Flashcards in Pestana- 4. General Surgery Deck (252)
What is the best way of diagnosing GERD when the diagnosis is uncertain?
What should be performed in a patient with longstanding GERD where you are concerned for potential peptic esophagitis or Barrett esophagus?
Endoscopy and biopsies
What is the treatment for a patient with GERD and severe dysplastic changes?
What is the first line study for suspected esophageal motility problems?
What provides a definitive diagnosis in a patient with suspected esophageal motility problems?
What is the typical symptom of achlasia?
dysphagia that is worse for liquids (needing to sit up straight after swallowing drink)
What is seen on x-ray with achlasia?
What is the diagnostic tool for achlasia?
What is the most appealing current treatment for achlasia?
balloon dilatation by endoscopy
What is the typical symptom of esophageal cancer?
progression of dysphagia (meats--> other solids --> liquids --> saliva)
What is the typical esophageal cancer in a alcoholic black man who smokes?
squamous cell carcinoma
What is the typical esophageal cancer in a patient with long-standing GERD?
How do you diagnose esophageal cancer?
1) Barium swallow
2) Endoscopy + biopsies
Is surgery for esophageal CA usually palliative or curative?
How do you diagnose Mallory-Weiss tear?
How do you treat Mallory-Weiss tears?
photocoagulation (during diagnostic endoscopy)
What is esophageal perforation after prolonged, forceful vomiting?
What are the symptoms of Boerhaave syndrome?
Continuous, severe, wrenching epigastric/low sternal pain of sudden onset (with fever, leukocytosis, and sick looking patient)
How do you diagnose Boerhaave syndrome?
Contrast swallow (Gastrografin first, barium if negative)
What is the most common reason for esophageal perforation?
instrumental perforation of the esophagus (shortly after completion of endoscopy)
What should you suspect in an elderly patient with anorexia, weight loss, early satiety, vague epigastric distress and occasional hematemesis?
When do you treat a gastric lymphoma with surgery (rather than chemo or radiotherapy)?
if perforation of stomach is feared as tumor melts away
How do you treat low-grade lymphomatoid transformation (MALTOMA)?
eradication of H. pylori
What is the most common cause of mechanical intestinal obstruction?
adhesions in those who have had a prior laparotomy
What are symptoms of a mechanical intestinal obstruction?
-Colicky abdominal pain
-Progressive abdominal distention (if it is low)
-NO passage of gas or feces
-High pitched bowel sounds --> no bowel sounds
What does x-ray of a mechanical intestinal obstruction show?
distended loops of small bowel with air-fluid levels
What is the initial treatment for a patient with a mechanical intestinal obstruction?
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
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?