Pestana: general surg Flashcards by Karin Lavie

diagnosing motility disorder of esophagus

barium swallow

2. definitive: manometry

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treatment for achalasia

balloon dilatation- endoscopy

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achalsia has dysphagia worse for liquids or solids

liquids

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achalsia on x ray

megaesophagus

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diagnostic for boerhaave syndrome

contrast swallow (gastrografin first, barium if negative)

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most common reason for esophageal perforation

instrumental perf

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gastric adenocarcinoma presentation

elderly

anorexia, weight loss,
epigastric distress, early satiety

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treatment of gastric adenocarcinoma vs gastric lymphoma

adeno: surgery
lymphoma: Chemo/RT (surgery if perf risk)

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SBO presentation

colicky pain, vomiting, distension
no gas or feces

high pitched bowel sounds

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treatment of SBO

NPO, NG suction, IV fluids

if doesn’t spontaneously resolve within 24 hrs (for complete) or few days (if partial)–> surgery

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strangulated obstruction presentation

compromised blood supply–> fever, WBCs, peritoneal signs, sepsis

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carcinoid syndrome in small intestine seen with mets to where?

liver

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other symptoms of carcinoid syndrome

diarrhea, flushing, wheezing

right sided heart damage

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diagnosing carcinoid syn

24 hr urinary 5-HIAA

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cancer of left vs right colon presentations

right: iron def anemia
left: bloody bm’s

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are polyps that are juvenille or peutz-jeghers premalignant?

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most common antibiotic to cause c dif

cephalosporins

clinda was the first described

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cause of anal fissure

tight sphincter

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treatment for anal fissure

CCBs
botox
nitroglycerin
forceful dilatation
stool softeners

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75% of GI bleeding comes from where

upper GI tract

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red blood per rectum indicates bleeding from…

anywhere in the GI tract!

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diagnostic steps when patient is actively bleeding from rectum

pass NG tube and aspirate gastric contents

if bleeding–> upper GI bleed
if white–> do endoscopy to see if duodenum is a source
if green–>lower GI

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lower GI bleeding workup

anoscopy: r/o hemorrhoids
if bleeding rate:
> 2 ml/min: angiogram
<0.5 mL/min: wait and do c-scope
0.5

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massive upper GI bleed in the stressed, multiple trauma, or complicated post-op patent is probably from…

stress ulcers

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stress ulcers diagnosis confirmation and therapy

diagnostic: endoscopy treatment: angiographic embolization

diagnosis to confirm acute abdominal pain by perf

x ray: free air under diaphragm

most common example of perforation to cause abdominal pain

peptic ulcer

what is this: x-ray of air fluid levels in small bowel, disteneded colon, huge air-filled loop in RUQ rhat tapers down toward LLQ with shape of "parrot's beak"

volvolus of sigmoid

volvolus of sigmoid occurs in which population

elderly

treating volvolus of sigmoid

proctosigmoidoscopic rectal tuble left in recurrent--> sigmoidectomy

presentatiion of mesenteric ischemia

elderly acute abdomen + afib/recent MI (clot breaks off into superior mesenteric artery)

specific blood marker for primary hepatoma

alpha fetoprotein

whats more common: mets to liver or primary liver cancer?

mets to liver (20:1)

pyogenic liver abscess seen as complication of

biliary dz- acute asc. cholangitis

amebic abscess of liver affects which population

mexican men

diagnosis and treatmnet of pyogenic liver abscess vs. amebic abscess

pyogenic: Diagnose: US Treat: percutaneous drainage amobeic: diagnose: serology treat: metronidazole

hemolytic jaundice is unconjugated or conjugated bilirubin?

unconjugated

labs of hepatocellular jaundice

very high AST/ALT modest high Alk phosph high unconjugated and conjugated bili

courvoiser-terrier sign

seen in malignant obstructive jaundice thin-walled distended gallbladder seen

ERCP

invasive, need anesthesia visualizes biliary and pancreatic ducts also therapeutic: can do sphincterotomies, retrieve stones, drain pus, make stents, biopsy tumors, etc.

MRCP

non-invasive, patient awake only diagnostic of biliary and pancreatic

which cancer: obstructive jaundice with anemia and positive blood in stools?

ampullary cancer

presentation of biliary colic vs cholecystitis

colic: temporary (10-30 minutes), no periotoneal signs cholecystitis: constant; fever, WBCs, peritoneal signs

acute ascending cholangitis presentation

deadly! sonte reached common duct--> obstruction/inf. 104-105 degree fevers, sepsis

treatment of acute ascending cholangitis

IV antibiotics and emergency decompression of common duct- ERCP or percutaneous transhepatic cholangiogram eventually cholecystectomy

treatment of acute edematous pancreatitis (gallstones, alcoholics)

few days of pancreatic rest- NPO, NG suction, IVF

labs in acute hemorrhagic pancreatitis

starts as edematous (elevated amylase, lipase) low hematocrit! elevated: WBCs, glucose, BUN Low calcium metabolic acidosis, low arterial PO2

how is acute hemorrhagic pancreatitis deadly?

leads to mutiple pancreatic abscesses

which antibiotics for acute hemorrhagic pancreatitis abscesses

carbapanems quinolones metronidazole

pancreatic psuedocyst sequelae of...

5 weeks after acute pancreatitis or pancreatic trauma

treatment of pancreatic pseudocyst depending on size/time

under 6 cm/<6 weeks: observe over 6 cm/>6 cm: drainage

what are the two exceptions for hernias that dont need to be surgically repaired?

umbilical hernias in kids 2-5 (close by themselves) esophageal sliding hiatal hernias

medullary cancers of thyroid come from which cells

C cells - make calcitonin

therapy for follicular neoplasm of thyroid

total thyoidectomy

treatment for hyperthyroidism

radioactive iodine

what should you check for if hyperparathyroidism found?

bone mets

dexamethasone test results meaning and workup

suppression at low dose--> r/o cushing's no suppression--> 24 hr urine free cortisol measurement --> if elevated: high dose dex test suppression at high dose: pitutiary microadenoma no suppression --> adrenal adenoma or paraneoplastic sy

insulin and c peptide high or low in diabetics vs insulinomas?

diabetics: insulin high, low c-peptide insulinomas: both high

nesidioblastosis

hypersecretion of insulin in new born pancreatectomy required

glucagonoma symptoms

severe migratory necrolytic dermatitis anemia glossitis stomatitis

treatment of glucagonoma

resection is curative somatostain and stretozocin will help with metastatic/inoperable

primary hyperaldosteronism symtoms

hypokalemia hypertensive- but renin low hypernatremia, metabolic alkalosis

hyperaldosteronism caused by hyperplasia vs adenoma

hyperplasia: - responds to postural changes (more aldosterone when upright than lying down) - treated medically adenoma: - no postural response - surgical resection

diagnosing coarctation of aorta

spiral CT diagnostic CXR: scalloped ribs

renovascular HTN seen in two groups

women with fibromuscular dysplasia old men with arteriosclerotic occlusive dz

Pestana: general surg Flashcards

(65 cards)