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Flashcards in Pestana- 4. General Surgery Deck (252)
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1

What is the best way of diagnosing GERD when the diagnosis is uncertain?

pH monitoring

2

What should be performed in a patient with longstanding GERD where you are concerned for potential peptic esophagitis or Barrett esophagus?

Endoscopy and biopsies

3

What is the treatment for a patient with GERD and severe dysplastic changes?

-Medical therapy
-Radiofrequency Ablation
-Nissen fundoplication

4

What is the first line study for suspected esophageal motility problems?

Barium swallow

5

What provides a definitive diagnosis in a patient with suspected esophageal motility problems?

manometry

6

What is the typical symptom of achlasia?

dysphagia that is worse for liquids (needing to sit up straight after swallowing drink)

7

What is seen on x-ray with achlasia?

megaesophagus

8

What is the diagnostic tool for achlasia?

manometry

9

What is the most appealing current treatment for achlasia?

balloon dilatation by endoscopy

10

What is the typical symptom of esophageal cancer?

progression of dysphagia (meats--> other solids --> liquids --> saliva)

11

What is the typical esophageal cancer in a alcoholic black man who smokes?

squamous cell carcinoma

12

What is the typical esophageal cancer in a patient with long-standing GERD?

adenocarcinoma

13

How do you diagnose esophageal cancer?

1) Barium swallow
2) Endoscopy + biopsies

14

Is surgery for esophageal CA usually palliative or curative?

palliative

15

How do you diagnose Mallory-Weiss tear?

endoscopy

16

How do you treat Mallory-Weiss tears?

photocoagulation (during diagnostic endoscopy)

17

What is esophageal perforation after prolonged, forceful vomiting?

Boerhaave syndrome

18

What are the symptoms of Boerhaave syndrome?

Continuous, severe, wrenching epigastric/low sternal pain of sudden onset (with fever, leukocytosis, and sick looking patient)

19

How do you diagnose Boerhaave syndrome?

Contrast swallow (Gastrografin first, barium if negative)

20

What is the most common reason for esophageal perforation?

instrumental perforation of the esophagus (shortly after completion of endoscopy)

21

What should you suspect in an elderly patient with anorexia, weight loss, early satiety, vague epigastric distress and occasional hematemesis?

gastric adenocarcinoma

22

When do you treat a gastric lymphoma with surgery (rather than chemo or radiotherapy)?

if perforation of stomach is feared as tumor melts away

23

How do you treat low-grade lymphomatoid transformation (MALTOMA)?

eradication of H. pylori

24

What is the most common cause of mechanical intestinal obstruction?

adhesions in those who have had a prior laparotomy

25

What are symptoms of a mechanical intestinal obstruction?

-Colicky abdominal pain
-Protracted vomiting
-Progressive abdominal distention (if it is low)
-NO passage of gas or feces
-High pitched bowel sounds --> no bowel sounds

26

What does x-ray of a mechanical intestinal obstruction show?

distended loops of small bowel with air-fluid levels

27

What is the initial treatment for a patient with a mechanical intestinal obstruction?

-NPO
-NG suction
-IV fluids

28

When do you do surgery for a mechanical intestinal obstruction?

-If conservative management is unsuccessful
-Within 24 hours in cases of complete obstruction
-Within a few days in cases of partial obstruction

29

What should you be concerned about in you patient with a mechanical intestinal obstruction who develops fever, leukocytosis, constant pain, signs of peritoneal irritation and ultimately full-blown peritonitis and sepsis?

strangulated obstruction

30

Other than adhesions, what is another cause of mechanical intestinal obstruction?

incarcerated hernia (irreducible)