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SURGERY > Stomach, Liver > Flashcards

Stomach, Liver Flashcards

1
Q

Surveillance laboratory finding in gastric CA

Useful for postoperative surveillance

A

CEA

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2
Q

Gold standard diagnostic exam for gastric adenocarcinoma

A

Upper endoscopy (EGD) + biopsy

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3
Q

Tumor markers for GIST

A

c-KIT (CD 117)

CD 34

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4
Q

Managment for Carcinoid tumors

A

Debulking sc + somatostatin

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5
Q

Barium study: gastric ulceration that is described as having a “doughnut” sign

A

Carcinoid syndrome

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6
Q

Regurgitation of feedings, projectile non-bilious emesis, OLIVE-SHAPED mass on right upper epigastrium.
(+) hypokalemic, hypochloremic metabolic alkalosis

Dx?
Mgt?

A

Pyloric stenosis

Fedet-Ramstedt pyloromyotomy

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7
Q

Innervation of stomach

A

Left vagal trunk- anterior surface

Right vagal trunk- posterior surface

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8
Q

Part of the stomach where gastric ulcer and CA are most commonly located

A

Lesser curvature

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9
Q

Gold standard for h. Pylori

A

Histologic exam of antral mucosal biopsy

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10
Q

Standard test to confirm eradication of h. Pylori post treatment

A

Urease breath test

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11
Q

Usual site of

Gastric ulcer
Duodenal ulcer

A

Incisura, near the lesser curvature

First portion of the duodenum- w/in 3cm of pylorus

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12
Q

Mgt for gastric ulcer types 1-3

A

Distal gastrectomy

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13
Q

Early vs late dumping syndrome

Timing?
Cause?
Mgt?

A

Timing: Early: 15-30mins post prandial
Cause: Peripheral and splanchnic vasodilation
Mgt: Saline or recumbency
Octreotide

Timing: Late: 2-3hrs post prandial
Cause: Hyperinsulinemia
Mgt: Glucose administration
Alpha-glucosidase inhibitors

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14
Q

Confirmatory test for Zollinger-Ellison syndrome (value for positive result)

A

Secretin stimulation test

Gastrin >200pg/ml

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15
Q

Borders of Passaro’s triangle

A

S: cystic duct and cbd
I: 2nd and 3rd portion of duodenum
M: neck and body of pancreas

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16
Q

Most common malignant neoplasm of the stomach

A

Gastric adenocarcinoma

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17
Q

Common location of gastric adenocarcinoma

Intestinal type?
Diffuse type?

A

Distal stomach

Cardia

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18
Q

Shelf-like tumor indicating mets in Pouch of Douglas

A

Blumer shelf

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19
Q

Mgt for gastric tumor located in the antrum

A

Radical subtotal gastrectomy

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20
Q

Structures removed in radical subtotal gastrectomy

A

Distal 75% of the stomach
Pylorus + 2cm of prox duodenum
Greater and leaser omentum
Assoc LN

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21
Q

T/F

95 % of gastric lymphoma are non-hodgkin type

A

True

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22
Q

First line of tx for low-grade gastric lymphoma

A

H. Pylori eradication

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23
Q

Ast:alt ratio indicative of alcoholic liver disease

A

> 2:1

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24
Q

Ist line antibiotic for spontaneous bacterial peritonitis

A

Cefotaxime

25
Q

Parameters of Child-Turcotte-Pugh Score

A 
Nutritional status
Ascites
Encephalopathy 
S. Bilirubin 
S. Albumin
PT
26
Q

Normal portal pressure

A

5-10mmHg

27
Q

First line treatment for spontaneous bacterial peritonitis

A

Cefotaxime

28
Q

Diagnosis of SBP

A

Ascitic fluid with neutrophil > 250/uL

29
Q

Indications for Aspiration of Amoebic Liver Abscess

A

Large abscesses
Failure of medical management
Superinfection
Abscesses of the left lobe

30
Q

Most frequently encountered liver lesion overall

A

Hepatic Cysts

31
Q

Most common benign solid lesion in the liver

A

Hemangioma

32
Q

Clearest risk factor for the development of liver adenoma

A

Prior or current use of OCP

33
Q

Requirements for transplantation in Liver Ca (Milan Criteria)

A 
One nodule <5 cm
2 or 3 nodules < 3 cm
No vascular invasion
No extrahepatic spread
Child A B C
34
Q

Choledochal Cyst Subtypes

A 
1 - Fusiform
2 - Saccular diverticulum 
3 - choledochocoele
4a - extra AND intrahepatic
4b - extrahepatic only
5- intrahepatic only (Caroli Disease)
35
Q

Choledochal cyst subtype that can be managed with a simple sphincterotomy

A

Type 3 - choledochocoele

36
Q

Which benign liver lesion carries a risk for malignant degeneration?

A

Adenoma

37
Q

Indications for Prophylactic Cholecystectomy

A

Hemoglobinopathies
HS and Thallasemia at the time of splenectomy
Transplant recipients (cardiac and lung)

38
Q

Management for grade 3 acute cholecystitis

A

Urgent management of organ dysfunction and gallbladder drainage (delayed elective choelcystectomy 2-3 months later)

39
Q

Most accurate method for determining portal HTN

A

Hepatic venography

40
Q

Natural hx of esophageal varices

A

1/3 of varices will bleed
Each bleed=20-30% mortality
70% of survivors will rebleed within 1 year

41
Q

Disadvantage of distal splenorenal (Warren) surgical shunt?

A

Aggravates ascites

42
Q

DOC for amebic liver abscess

A

Metronidazole

43
Q

Most common presentation of amebic liver abscess

A

Mod elevated ALP

44
Q

Common location of amebic liver abscess

A

Superior-anterior aspect of right lobe

45
Q

Most common primary malignancy of liver CA

A

Colonic carcinoma

46
Q

Liver conditions where biopsy is absolutely contraindicated

A

Hemangioma

Adenoma

47
Q

Most common symptom and indication for resection in liver hemangioma

A

Pain

48
Q

Borders of Calot triangle

A

Cystic a.
Cystic duct
Common hepatic duct

49
Q

Predictors of malignancy in a gall bladder polyp

A 
single
size > 1 cm
age > 50y
rapid growth
sessile
adenomatous
(First three are most consistent)
50
Q

Most important risk factor in the development of GB carcinoma

A

Gallstones

51
Q

Exposure to which substances increases risk for GB carcinoma?

A

Azotoluene

Nitrosamines

52
Q

Tumor markers for GB carcinoma

A

CEA

CA 19-9

53
Q

The gall bladder lacks which tissue layers?

A

Muscularis mucosa

Submucosa

54
Q

Cholangiocarcinoma occuring at the confluence of the right and left hepatic ducts

A

Klatskin tumor

55
Q

Major organic solutes of gallstones

A

Cholesterol
Bile salts
Phospholipids

56
Q

Indications for prophylactic cholecystectomy

A

Hemoglobinopathies
Hereditary spherocytosis and thallasemia
Tansplant recipients (cardiac and lung)

57
Q

Absolute contraindications for cholecystectomy

A

INABILITY TO TOLERATE GEN. ANESTH OR LAPAROTOMY
Refractory coagulopathy
Diffuse peritonitis with hemodynamic compromise
Cholangitis
Potentially curable GB CA

58
Q

Usual type of biliary stone in choledocholithiasis

Primary
Secondary

A

Brown pigment type

Cholesterol type

59
Q

Most important risk factor for GB CA

A

Gall stones >3cm

SURGERY (8 decks)

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