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Flashcards in Pestana Gen Surgery Deck (141)
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1

When is surgery for GERD indicated? 3

for anyone with: 

  1. long-standing symptomatic disease not controlled by medical means
  2. complications (ulceration, stenosis)
  3. severe dysplastic changes

2

what type of surgery is appropriate for GERD? 2

  • Laparoscopic Nissen Fundoplication (LNF) - if patient has symptomatic disease not controlled by medical means or developed complications (ulceration+stenosis)
  • LNF + radiofrequency ablation if there are severe dysplastic changes

3

how does achalasia usually present?

since it is a motility issue, there is dysphagia for liquids AND solids 

(dysphagia initially to solids w/ progression to involve liquids -> think mechanical obstruction, i.e. cancer)

4

diagnosis and management of achalasia?

  • diagnosis: barium swallow + manometry 
  • mgmt: balloon dilation

5

how does esophageal cancer present itself?

dysphagia initially to solids only but progresses to solids AND liquids

significant weight loss

6

what are 2 types of esophageal cancers and in what patient population do you normally see them in?

  • squamous cell carcinoma - men with hx of smoking + EtOH
  • adenocarcinoma - long-standing GERD

7

diagnosis & mgmt of esophageal cancers

diagnosis: barium swallow followed by endoscopic biopsy and CT scan (assesses operability)

mgmt: palliative surgery

 

8

Patient with prolonged, forceful vomiting eventually starts to vomit bright red blood. Diagnosis and management?

diagnosis: mallory weiss tear

mgmt: endoscopy + laser photocoagulation

9

Patient with prolonged, forceful vomiting suddenly develops epigastric pain, fever, and leukocytosis. Diagnosis and management?

diagnosis: boerhaave syndrome

mgmt: contrast swallow followed by emergency surgical repair

10

shortly after an endoscopy procedure, a patient develops sub-cutaneous emphysema in the lower neck. Diagnosis and management?

diagnosis: iatrogenic perforation of the esophagus

mgmt: contrast study + prompt repair

11

diagnosis and management of an elderly patient who presents with anorexia, weight loss, intermittent hematemesis, and early satiety

gastric adenocarcinoma or lymphoma

mgmt: endoscopic biopsy w/ CT to assess operability

if adenocarcinoma --> surgery

if lymphoma --> chemoRx + radioRx

12

best treatment for gastric adenocarcinoma

surgery

13

best treatment for gastric lymphoma

chemoRx or radioRx

14

best treatment for MALT lymphoma (MALToma) 

eradication of H. pylori

( 1 wk of  "triple therapy" consisting of omeprazole + clarithromycin + amoxicillin)

15

patient with a prior history of laparoscopic appendectomy presents with colicky abdominal pain with progerssive abdominal distension, protracted vomiting, and absence of BM/flatulence. 

What should you think of? How would you confirm your suspicion?

mechanical intestinal obstruction

Xray -> distended loops of small bowel with air-fluid levels

16

mgmt of patient with SBO 3

NPO, NG suction, and IVF with hopes for spontaneous resolution and watching for early signs of strangulation (fever, leukocytosis, constant pain, signs of peritoneal irritation, peritonitis, sepsis)

17

when is surgery indicated for a patient with SBO? 3

1) conservative mgmt is unsuccessful 

2) within 24h of complete obstruction

3) within a few days in partial obstruction

18

5 indications that a patient with SBO has a compromised blood supply (ie strangulated obstruction).

how are these patients managed?

fever

leukocytosis

constant pain

signs of peritoneal irritation/peritonitis

sepsis

mgmt: emergency surgery

19

mgmt of a patient with an irreducible hernia that used to be reducible

surgical repair

20

Carcinoid syndrome

how do these patients present? how to make the diagnosis?

seen in patients with small bowel carcinoid tumor with liver metz

diarrhea, facial flushing, wheezing, R valvular damage

dx: 24 hour urinary collection for 5-hydroxyindolacetic acid

21

how do cancers of the R colon usually present?

elderly

anemia (hypochromic) 

(+) FOBT

22

diagnosis and mgmt of R colon cancers

diagnosis: colonoscopy and biopsy

mgmt: R hemicolectomy

23

how do cancers of the L colon usually present?

bloody bowel movements such that blood coats the outisde of the stool

stools are of narrow caliber

24

diagnosis and mgmt of L colon cancers

  • diagnosis: flexible proctosigmoidoscopic exam + biopsy
  • prior to surgery:
    • full colonoscopy (to r/o a second primary) and CT scan (assess operability)
    • chemoRx and radiation Rx necessary for large rectal cancers

25

when is surgery indicated for chronic ulcerative colitis? 4 

what does the surgery entail?

  1. disease >20 years
  2. severe nutritional deficits
  3. multiple hospitalizations
  4. need for high-dose steroids or immunosuppressants
  5. development of toxic megacolon

surgery entails removing all of the affected colon, including all of the rectal mucosa (which is always involved)

26

when is emergency colectomy indicated for pseudomembrane enterocolitis? 

(c. diff)

surgery indicated when

  • disease that is unresponsive to standard metronidazole/vancomycin
  • WBC >50K
  • serum lactate level above 5

27

∆ between external and internal hemorrhoids

external = painful (attributed to thrombosed hemorroids)

internal = bleeding after defecation

28

treatment for internal hemorrhoids 

rubber band ligation

29

treatment for external hemorrhoids 

surgical removal

30

who typically gets anal fissures?

young women