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PANCE prep JQ > Surg/GI/nutrition/endo > Flashcards

Surg/GI/nutrition/endo Flashcards

(90 cards)

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1
Q

Virchow triad

A

Stasis/immobility, endothelial injury, hypercoagulability

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2
Q

UFH DVT prophylaxis

A

80U/kg bolts followed by 18U/kg infusion. Check aPTT at 6hr and q 2hr till 1.5x control achieved

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3
Q

LMWH DVT prophylaxis

A

1mg/kg SC. Bid. Therapeutic peak 0.6-1 of anti Xa

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4
Q

Arixta DVT prophylaxis

A

2.5mg SC daily go up to 10 d

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5
Q

Risk factors for DVT

A 
Recent surgery
Acute medical illness
Immobilization
Central venous cath
Prior VTE
Pregnant or postpartum 
Active malignancy
Obesity
Estrogen/testosterone 
IBD
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6
Q

HITT treatment

A

Direct thrombin inhibitor

Acova 2mvg/kg/min IV over 3hr

If PCI bivalirudin 0.75mg/kg IV Nokia then 1.75mg/kg/hr IV

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7
Q

SCIP abx guidelines

A

Abx should be administered 1hr before incision (2hr for vanco)

First or second gen cephalosporins preferred for most procedures

Dc abx 24hr post surgery

Hair not removed or cut with clippers

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8
Q

Cefazolin

A

DOC surg prophylaxis

1-2g preop
0.5-1g q6-8hr post op

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9
Q

Vanco

A

Surg abx if beta lactam sensitivity

GI/GU: 1g IV over slow 1hr infusion

Other procedures: 15mg/kg IV over 1-2hr

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10
Q

Metronidazole

A

Anaerobic coverage that should be added for colon surgery

15mg/kg IV over 30-60min followed by 7.5mg/kg IV at 6 and 12 hr

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11
Q

Most common locations for hemorrhoids

A

R anterior, R posterior, and lateral

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12
Q

Grade 3 internal hemorrhoid

A

Prolapse and manual reduction

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13
Q

Grade 4 hemorrhoid

A

Prolapse that can not be manually reduced

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14
Q

Most common annal carcinoma?

A

SCC

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15
Q

What is the incidence of anal cancer?

A

Rare (1% colon cancers)

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16
Q

What is paget’s dz if the anus?

A

Adenocarcinoma in situation of the anus

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17
Q

Risk factors for anal cancer?

A

STDs, chronic inflammation, immunosuppression, MSM, cervical/vaginal cancer, smoking

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18
Q

Most common sx of anal carcinoma?

A

Anal bleeding

Other sx include pain, mass, priritus. 25% asx

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19
Q

Describe lymphatic drainage of anus.

A

Above dentate line to pelvic chains

Below dentate line to inguinal lymph nodes

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20
Q

Margin cancer

A

Anal verge out 5cm into perianal skin

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21
Q

Canal cancer

A

Proximal to anal verge up to the border of internal sphincter

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22
Q

Nigro protocol

A

Used to to anal carcinoma

1chemo(5FU or mitomycin C)
2radiation
3postradiation scar bx at 8wk

90%response rate to protocol

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23
Q

Tx of anal melanoma

A

Wide excision with abdolominoperineal resection with possible chemo

Poor prognosis

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24
Q

What is Goodsall’s rule?

A

Anal fistula originating anterior to the transverse line Will course straight and fistula that originate posteriorly with have a curved course.

(Think of a dog nose and tail)

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25
What percentage of perirectal abscesses develop into fistula?
About 50%
26
Anorectal fistula management
Marsupialization of tract, wound care, and seton if fistula through muscle
27
Where do perirectal abscesses originate?
Crypt glands in dentate line
28
What is a sentinel pile?
Thicker mucosa/skin at the distal end of an anal fissure that is often confused with a sm hemorrhoid
29
What dz processes must be considered with a chronic anal fissure?
IBD, STDs, and anal cancer
30
Treatment for perianal warts
Topical podophyllin, imiquimod resection or ablation if not responsive to conservative methods.
31
Excruciating anal pain and history of hemorrhoids should make you think of this.
Thrombosis external hemorrhoid
32
What are the dreaded complications of hemorrhoidectomy?
Exsaguination ( bleeding pools proximally in lumen of colon without signs of bleeding), pelvic infection (may be extensive and fatal), and inconsistence from anal sphincter damage
33
What dz is a contraindication to a hemorroidectomy?
Crohns
34
Hyperplastic polyp
Usually pale benign polyp found in distal colon and rectum
35
Sessile polyp
Flat polyp that is more difficult to remove
36
Pedunculated polyp
Mushroom appearance/stalk and cap
37
APR
Abdominal perineal resection Tx for low-lying rectal cancer Rectum and anus removed leaving pt with a permanent colostomy
38
LAR
Low anterior resection Tx for rectal cancer above levator muscles Resection of rectum and lower sigmoid preserving continence
39
When should the average person start colorectal cancer screening?
45-50
40
When should a pt with FAP start getting colonoscopies?
10-12
41
When should an HNPCC pt start getting colonoscopies?
20-25 or 10yr before youngest relative was dx Repeat q1-2yr
42
Most common colonic polyp
Tubular adenoma
43
Colonic polyp associated with the highest risk of cancer
Villous adenoma *think VILLous is VILLanous
44
What is the most common site for colon cancer metastasis?
Liver
45
Most common site for lower rectal cancer metastasis?
The lungs | Colon venous drainage is portal so mets to liver but rectum venous drainage is IVC so lungs
46
Describe rectal blood supply
Superior rectal from IMA Middle rectal from internal iliac Inferior rectal branch of pudendal(off internal iliac)
47
What is another name for lynch syndrome?
Hereditary nonpolyposis colon cancer (HNPCC)
48
What does microcytic anemia on a postmenopausal woman indicate until proven otherwise?
Colon cancer
49
TNM stage III
Colon cancer with nodal involvement Adjuvant chemo needed after resection
50
90% of colon cancers recur within...
3yrs of surgery/resection
51
What is the 5yr survival rate of unresectable colon cancer with liver metastasis?
0%
52
What are the subtypes of neoplasticism colon polyps?
Tubular adenomas Tubulovillous adenomas Villous adenomas
53
HCl is secreted by these cells in the stomach
Parietal cells *HCl dissolves food, activates pepsin, and kills bacteria
54
Pepsin is secreted by these cells in the stomach
Chief cells *pepsin digest protein into peptides
55
Parietal cells are stimulated to secrete HCl by these 3 things:
Gastrin released by G cells which stimulate ECL cells to secrete Histamine Acetylcholine released by the vagus nerve (parasympathetic nervous system)
56
Somatostatin
Inhibitory hormone released by pancreatic D cells. Decreases GI hormones
57
Vitamins produced by colonic bacteria (2).
Vit k Biotin
58
Secretin
Hormone released by the duodenum which inhibits release of gastrin and causes the release of bicarbonate from the pancreas
59
Cholecytokinin (CCK)
Hormone released by the duodenum in response to fat Stimulates pancreases to release bicarb and digestive enzymes. Also stimulates gallbladder to contract release bile
60
If someone has infectious esophagitis you should be looking for this?
Cause of immunocompromise
61
Multiple corrugated rings in the esophagus
Suggestive of eosinophilia esophagitis
62
What do you expect to see on EGD if pt has pull induced esophagitis?
Small well-defined ulcers of varying depths
63
Risk factors for pill-induced esophagitis
Prolonged supination after pill ingestion Chronic use of NSAIDs, bisphosphonates, potassium chloride, iron pills, vit C, BB, and CCBs
64
GERD alarm symptoms
Dysphagia Odynophagia Weight loss Bleeding
65
Tx options for achalasia
Botox injection Nitrates CCBs Pneumatic dilation of LES
66
Compare achalasia and diffuse esophageal spasm esophograms
Achalasia- birds beak Diffuse esophageal spasm - corkscrew *both could be treated with nitrates or CCBs
67
2 MC causes of Boerhaave syndrome
Bulimia Perforation on EGD
68
UGI bleed from longitudinal mucosal laceration of gastroesophageal junction or gastric cardia
Mallory-Weiss tear *MC after ETOH binge with persistent retching/vomiting
69
What is Schatzki ring associated with?
Sliding hiatal hernias
70
If a child has esophageal varies you should consider this
Portal vein thrombosis - clotting disorders
71
These two things seen on EDG with esophageal varies are suggestive of increased bleeding risk
Red whale marking Cherry red spots
72
Management of acute active esophageal varice bleed
Stabilize with 2 lrg bore IVs and fluids Endoscopic ligation Octreotide (DOC) or somatostatin Balloon tamponade or TIPS in refractory cases
73
Preventing rebleed of esophageal varices
Nonselective BB like propranolol or nadolol is DOC Long acting nitrates can also help
74
Compare squamous cell and Adenocarcinoma of the esophagus
Squamous cell: MC worldwide, upper 1/3, associated with tobacco/ETOH use, increased incidence in African Americans Adenocarcinoma: MC in US, lower 1/3, associated with GERD, seen in younger obese caucasians
75
Medication that is good for preventing NSAID ulcers
Misoprostol (Cytotec)
76
Complete this 8-12wk after starting thx for peptic ulcer dz to document healing and r/o malignancy
EGD
77
Correlate sx with location of a GI ulcer
Gastric: pain for 1-2 hr after eating and weight loss (older pts ass. With malignancy) Duodenal: pain before meals relived with food, classically associated with nocturnal sxs (4x MC, seen in younger pts)
78
How do you dx ZES?
Fasting gastrin levels is the best screening Confirm with secretin test Localized tumor with somatostatin receptor scintigraphy
79
Linitis plastica
Leather bottle appearance of stomach due to cancer infiltration of stomach Associated with worse prognosis
80
LAD associated with GI malignancy
Virchows node- left supraclavicular Sister many Joseph’s- umbilical Blumer’s shelf- rectal Irish sign - left axillary
81
Krukenburg tumor
Ovarian Mets from GI tumor
82
Compare squamous cell and Adenocarcinoma of the esophagus
Squamous cell: MC worldwide, upper 1/3, associated with tobacco/ETOH use, increased incidence in African Americans Adenocarcinoma: MC in US, lower 1/3, associated with GERD, seen in younger obese caucasians
83
Medication that is good for preventing NSAID ulcers
Misoprostol (Cytotec)
84
Complete this 8-12wk after starting thx for peptic ulcer dz to document healing and r/o malignancy
EGD
85
Correlate sx with location of a GI ulcer
Gastric: pain for 1-2 hr after eating and weight loss (older pts ass. With malignancy) Duodenal: pain before meals relived with food, classically associated with nocturnal sxs (4x MC, seen in younger pts)
86
How do you dx ZES?
Fasting gastrin levels is the best screening Confirm with secretin test Localized tumor with somatostatin receptor scintigraphy
87
Linitis plastica
Leather bottle appearance of stomach due to cancer infiltration of stomach Associated with worse prognosis
88
LAD associated with GI malignancy
Virchows node- left supraclavicular Sister many Joseph’s- umbilical Blumer’s shelf- rectal Irish sign - left axillary
89
Krukenburg tumor
Ovarian Mets from GI tumor
90
Increased bilirubin without increased LFTs should make you think of this
Familial bilirubin disorders and hemolysis

PANCE prep JQ (15 decks)

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