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Surgery > More Holliday > Flashcards

More Holliday Flashcards

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1
Q

mid epigastric pain worse with eating, steroids, NSAIDS… think…
workup…
surgery if…

A

gastric ulcer

double-contrast barium swallow
EGD shows punched-out lesion w/ red margins, get Biopsy – tells H.Pylori, Malignant, Benign

Surgery if… lesion persists after 12 wks of treatment

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2
Q

most common gastric cancer

A

adenocarcinoma

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3
Q

where is gastric cancer most common

A

Japan

adenocarcinoma

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4
Q

Gastric Cancer mets to Ovaries eponymn

A

Krukenberg

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5
Q

Gastric Cancer mets to Left Supraclavicular Fossa lympn node eponymn

A

Virchow’s node

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6
Q

what is virchow’s node

A

GI cancer met to lymph node in Left Supraclavicular fossa

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7
Q

who gets gastric lymphoma

A

HIV pts

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8
Q

gastric cancer mets felt on DRE is called…

A

Blummer’s Shelf

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9
Q

what is Blummer’s Shelf

A

gastric cancer mets felt on DRE

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10
Q

gastric cancer mets to umbilical node is called…

A

Sister Mary Joseph

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11
Q

what is Sister Mary Joseph

A

gastric cancer mets to umbilical node

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12
Q

who gets gastric MALT lymphoma

A

pts w H.Pylori

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13
Q

eponymns assoc w Gastric Cancer GC

A

Krukenberg - GC mets to ovary

Virchow’s node - GC mets to L supraclavicular node

Blummer’s Shelf - GC mets felt on DRE

Sister Mary Joseph - GC mets to umbilical node

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14
Q

treat Gastric MALT Lymphoma

A

treat associated H.Pylori

-triple therapy… ppi, clarithromycin, amoxacillin

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15
Q

what are the cliff notes on mentrier’s disease

A

protein losing gastroenteropathy
(lose protein in GI tract)
also associated with enlarged rugae

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16
Q

gastric varices most often caused by…

A

splenic vein thrombosis

eg from pancreatitis

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17
Q

Dieulafoy’s is….

A

congenital superficial gastric? esophageal? vessel can cause hematemesis…. see other online meded flashcards

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18
Q

mid epigastric pain better with eating vs worse with eating

A

better with eating - duodenal ulcer

worse with eating - gastric ulcer

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19
Q

tests for h.pylori in peptic ulcer

A

stool or breath test

best is endoscopy with biopsy and CLO test… also best because can rule out cancer this way

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20
Q

how to assess effectiveness of H.Pylori treatment

A

stool or breath test

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21
Q

what to suspect if mid epigastric pain / ulcers do not improve with triple therapy?
best test?
tx?
what else to look for?

A

Zollinger Ellison syndrome (gastrinoma)

Secretin stim test (gastrin remains inappropriately high)

surgical resection - gastrinoma usually located in pancreas

look for MEN1 panc, pituitary, parathyroid tumors

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22
Q

patient lost a lot of weight, now has bilious vomiting and post-prandial pain

suspect. ..
treat. …

A

SMA syndrome aka Nutracker syndrome
-duodenum part 3 compressed between aorta and SMA, pain after eating when duodenum demands more blood

treat with Weight Restoration… can do surgery eg. Roux-Y… think you have to mobilize duodenum to do that…. or maybe just better with food bypassing duodenum less blood demand….

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23
Q

2 most common causes of pancreatitis

Study These Flashcards
A

gallstones and alcohol

drinking and McDonalds

24
Q

define pseudocyst

Study These Flashcards
A

a fluid-filled cavity resembling a cyst but lacking a wall or lining.

25
most common cancer of pancreas
Adenocarcinoma
26
Pancreatic cancer (adenocarcinoma) usually asymptomatic until advanced unless maybe....
cancer in Head of pancreas, causing Obstructive Biliary symptoms aka Courvoisier's sign - large non-tender gallbladder, itching and jaundice
27
Large Non-tender Gallbladder, Itching, Jaundice think...
Courvoisier's sign pancreatic cancer of head of pancreas, fortunately causing symptoms early so maybe you can get it before widely metastasized
28
eponymned signs associated with pancreatic cancer
Courvoisier's sign - Large Non-tender Gallbladder, Itching, Jaundice think - pancreatic cancer of head of pancreas, fortunately causing symptoms early so maybe you can get it before widely metastasized Trousseau's sign - migratory thrombophlebitis
29
what to you call migratory thrombophlebitis in setting of pancreatic cancer
Trousseau's sign
30
what is Trousseau's sign in setting of pancreatic cancer
migratory thrombophlebitis
31
when to Whipple pancreatic cancer
``` no mets Outside Abdomen no extension into SMA no extension into Portal Vein no Liver Mets no Peritoneal Mets ``` basically, if caught early, pretty local
32
Whipple's triad labs to get?
hypoglycemic symptoms - such as sweating, tremors, hunger, seizures hypoglycemia - blood glucose low v45 symptoms resolve with glucose administration Dx is INSULINOMA Labs Insulin (high) and C-peptide (to rule out exogenous abuse)
33
Glucagonoma | sx
hyperglycemia diarrhea weight loss characteristic rash - necrolytic migratory erythema
34
Somatistatinoma sx benign or malignant?
malabsorption - steatorrhea, etc, because pancreas malfunction (somatistatin decreases like all GI secretions...) commonly malignant
35
which is commonly malignant insulinoma, glucagonoma, somatistatinoma, VIPoma
somatistatinoma is commonly malignant, the worst one to have
36
VIPoma sx looks similar to... tx...
watery diarrhea, flushing (hypokalemia and dehydration from diarrhea) sx similar to carcinoid syndrome treat with octreotide
37
differentiate between symptomatic gallstones and cholecystitis
fever and WBC with cholecystitis
38
when do symptomatic gallstones get percutaneous cystostomy
when too unstable for cholecystectomy
39
charcot's triad | vs raynaud's pentad
RUQ pain, fever, jaundice -acute cholangitis RUQ pain, fever, jaundice, shock (hypotension, AMS (confusion) -ascending cholangitis
40
choledocal cysts demographic type 1 type 4
peds type 1 - most benign. fusiform dilation of CBD. Excise type 4 - most severe. cysts all the way up into intrahepatic bile ducts. liver transplant
41
risk factors for primary sclerosing cholangitis treatment
UC ulcerative colitis Liver Flukes Thorotrast exposure (radiocontrast used in 1930's-40's) surgery plus/minus radiation
42
AST mildly elevated 2x ALT think...
alcohol hepatitis
43
ALT greater than AST | both highly elevated into 1000s... think...
viral hepatitis
44
AST and ALT elevated s/p hemorrhage, surgery, or sepsis... think...
shock liver | liver ischemia from hypotension
45
when to band or sclerotherapy esophageal varices
as soon as they bleed once
46
treat portal htn from cirrhosis watch out for... how to treat that...
SS and VP somatostatin and vasopressin to upstream vasoconstrict and decrease portal flow and pressure BBs beta blockers for the same reason, drop BP decrease portal pressure Endoscopic Sclerotherapy or Banding of esophageal varices if they bleed once TIPS relieves portal htn but risks ENCEPHALOPATHY from ammonia accumulation because not being processsed in liver treat encephalopathy with LACTULOSE to poop out ammonia
47
risk factors for hepatocellular carcinoma
chronic Hep B more so than Hep C Cirrhosis for any reason Aflatoxin (mycotoxin that contaminates corn, soybeans, peanuts) Carbon Tetrachloride (used to be in fire extinguishers, refrigerants, cleaning agents)
48
diagnose hepatocellular carcinoma treat
CT/MRI AFP often elevated as well (70%) - surgically remove soiltary mass - radiation or cryoablation for palliation if multiple masses
49
woman on OCP, palpable abdominal mass w spontaneous rupture into hemorrhagic shock... makes you think... dx tx
hepatic adenoma Dx US or MRI ``` Discontinue OCPs (grows from estrogen). Resect if large or desire pregnancy (again, estrogen will make grow, so resect before pregnancy) ```
50
most common benign liver tumor pres dx tx
hepatic adenoma woman on OCP, palpable abdominal mass w spontaneous rupture into hemorrhagic shock... Dx US or MRI ``` Discontinue OCPs (grows from estrogen). Resect if large or desire pregnancy (again, estrogen will make grow, so resect before pregnancy) ```
51
2nd most common benign liver tumor tx
focal nodular hyperplasia no tx (hepatic adenoma the most common)
52
most common bugs in abdominal bacertial abscess
e.coli bacteroides enterococcus
53
RUQ pain, profuse sweating and rigors, palpable enlarged liver ....think.... dx....
entamoeba histolytica metronidazole
54
2 abscesses surgeons DON'T drain
lung abscess amoebic liver abscess
55
Mexico/South America, RUQ pain, large liver cysts on US... ``` think... mode of transmission lab findings tx watch out for ```
Enchinococcus hydatic cyst paracyte from dog feces eosinophilia, +Casoni skin test albendazole and surgery to remove ENTIRE cyst watch out for rupture causing anaphylaxis
56
what to give post-splenectomy
Aspirin (thrombocytosis ^1mil aka 1,000 platelet count prophylactic Penicillin S.pneumo H.flu N.meningitis vaccines
57
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Surgery (22 decks)

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