphamide + Hydroxyduanomycin + Oncovin + Prednisone)
Surgical: Gastrectomy
65
What is a Gastric Sarcoma
Uncommon Cancer that arises from mesenchymal cells
66
Sx of Gastric Sarcoma
Usually incidental until large and obstruction
67
Dx of Gastric Sarcoma
Immunohistochemical stain hows CD1117
68
Tx of Gastric Sarcoma
Surgical removal
| Imatinim (Gleevac)
69
What is Gastric Dumping Syndrome
When ingested food passes through the stomach rapidly and enters small intestine largely undigested
70
What causes Gastric Dumping Syndrome
Gastric Bypass, Roux-en-Y Surgery
71
Sx of Early Dumping Syndrome
15-30 minutes after a meal
| N/V, bloating, cramping, diarrhea, dizziness, and fatigue
72
Sx of Late Dumping Syndrome
1-3 hours after meal
| Weakness, sweating, dizziness
73
Dx of Dumping Syndrome
Clinical
74
Tx of Dumping Syndrome
Avoid foods that cause it
| Eat several small meals a day low in carbs, avoid simple sugars
75
What is Pyloric Stenosis
Hypertrophy of muscular layer of pylorus that obstructs the gastric outlet
76
What age group does Pyloric Stenosis usually present in
2 weeks to 2 months old
| Usually males, caucasians
77
Sx of Pyloric Stenosis
Projectile vomiting in infants
| May lead to dehydration, Hypochloremia + Hypocalcemia + Metabolic Alkalosis + Jaundice
78
Dx of Pyloric Stenosis
Olive Shaped mass at midepigastric region
Ultrasound: Thick Pylorus, muscular wall width
Upper GI Xray: Gastric retention, elongation/narrowing antrum, string sign
79
Tx of Pyloric Stenosis
Pyloromyotomy: Incision of the longitudinal and circular muscles of the antrum
80
What are 4 causes of Small Bowel Obstruction
Adhesions
Hernias
Malignancy
Gallstones/Crohn's/Intussusception/Volvulus
81
Sx of Small Bowel Obstruction
Crampy Abdominal pain + N/V + Bloating
| Inability to pass stool or flatus
82
Dx of Small Bowel Obstruction
Abdominal Xray: Dilated small bowel loops + Air-fluid levels
| CT: Localizes obstruction
83
Tx of Small Bowel Obstruction
Conservative: IV Resuscitation + NG tube decompression
Surgical: If alarm sx (peritoneal signs + Leukocytosis + Fever + No Resolution)
84
What is Crohn's Disease
Ulcerative changes from transmural inflammation especially in Ileum.
Rectum is usually spared
85
What causes Crohn's Disease
Idiopathic
| Increased colon cancer risk after 8-10 years
86
Sx of Crohn's Disease
Abdominal cramping + Chronic diarrhea with or without blood/mucus
Constitutional sx
Fulminant: Bowel obstruction or ileus/acute abdomen/sepsis
87
Dx of Crohn's Disease
CT or Barium Enema: Skip lesions + Cobblestoning of mucosa + Fistulas
Endoscopy with small bowel follow through (see short thickened mesentry + grayish pink discoloration + fat wrapping)
88
Tx of Crohn's Disease
Diet Modification: Low Fiber
Low Risk: Corticosteroids + Azathiopurine
High Risk: Anti-TNF (Infliximab)
Bowel Resection
89
What is Meckel's Diverticulum
Remnant omphalomesenteric duct, pouthc near ileocecal valve
90
Sx of Meckel's Diverticulum
PainLESS Rectal Bleeding without fever, nausea, vomiting or diarrhea
91
Dx of Meckel's Diverticulum
Radionuclide Scan: IV infusion of technitium-99m pertechnetate taken up by ectopic gastric mucosa
92
What are risk factors for Colorectal Cancer
```
Family Hx
IBD and Polyps
Age>50
Diet (high fat or low fiber, fruits, veggies, calcium)
Lifestyle (Inactive, Obesity, Alcohol)
```
93
What is Familial Adenomatous Polyposis
More than 100 polyps in colon at a young age
| Has 100% risk of Colon Cancer
94
What is HNPCC
No polyposis preceding cancer
| One site of mutation leading to colon and extracolonic malignancy
95
What is the most common form of colorectal cancer
Adenocarcinoma
96
Sx of Colorectal Cancer
Blood in stools
Change in bowel pattern
Abdominal Pain
97
Sx of Right sided Colorectal Cancer
Bleeding: Melana, Iron Deficiency Anemia, Right sided mass
98
Sx of Left sided Colorectal Cancer
Obstruction: Change in bowel habits, blood in stools, cramping abdominal pain
99
Dx of Colorectal Cancer
Colonoscopy with bopisy
CEA to later evaluate for recurrence
CT for extent and mets
100
Tx of Colorectal Cancer
Curative: Surgery +/- chemo
Chemo: 5-FU for patients with positive LN or mets
Radiation: Pre-operative to shrink tumor
Palliative: Chemo, Diverting Ostomy, Pain Management
101
Discuss Colorectal Cancer Screening
Average Risk: 50 yrs
1st degree relative with CRC: 40yrs or 10yrs younger than dx
Ulcerative Colitis: 8 years after dx
Primary Sclerosing Cholangitis + UC: Time of dx
FAP: Age 10 + Prophylactic Colectomy
HNPCC: Age 20 or 10 yrs younger than dx relative
102
What risk does someone with FAP have of developing cancer vs. someone with HNPCC
FAP: 100%
HNPCC: 80%
103
What is a Carcinoid Tumor
Neuroendocrine Tumors of Appendix, Ileium, Rectum, Stomach, Colon
104
Sx of Carcinoid Tumor
Flushing, Heart Palpitations, Abdominal Cramping, Wheezing and SOB
105
Tx of Carcinoid Tumor
Excision
106
What is Diverticulosis
Not a true diverticula
| It only involve 2 layers: Mucosa and Submucosa
107
Where is the most common site for Diverticulosis
Sigmoid Colon
108
What causes Diverticulosis
Low Fiber
109
Sx of Diverticulosis
Asymptomatic
| LLQ pain, Bleeding, Point tenderness
110
Dx of Diverticulosis
Colonoscopy, but can't do while there is active bleeding
| CT Scan
111
Tx of Diverticulosis
High fiber diet
| Fiber supplements
112
What is Diverticulitis
Inflamed diverticula secondary to obstruction/infection (Fecaliths)
113
Sx of Diverticulitis
Fever, LLQ pain, Leukocytosis
114
Dx of Diverticulitis
CT
| Increased WBC
115
Tx of Diverticulitis
Clear liquid diet, Broad Spectrum Abx (Cipro, Bactrim, Metronidazole)
116
What are the categories of IBD
Ulcerative Colitis and Crohn's Disease
117
What is Ulcerative Colitis
```
Diffuse, CONTINUOUS superficial ulcers restricted to the colon
Starts distal (rectum)
Involves Mucosa and Submucosa only
```
118
Sx of Ulcerative Colitis
LLQ pain, Colicky
Tenesmus, urgency
Bloody Diarrhea, hemeatochezia
119
Dx of Ulcerative Colitis
Colonoscopy: See uniform inflammation, sandpaper appearance, pseudopolyps
Barium Study shows Stovepipe sign (loss of haustral markings)
+P-ANCA
120
Tx of Ulcerative Colitis
Surgery is curative
121
What is a Sigmoid Volvulus
Twist or torsion of organ on pedicle due to long freely moveable sigmoid colon or mesentery
122
What causes a Sigmoid Volvulus
Sigmoid twists counterclockwise around mesenteric axis
| Torsion causes bowel obstruction and ischemia
123
Sx of Sigmoid Volvulus
Abdominal Pain and Distension + Obstipation
124
Dx of Sigmoid Volvulus
Barium Enema: Bird beak twist
| Abdominal Radiograph: Bent inner tube or Coffee Bean Sign
125
Tx of Sigmoid Volvulus
Sigmoidoscopic Decompression if non-strangulated
| sigmoidectomy if non-decompressible
126
What are Hemorrhoids
Swollen and inflamed subepithelial veins of the rectum and anus
127
What causes Hemorrhoids
Prolonged straining during defecation
128
What is an internal Hemorrhoid and its sx
Anastomosis of superior rectal artery and rectal veins
NOT painful
Associated with bleeding, discharge, prolapse and pruritis
129
What is an external Hemorrhoid and its sx
Anastomosis of inferior hemorrhoidal arteries and veins below the dentate line
May cause acute swelling and pain
130
Tx for Hemorrhoids
Conservative: High fiber diet, increase water bulk laxatives all to decrease strain during defectation
Medical: Injection sclerotherapy, rubber band ligation, electrocoagulation
Surgical: Hemorrhoidectomy
131
What is an Anal Fissure
Linear shaped ulcer
| Due to tear in anoderm
132
What causes Anal Fissures
Trauma to the anal canal during defectation
133
Sx of Anal Fissures
Painful tearing type pain
| Blood on defectation
134
Dx of Anal Fissures
Visual Inspection
135
Tx of Anal Fissures
```
Sitz Baths
Topical Anaesthetics
Nitroglycerin Topical
Botulinium Toxin
CCB: Nifedipine or Diltiazem
```
136
What is a Pilonidal Cyst
Chronic gland infection from hair foreign body leading to infection
137
Tx of Pilonidal Cyst
Perianal hygiene and shaving or laser epilation of area to reduce hair getting stuck
Surgical I&D: For acute abscess
Bascom Closure Flap
138
What is an Anorectal Fistula
Palpable subcutaneous tract between the external opening and the anus
Often created by drained abscess
139
Tx of Anorectal Fistula
Fistulotomy (open a fistular tract)
140
What is Cholelithisis
Gallstones
141
What are most gallstones made of
Cholesterol
| Can be Bilirubin or Calcium Bilirubinate
142
Sx of Gallstones
Infrequent episodes of epigastric/RUQ pain that radiates to Right Scapula
143
Dx of Gallstones
Ultrasound
144
Tx of Gallstones
Elective Cholecystectomy
145
What is Acute Cholecystitis
Persistent bile duct obstruction
146
What causes acute cholecystitis
Gallstones trapped in the duct passageways
147
Sx of Acute cholecystitis
Steady, Severe RUQ/Epigastric pain, radiation to right shoulder Leukocytosis
Postprandial N/V, Diaphoresis, Fever
148
Dx of Acute Cholecystitis
+ Murphy's Sign
Ultrasound shows stones and wall thickening
HIDA scan
149
Tx of Acute Cholecystitis
Conservative: NPO, IV Fluids, Abx
Cholecystectomy: Usually within 72 hours of onset
150
What is a Choledochal Cyst
Congenital malformation of pancreaticobiliary tree
151
Sx of Choledochal Cyst
Intermittent jaundice, pain, abdominal mass
152
Dx of Choledochal Cyst
Ultrasound or Radionuclide scan
153
What is Choledocholithiasis
Stones in the common bile duct
| Most come from gallstones but these can form without a gallbladder
154
Sx of Choledocholithiasis
Asymptomatic
| RUQ pain, radiates to shoulder, intermittent obstructive jaundice, acholic stools, bilirubinemia
155
Dx of Choledocholithiasis
ERCP (Endoscopic Retrograde Cholangiopancreatography)
156
Tx of Choledocholithiasis
Small stones will pass spontaneously
Surgical: Common Bile Duct Exploration
Mechanical Extraction: Under Fluoroscopic Guidance
157
What is Cholangitis
Stones impacted within bile duct with inflammation behind the obstruction, leads to bacterial infection
158
Sx of Cholangitis
Charchot's Triad: Fever and Chills, Jaundice, Frequent RUQ pain
Reynold's Pentad: Above + Altered mental status, Hypotension
159
Dx of Cholangitis
Patient looks toxic, febrile, jaundice, hypotensive
Leukocytosis
Ultrasound: Bile duct dilation
160
Tx of Cholangitis
Empiric Abx + Urgent ERCP + Cholecystectomy + fluid and electrolyte resuscitation
161
What is Primary Sclerosing Cholangitis
Inflammation and fibrosis causing stenosis and obstruction of biliary tract that can lead to biliary cirrhosis and liver failure
162
Sx of Primary Sclerosing Cholangitis
RUQ pain, Painless Jaundice, Pruritis, Fatigue, N/V, Hepative failure
163
Dx of Primary Sclerosing Cholangitis
ERCP or Percutaneous Transhepatic Cholangiogram
| Criteria: Thickening/Stenosis of biliary ducts, Rule out other factors, No primary liver disease
164
Tx of Sclerosing Cholangitis
Internal Biliary Drainage
| External Biliary Drainage
165
What is Cholangiocarcinoma
Typically associated with gallstones
| Typically Adenomas
166
Dx of Cholangiocarcinoma
ERCP or Percutaneous Transhpeatic Cholangiogram
| CT: 50% have porcelain gallbladder
167
Tx of Cholangiocarcinoma
Surgical Resection
| Whipple
168
What is Hepatocellular Carcinoma
Primary cancer of liver parenchyma
169
What causes Hepatocellular Carcinoma
Cirrhosis
| Hepatitis/Alcoholic Liver Disease/Non-Alcoholic Fatty Liver Disease
170
Sx of Hepatocellular Carcinoma
Pain, weight loss, cachexia, mass, bruit or friction rub, sudden ascites
171
Dx of Hepatocellular Carcinoma
```
Ultrasound every 6 months
Serum Alpha-Fetoprotein
CT/MRI with contrast
Leukocytosis/Anemia
Biopsy
```
172
Tx of Hepatocellular Carcinoma
Surgical Resection
Tx chronic viral hepatitis
Liver Transplant
173
What is the most common site for Mets
Lymph Nodes followed by Liver
174
What is Pancreatitis
Inflammation of the pancreas
175
What causes Pancreatitis
Alcohol Abuse
Biliary Tract Disease (gallstone pancreatitis)
Congenital Abnormalities and Latrogenic
176
Sx of Acute Pancreatitis
Mild abdominal discomfort, with eventual shock, hypotension, and hypoxemia
Epigastric pain that radiates to back
177
What are the following signs related to Acute Pancreatitis:
Turner's Sign
Cullen's Sign
Turner's Sign: Flank Ecchymosis when blood extends into tissues
Cullen's Sign: Periumbilical Ecchymosis from blood traveling along falciform ligament
178
Dx of Acute Pancreatitis
Serum Amylase: 200-500 in Alcoholic Pancreatitis
Amylase:Creatinine Clearance
Serum Lipase: Elevated
Ultrasound and CT is Diagnostic
179
Tx of Acute Pancreatitis
```
NPO + IV Fluids
ERCP
Fluids, Pain Management, Enteral Feeding
NG tube
Abx
```
180
What is Chronic Pancreatitis
Unrelenting sx of inlammation and fibrosis and ductal calcifications
Leads to both exocrine and endocrine failure
181
What causes Chronic Pancreatitis
Alcohol Abuse
| Prolonged duration of acute causes
182
Sx of Chronic Pancreatitis
May eventually lead to glucose intolerance in diabetics
| Common bile duct or duodenal obstruction form calcifications
183
Tx of Chronic Pancreatitis
Analgesia/Pain Meds
Endocrine Hormone Replacement
Exocrine (Lipase and Amylase) Replacement
Smaller meals, low fat content, elimination of smoking and alcohol, enzyme replacement, vitamins
Surgery
184
What is a Pancreatic Adenocarcinoma
4th most common cause of cancer
| Increased risk with smoking, obseity, diet, and hereditary polyposis syndrome
185
Sx of Pancreatic Adenocarcinoma
Vague epigastric pain, weight loss, back pain
Thrombophlebitis (inflammation of wall of vein)
HEAD of pancreas is the most common site
186
Dx of Pancreatic Adenocarcinoma
Chemo: 5-FU + Gemcitabine
Intraoperative Radiotherapy
Whipple Procedure
187
What is a Direct Hernia
Medial to epigastric vessels
| Goes directly through Hasselbach's Triangle through abdominal and inguinal canal
188
What is an Indirect Hernia
Lateral to epigastric vessels
Passes through internal inguinal ring
5x more common!
189
Tx for Inguinal Hernia
Surgery: Return hernia contents to peritoneal cavity, Ligate the base of hernia sac, Tighten internal ring and repair abdominal wall
190
What is Bariatric Surgery
Weight loss surgery for morbid obseity
191
What are indications for Bariatric Surgery
BMI>40 or BMI>35 with co-morbidities (obesity hypoventilation syndrome/cardiopulmonary problems/Diabtes)
192
What are contraindications for Bariatric Surgery
Superobesity (BMI>50)
Pyschiatric Illness
Lack of motivation or understanding
Age>60
193
What is a Roux-en Y Gastric Bypass
Stomach is divided and attached to the small intestine about 50-60cm distally leaving a "roux limb" that drains all bile, pancreatic, and stomach enzymes
194
What are complications that can arise with Roux-en Y Gastric Bypass
```
Anastomotic Stricture
Marginal Ulcer
Anastomotic Leak
Dumping Syndrome
Gallstone Formation
Vitamin and Mineral Deficiency (Folate/B12/Iron/Calcium)
```
195
What is a Lap Band
Laproscopically placed band around the stomach that can be adjusted post operatively
196
What are complications that can arise with a Lap Band
Erosions
Stenosis
Slippage of the band
197
What are results of Bariatric Surgery
50-70% of excess weight is lost in the first year
| 70-80% of excess weight is lost in the next 3 years
198
What results with Vitamin C Deficiency
Scurvy
| Bleeding, Impaired Wound Healing
199
What results in Vitamin E Deficiency
Hemolytic Anemia
200
What results in Vitamin A Deficiency
Problems with vision
| Night Blindness, Bitot Spots, Corneal Xerosis
201
What results with Niacin Deficiency
Pellagra
| 4 D's: Dermatitis, Diarrhea, Dementia, Death
202
What results with Vitamin B6 Deficiency (Pyridoxine)
Peripheral Neuropathy
Seborrheic Dermatosis
Glossitis
Cheilosis
