GI Surg Condition

Question 1

Diverticular disease- Eti

Answer 1

DiverticuliItis- acute illness due to points of weakness in near blood supply
Free perforation- infection into peritoneal cavity, may abscess
95% in sigmoid colon sue to increased pressure

Question 2

Diverticular disease- Sx

Answer 2

• LLQ pain
• Constipation
• Bloating
• Subjective fever
• Tachy, abd tenderness, leukocytosis
• Maroon or bright red hematochezia in > 50

Question 3

Diverticular disease- Dx

Answer 3

CT scan

Question 4

Diverticular disease- Tx

Answer 4

• Mild- abx
• Elective colonoscopy after 4-6 weeks
• Operation- Free perforation (sigmoid resection) or abscess (percutaneous drainage)

Question 5

Appendicitis- Eti

Answer 5

• Blockage in lining of appendix leading to infection

Question 6

Appendicitis- Sx

Answer 6

• RLQ tenderness with guarding
• Malaise followed by periumbilical pain, localizes to RLQ followed by fever
• McBurney point
• Anorexia, nausea, vomiting

Question 7

Appendicitis- Dx

Answer 7

• US or CT scan

Question 8

Appendicitis- Tx

Answer 8

• Operation to remove

- Abx- Cephalosporin

Question 9

Cholecystitis/ cholelithiasis- Eti

Answer 9

• cholithiasis- having a gall stone

- Cholecystitis- stuck, bile can’t get out

Question 10

Cholecystitis/ cholelithiasis- Sx

Answer 10

• Epigastric pain to RUQ radiating to back and shoulder
• Exacerbated by fatty foods
• Abrupt onset of pain, cessation over mins to hrs
• Bloating and flatulence
• Murphy sign

Question 11

Cholecystitis/ cholelithiasis- Dx

Answer 11

Ultrasound

Question 12

Cholecystitis/ cholelithiasis-Tx

Answer 12

• Laparoscopic cholecystectomy if symptomatic
• Abx
  Choledocholitiasis- ERCP

Question 13

Hernia- Eti

Answer 13

• Abnormal protrusion of an organ through abd cavity
• Can be reducible, incarcerated or strangulated (loss of blood supply)
• Higher risk in men
• Right side more common
• Femoral more common in women

Question 14

Hernia- Sx

Answer 14

• Bulge, pain of ache

- Protrusion in canal on exam

Question 15

Hernia-Tx

Answer 15

• Reduce the sac and repair the defect

- Can watch and wait but doesn’t get better on own

Question 16

Hernia- Dx

Answer 16

• Diagnostic tests unnecessary

- Clinical exam

Question 17

Ruptured spleen- Eti

Answer 17

• Direct blow or trauma to abd

- Mono, AIDS, malaria, leukemia, sickle cell

Question 18

Ruptured spleen- Sx

Answer 18

• Pain and tenderness radiating to left neck or shoulder (Kehr’s sign)
• LUQ at 9th-10th rib
• Shock, falling hematocrit

Question 19

Ruptured spleen- Dx

Answer 19

• Ultrasound- multi view

- CT in stable pts

Question 20

Ruptured spleen- Tx

Answer 20

Emergent splenectomy

Question 21

Perforated bowel- Eti

Answer 21

Appedicitis, diverticulits

• Blunt trauma
• ASA or NSAID OD

Question 22

Perforated bowel- Sx

Answer 22

• Sudden explosive onset of severe mid to lower abd pain
• Shock
• Rigid, tender abd

Question 23

Perforated bowel- Dx

Answer 23

• Abd XR

Question 24

Perforated bowel- Tx

Answer 24

• Crystalloid fluids
• Abx
• Remove infected material
• Repair

Question 25

Peritonitis- Eti

Answer 25

Perforation of abd wall | - D/t trauma, diverticulits, pancreatitis

Question 26

Peritonitis- Sx

Answer 26

- Abrupt pain, distension, fever - Diminished bowel sounds - Rebound tenderness

Question 27

Peritonitis- Dx

Answer 27

Examine fluid- bacteria, lactic acid

Question 28

Peritonitis- Tx

Answer 28

- Exploration, debridement and drainage | - Abx x 14 days

Question 29

Bowel obstruction- Sx

Answer 29

- Constipation or obstipation - Distention and tenderness - Abd pain - N/V

Question 30

Bowel obstruction- Dx

Answer 30

- CT with contrast

Question 31

Bowel obstruction- Tx

Answer 31

- Resection and decompression

Question 32

Colon CA- Eti

Answer 32

- Screen at age 50 q 10 yrs - Yearly fecal occult - Adenocarcinoma most common

Question 33

Colon CA- Sx

Answer 33

- Blood in feces - Weakness and anemia - Change in bowel habits - Dyspepsia

Question 34

Colon CA- Dx

Answer 34

- Colonoscopy and biopsy of polyps

Question 35

Colon CA- Tx

Answer 35

- Resection of lesion and lymph - CEA levels pre and post op - Colonoscopy at 6 mo, 12 mo, 3 yrs, 5 yrs

Question 36

Volvulus- Eti

Answer 36

- Rotation of bowel loops around fixed point - Ischemia, gangrene - Sigmoid most common

Question 37

Volvulus- Sx

Answer 37

- Colicky abd pain - Spasms - Distension, tympany - High pitched bowel sounds

Question 38

Volvulus- Dx

Answer 38

- XR: loss of haustra, kidney bean appearance | - Bird beak sign, loop distension

Question 39

Volvulus- Tx

Answer 39

- Decompression with sigmoidoscopy | - Fluid resuscitation

Question 40

Umbilical hernia- Eti

Answer 40

- W>M

Question 41

Umbilical hernia- Sx

Answer 41

- Increased size | - Sharp pain with coughing or sneezing

Question 42

Umbilical hernia- Dx

Answer 42

Clinical

Question 43

Umbilical hernia- Tx

Answer 43

- Repair to avoid incarceration | - Mesh

Question 44

Inguinal hernia- Eti

Answer 44

- M>W | - Indirect > direct

Question 45

Inguinal hernia- Sx

Answer 45

- Bulge and pain in inguinal canal | - Aching

Question 46

Femoral hernia- Eti

Answer 46

- Prone to incarceration/ strangulation - W>M - Descend through femoral canal beneath inguinal ligament - Difficult to reduce

Question 47

Femoral hernia- Sx

Answer 47

- Asymptomatic until incarcerated - Small bulge in medial thigh - Colicky abd pain

Question 48

Femoral hernia- Tx

Answer 48

- Open laparoscopy

Question 49

Incisional hernia- Eti

Answer 49

- Complication of laparotomy | - COPD, steroids, wt, smoking

Question 50

Incisional hernia- Sx

Answer 50

- Bulging, pain, ache at incision site | - Protrusion and obstruction at surgical site

Question 51

Incisional hernia- Tx

Answer 51

- Recurrence is common | - Mesh repair