Surgery GI/GU Flashcards
(223 cards)
1
Q
RENAL ABD PAIN
- CC sounds like?
- work up
- ddx
A
CC: colicky right sided flank pain, n, v, hematuria, CVA tenderness
WU: UA, BUN/Cr, CT abdomen, renal US, KUB, blood cultures
DDx: nephrolithiasis, renal cell carcinoma, pyelnephritis, GI etiology, glomerulonephritis, splenic rupture
2
Q
PANCREAS ABD PAIN
- cc
- wu
- ddx
A
CC: dull epigastric pain that rad to back
WU: Ct abd, CBC, electrolytes, amylase, lipsae, AST, ALT, bilirubin, alk phosh, US Abd
DDX: pancreatitis, pancreatic CA, PUD, cholecystitis/cholechodo
3
Q
GALLBLADDER ABD PAIN
- cc
- wu
- ddx
A
CC: RUQ
WU: RUQ US, CBC, CMP, HIDA scan, MRCP/ERCP, Amylase/lipase, alk phosp, bili
ddx: cholecystitis, choledoco, hepatitis, asending cholangiitis, fitz-hugh-curtis syndrome, acute subhepatic appendicitis
4
Q
LIVER ABD PAIN
- cc
- wu
- ddx
A
CC: RUQ pain, fever, anorexia, nausea, vom, dark urine, clay stool
WU: CBC, amylase, lipase, liver enzymes, viral hepatitis serologies, UA, US Abd, ERCP, MRCP
ddx: acute hep, acute chole, asend cholangitis, choledocho, pancreatitis, primary sclerosing cholangitis, primary biliary cirrhosis, glomerulonephritis
5
Q
SPLEEN ABD PAIN
- cc
- wu
- ddx
A
CC: severe LUQ pain +rad to left scapula with hx of infectious mono
wu: CBC, CXR, CT/US abd
ddx: splenic rupture, splenic infarct, kidney stone, rib fx, pneumoina, perf peptic ulcer
6
Q
STOMACH ABD PAIN
- cc
- wu
- ddx
A
CC: burning epigastric pain after meals
WU: rectal exam–occult blood in stool, amylase, lipase, lactate, AST, ALT, bili, alk phosph, upper endoscopy (H. Pylori biopsies), upper GI series
ddx: PUD, perf PUD, gastritis, GERD, cholecystitis, mesenteric ischemia, chronica pancreatitis
7
Q
INTESTINES ABD PAIN
- cc
- wu
- ddx
A
CC: crampy abd pain, v, abd distention, inability to pass flatus
workup: rectal exam, CBC, electrolytes, CT abd/pelvis, colonoscopy
DDX: obstruction, SB or colon CA, volvulus, gastroenteritis, food poisoning, ileus, hernia, mes ischemia/infarction, diverticulitis, UC, Crohns, IBS, celiac,
8
Q
Boas sign
A
ref pain to subscapular area due to phrenic nerve irritation
-cholecystitis
9
Q
TOC for cholecystitis
-findings?
A
US
- thickened GB >3mm
- distention
- sludge
- stones
- pericholecystic fluid
- sonographic murphys sign
10
Q
gold standard test for cholecystitis
A
HIDA scan–>shows GB ej fraction and if stones are present in cystic ducts
**if pt is fasting… scan can show false decr ejcection fraction—– inject with morphine or CCK (Cholecystokinin)
11
Q
TX options for acute chole
A
Conservative: NPO, IV ABX (third gen ceph + metronidazole)
Cholecystectomy
Meperidine preff to Morphine (causes contraction of spincter of oddi)
12
Q
what patient population does acalculous cholecystitis occur in
A
very ill pt–hospitalized
13
Q
lab findings for acute chole
A
- evelv WBC
- elev lipase, AST/ALT
- elev Total Bili: direct»_space;»indirct
14
Q
most specific test for acute chole
A
HIDA
15
Q
what can chronic cholecysttis lead to
A
porcelin GB—premalignant condition
16
Q
List Charcot’s triad
A
RUQ + Jaundice + fever =cholangitis
17
Q
List Reynold’s pentard
A
RUQ + Fever +Jaundice +AMS + hypotension
18
Q
RUQ + Fever +Jaundice +AMS + hypotension
A
Reynold’s pentad
19
Q
RUQ + fever + jaundice
A
Charcot’s triad
20
Q
define cholangitis
A
omplication of gallstones with symptoms secondary to an infected obstruction of the common bile duct (E.coli is the #1 cause)
21
Q
Pruritis + jaundice=?
A
primary sclerosing cholangitis
-chronic liver dz characterized by a progressive course of cholestasis with inflammation and fibrosis of intrahepatic and extrahepatic bile ducts
22
Q
Primary Sclerosing Cholangitis MC ocurs in who
A
UC patients
23
Q
what does an elevated alk–phosphate mean
A
obstruction to bile flow—- cholestasis in ANY part of the biliary tree
-normal levels make cholestasis unlikely
24
Q
what is GGT
A
used to confirm that the ALK-P elevation is of hepatic origin ***enzyme found in liver
25
Pancreatitis
- mcc acute
- chronic mcc?
- other causes
Gallstones (mc acute)
ETOH (MC chronic)
Trauma
```
Steroids
Mumps
Autoimmune
Scorpion
Hypercalcemia/hypertrigs
ERCP
Drugs
```
26
what does pancrease secrete
glucagon
amylase
insulin
27
pain assoc with pancreatitis lessens when?
pt leans forward or sits in fetal position
28
Triad for chronic pancreatitis
DM
Steatorrhea
Calcifications
29
diagnostic findings for pancreatitis acute and crhonic
- labs
- toc for acute and crhonic
-prandial epigastric pain
LABS:
*incr lipase -->more sensitive and specific vs amylase--->but has to be elev 3x
*amylase: transient, can go back to normal 24-72 hrs
*incr WBC
*liver enzyes +/- increase
*mild hyperbilirubinemia
*hyperglycemia
*hypocalcemia
*
CHRONIC: calcifications on US/gallstones, amylase and lipase NOT elevated
TOC acute= abd CT
TOC chronic= MRCP
Abd XRL sentinel loop-->look for diminished bowel sounds in exam question
30
TX for pancreatitis
MAINSTAY=supportive: NPO, IVF*****, analgesics, bowel rest
*****inadeaute IVF resustication in first 48 hours-->can lead to severe pancreatiits
*ERCP if biliary sepsis suspected
CHRONIC= addresss underling cause: most commonly is ETOH abuse
- stop drinking
- low fat diet
- enzyme replacement
- surgical removal of damaged part
31
Dysphagia with liquids AND solids suggest?
Achalaisa
| -motility disorder
32
dysphagia with only solid food suggestive of? (3)
- stricture
- ring
- tumor
33
upper endoscopy
- another name?
- proceudre
- what is seen?
- good for?
- not helpful for ??
esophagogastroduodenoscopy (EGD)
* put fiberoptic camera down into esophagus to visualize problem
* SEE: high quality color imaging of esoph, gastric and duodenal LUMENS
* can also do biopsies, injection catheters for delivery of drugs, balloon dilators or hemostatic devices
GOOD FOR: mucosal lesions, biopsies or interventional procedures are required (dilation, banding)
minimally invasive********
NOT GOOD FOR: looking at motion.. aka mobility disorders
34
Esophagram
* name the two types
- what is needed with these tests?
- Good for?
- cons?
- high sensitivtiy for?
1. XR --- still
2. Fluoroscopy---real time/moving XR
*contrast PO is needed so it illuminates inside esophagus "BARIUM SWALLOW"
GOOD FOR: function and morphology: strictures, compression and altered anatomy: reflux, hiatal hernias, mucosal granulairty, erosions, ulcerations, strictures
high sensitiity for detecting strictures vs endoscopy
CON:
-not good for looking at mucosa
-not fully diagnostic and PT will eventually need endoscopy---even if the esophagram study is negative ...why???? because next step would be to obtain biopsies, provide tx, or clarify any abnormal findings in case of + exam OR to add certainty to a - exam
35
two types of contrast used for esophagrams
brium
| gastrografin
36
what is the most useful test for evaluation of proximal gasotrintestinal tract
endoscopy
37
list advantages of endoscopy vs barium esophgram
| list the disadvantage
ADV
1. increased sensitivity for detection of mucosal lesions
2. increased sensitivity for detection of abnormalities like Barretts esophagus or vascular lesions
3. ability to obtain biopsies
4. ability to dilate strictures DURING exam
DISADV
1. expensive
2. low sensitivity for detection of non-focal esophageal strictures
3. sedatives or anesthetics are req
38
what is quad therapy
| -triple?
quad therapy (metronidazole, tetracycline, pepto, PPI)
proton pump inhibitor, clarithromycin and amoxicillin or an imidazole)
39
air under diaphgram on CXR
perf peptic ulcer
40
sudden onset of severe abdominal pain--may radiate to the shoulder blade with + peritonitis s/s
perf ulcer
41
MC site for anal fissure
posterior midline
42
severe tearing pain on defecation accomp with hematochezia
| *bright red stool on TP
anal fissure
43
throbbing rectcal pain worse with sitting, couhging and defication
anorectal abscess/fistual
44
sentinel pile on PE
aka fissure
| ***anorectal abscess, fissure
45
severe rectal pain when he defecates. He has a fever of 39 C. On exam a palpable mass is felt at the anal verge.
anorectal abscess
| *****result of an infection
46
fistula is what?
result of chronic abscess
47
perianal drainage, perirectal abscess, recurrent perirectal abscess, "diaper rash," itching
fistula
48
What disease should be considered with fistula in ano?
chrons dz
49
How do you find the internal rectal opening of an anorectal fistula in the O.R.
Inject H2 O2 (or methylene blue) in external opening—then look for bubbles (or blue dye) coming out of internal opening
50
sudden onset of severe colicky flank pain associated with nausea and vomiting as well as the absence of rebound or direct testicular tenderness
+microscopic hematuria
nephrolithiasis
- pain will radiate into testicles for men
- afebrile too
51
phren sign
(+)= ?
(-) = ?
if it is + seen with epididymitis
*pain is relieved with elevation of the scrotum
- sign is seen with testicular torsion
52
Marfans syndrome PE findings
Ectopia lentis, aortic root dilation and aortic dissection are major criteria for the diagnosis of the disease.
particularly long arms and fingers and a pectus excavatum
53
what is adjuvant therapy of choice in post-menopausal estrogen receptor positive axillary node negative breast cancer?
Tamoxifen
| -estrogen modulator
54
when is chemotherapy indicated with BC?
tumors > 1 cm
55
when is bisphosphonate therapy used in BC
if there is METS to the bone
56
Recurrent nephrolithiasis may be one of the presentations of
primary hyperparathyroidism
57
Measurement of ________levels would be the initial laboratory test for the evaluation of hypercalcemia.
parathyroid
58
____ prophylaxis considered in all burn patients
tetanus
59
when do you use LMW heparin for prophylaxis of venous thromboembolism
-ortho neuro trauma surgery with RF for clots
60
venous thromboembolism prophylaxis for low risk minor procedures in PT under 40
early ambulatio n
61
acute phase of adrenal crisis is treatred with
IVF
| hydrocortisone
62
Class I indications for CABG from the American College of Cardiology (ACC) and the American Heart Association (AHA) are as follows
- Over 50% left main coronary artery stenosis
- Over 70% stenosis of the proximal left anterior descending (LAD) and proximal circumflex arteries
- Three-vessel disease in asymptomatic patients or those with mild or stable angina
- Three-vessel disease with proximal LAD stenosis in patients with poor left ventricular (LV) function
- One- or two-Vessel disease and a large area of viable myocardium in high-risk area in patients with stable angina
- Over 70% proximal LAD stenosis with either an ejection fraction (EF) below 50% or demonstrable ischemia on noninvasive testing
63
_______is the treatment of choice in patients with pulmonary embolism with normal ventricular function and no absolute contraindications.
anticoagulatio n
64
_______ is the treatment of choice in a diabetic with two or three vessel disease
CABG
65
indications for Billroth I surgery
procedure for gastroduodenostomy is the most physiologic type of gastric resection, since it restores normal continuity
- gastric ulcers
* type of reconstruction after a partial gastrectomy in which the stomach is anastomosed to the duodenum
66
Dumping Syndrome
| -what is it
* complication of bariatric surgery
- s/s due to rapid gastric emptying and rapid fluid shifts when large amts of CHOs are ingested
CM
- early: bloating, flatus, diarrhea, abd pain, nausea, vasomotor (dizziness, tachypnea, hypotension, flushing)---withint 15 mins
- late: hypoglycemia, syncope
```
DX
-clinical
-
TX
-decr CHO intake
-eat more freq with smaller meals,
```
67
In patents with diabetic retinopathy, what clinical intervention is most successful in preserving vision?
Panretinal laser photocoagulation
| -
68
PTs taking steroid medicine, what should they do to the dose if they become sick?
To better mimic the normal physiologic response the baseline dose should be doubled for the duration of the illness. Doses should be increased 5-10 fold with major events such as surgery.
EX: takes 25 mg regulalry.... SICK DOSE= 50.... SURGERY DOSE= 125-250
69
Intestinal obstruction without complications is suggested by
crampy pain, abdominal distention, hyperactive bowel sounds, visible peristalsis, and minimal tenderness.
70
what is a key feature of duodenal ulcer
Epigastric tenderness
****pain is RELIEVED with eating
(gastric ulcer pain is worse with food)
71
________ represents one of the most common medical and surgical conditions seen during pregnancy.
GB disease
72
SBO xray finding
air fluid levels with distended loop of bowel
73
xray finding for perf duodenal ulcer
free air under the diaphragm
74
complaints of vague epigastric abdominal pain associated with jaundice and generalized pruritus. Physical examination reveals jaundice and a palpable non-tender gallbladder, but is otherwise unremarkable
pancreatic CA (head)
75
Courvoisier's sign
palpable non-tender GB---due to obstruction from pancreatic CA
76
RF for pancreatic CA (6)
age, tobacco use, obesity, chronic pancreatitis, family history and previous abdominal radiation.
77
MC skin CA
Basal
78
The most serious complication of Barrett's esophagus is
esophageal adenocarcinoma
79
Drugs to tx MRSA
- IV
- PO
IV:
- vanco (pref for hosp acquired)
- daptomycin
PO
- clindamycin
- bactrim
- doxy
- minocycline
80
witin first __ days post op pnma can occur
5
81
Elevated _____levels can help distinguish post op pnma from other causes of fever and infiltrates after surgery
procalcitonin
82
MC bacteria involved with post-op pnemonia
Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter species, and Staphylococcus aureus.
83
triad for DVT and name of it
Virchow's triad
vascular endothelial injury or inflammation, stasis, and hypercoagulable state
84
specific findings for DVT
swelling of the whole leg, > 3 cm difference in circumference between calves, pitting edema, and collateral superficial veins
85
how is definitive dx of DVT made
venography
86
study of choice for PE
CT angiography
87
tx of choice for dvt
Anticoagulation therapy using subcutaneous heparin followed by oral anticoagulant (warfarin or a factor Xa or direct thrombin inhibitor)
88
What is phlegmasia alba dolens?
A rare complication of deep vein thrombosis (DVT) in pregnancy where the leg turns milky white.
89
Warfarin is contraindicated in
pergnancy
90
Surgeries with high cardiac risk include ? (5)
laparoscopic total abdominal colectomy with ileostomy,
breast reconstruction with free flap,
open cholecystectomy,
open ventral hernia repair of incarcerated or strangulated hernia, and
Whipple procedure
91
first line tx for stable angina? also should be given this before surgery since its cardio protective
bb
atenolol, propranolol, metoprolol)
Initiation of a beta-blocker prior to elective surgery is an important part of optimizing the patient’s cardiac risk.
92
presence of lung sliding and comet tails on cxr
NORMAL findings
absence of those findings indiacte a pnmothorax
93
barcode or stratosphere sign on cxr
indicates pneumothorax (means no lung motion)
94
seashore sign on cxr
normal lung
| -indicates + lung movement
95
emergent large bore needle chest decompression should be followed by what procedure
thoracostomy aka chest tube placement
96
What type of pneumothorax occurs in conjunction with menstrual periods?
catamenial
97
What is the most appropriate IV fluid for a preoperative patient who is NPO?
LR
98
IV fluid solutions to treat hypernatremia
- half normal saline
| - normal saline withD5
99
how long before surgery should ASA be discontinued?
- metformin or any PO diabetic drug?
- Long-acting sulfonylureas?
1 wk for ASA
Metformin and other PO DM Drugs--> 1 day before
Long-acting sulfonylureas--> 48-72 hrs before
100
What is the best way to manage hyperglycemia during surgery?
continuous insulin drip
101
Protein status is often measured by the following three laboratory measures:
-which is used for short term changes and why
serum albumin,
serum transferrin,
serum prealbumin-->used for short term-->bc half life is 2-3 days
102
________ is recommended for patients requiring surgery who are at intermediate risk of hypothalamus-pituitary-adrenal axis (HPA axis) suppression aka on steroids for longterm
Morning serum cortisol level
103
two most common indiactions for pre-op emergent dyalisys
| -other reasons
Hyperk >6.5 with EKG changes
fluid overload
OTHER REASONS:
- acidosis--met acidosis with ph <7.1
- ingestion of salicylates, lithium, isopropanol, methanoly,
- uremia---elev BUN with signs of uremia-->uremic bleeding, pericarditis, encephalopathy, neruopathy
104
What should the peak expiratory flow rate be for patients with asthma before elective surgery?
>80% of their predicted value.
105
Which internal jugular vein follows a direct path to the superior vena cava?
The right internal jugular vein. The left internal jugular vein drains into the brachiocephalic vein.
106
list the order of highest risk for infection to least likely infection for the central venous access veinsitse
FEMORAL---highest risk of infection
INT JUGULAr---double the risk of infectino vs subclavian
subclavian--lowest risk
107
What is the initial imaging modality used to evaluate DVT
Compression ultrasound with Doppler
108
What is the reversal agent for apixaban and rivaroxaban?
Andexanet alfa
109
parkland formula
4 mL/kg x body weight in kg x percent of body surface area burned)
*det fluid resustiation for the firt 24hrs of burn pt
Half of the required fluid is given in the first 8 hours, and the remaining fluid is given over the next 16 hours
110
causes for transudative
cirrhosis
HF
Nephrotic syndrome
PE
111
causes for exudative
CA
pnma
PE
pancreatitis
112
next step for pt who is HD unstable with a PE
Thrombolysis with r-tPA
***stable would get IVC filter
113
low ph low bicarb
met acidosis
114
low ph high bicarb
resp acidosis
115
high pH high bicarb
met alkalosis
116
high ph low bicarb
resp alkalosis
117
_______ tx is indicated for patients with an INR > 10 with no significant bleeding present
vit K alone
118
______ tx is necessary when INR >10 with LT bleeding
Administer vitamin K and fresh frozen plasma
119
hypocapnia (PaCO2 < 35 mm Hg), increased blood pH (> 7.45), and normal bicarbonate (22 to 26 mEq/L)
resp alkalsosi
120
increase in pH (> 7.45), normal PaCO2 (35 to 45 mm Hg), and an increase in serum bicarbonate (> 26 mEq/L).
met alkalosis
121
What is the most common cause of respiratory alkalosis?
hyperventilation
122
Which of the following is the most common cause of hematochezia in a 68-year-old individual
AKA MCC of lower GIB
diverticulosis
hematochezia=lgib--->bright red stool per rectum
123
anatomic location for hematocheiza due to LGIB
distal to the ligament of Treitz
124
Causes of hematochezia (lower GI bleeding) include : (7)
1. DIVERTICULOSIS--- MCC >AGE 60
2. hemorrhoids (most common cause in patients < 50 years of age),
3. angiodysplasia,
4. colitis (infectious, ischemic, inflammatory bowel disease),
5. colon cancer,
6. anorectal disorder,
7. proctitis
125
MCC of UGIB
PUD
126
Chronic mesenteric ischemia is secondary to ?
atherosclerotic plaque proliferation
127
acute mesenteric ischemia mcc by?
arterial embolism or thrombosis
128
_______is the most commonly affected artery in cases of acute mesenteric ischemia.
SMA
129
classic triad for mesenteric ischemia (only sometimes pt will present with full triad)
abdominal pain, fever, and heme-positive stool
130
what drug to support BP if pt has mesenteric ischemia do we avoid
vasopressin
131
anotehr term for HIDA Scan
Cholescintigraphy
132
Cholescintigraphy another term
HIDA scan
| ***GS for acute chole
133
For patients with esophageal varices, an ________ is the diagnostic and therapeutic tool of choice
esophagogastroduodenoscopy (EGD)
134
acute management for esophageal varices
- hemodynamic resusication
- OCTREOTIDE
- banding, sclerotherapy
- ABX: ex Ceftriaxone
135
chronic management of esophageal varices
NS BB
| -ligation
136
tumor marker assoc with hepatic CA
alpha fetoprotein
137
what tumor marker is assoc with ovairan CA
cancer antigen 125 or CA 125
138
which tumor marker is assoc with pancreatic CA
cancer antigen 19-9
139
what markers assoc with colorectal CA
cancer antigen 19-9
and
carcinoembryonic antigen ***********aka CEA
140
first-line therapeutic option for achalasia
Laparoscopic Heller myotomy
141
first line tx for esophageal spasm
CCB alone
-doesnt work, then try TCA
**can also try botulism inj if medication doesntwork
142
indications for admission for diverticulitis
severe pain, inability to tolerate oral intake, sepsis, immunocompromised status, failing outpatient treatment, or the presence of complications.
143
list some PO abx used for tx of OUTPATIENT diverticulitis
ciprofloxacin and metronidazole,
trimethoprim-sulfamethoxazole and metronidazole,
or amoxicillin-clavulanate monotherapy
AND CLD
144
INPATIENT IV abx options for uncomplicated diverticulitis
piperacillin-tazobactam monotherapy,
a combination of ceftriaxone and metronidazole or ciprofloxacin and metronidazole
145
AB XR finding for perf diverticulitis
Free air outside the bowel in the abdomen.
146
abd pain worse when laying down and alleviated with leaning forward
acute pancreatitis
147
inguinal hernias are located ______ to the inguinal ligament.
vs femoral hernias are located_____ to the inguinal ligament
Inguinal hernias= superior
femoral=inferior
148
age of onset for chrons dz
BIMODAL
15-30 and then 60-80
149
imaging modality of choice for chrons
MRI with enterography
150
mainstays of medical management for chron dz
Sulfasalazine and aminosalicylates
151
primary choledoco can occur due to what kind of diseases
cystic fibrosis--causes biliary stasis
152
serum CA-19-9
pancreatic CA
| -NOT considered appropriate screenig test tho
153
Courvoisier sign
palpable GB
| -seen with pancreatic CA
154
Whipple procedure
pancreaticodudenectomy--used in pancretic CA
155
US finding for cholangitis
CBD dilation
156
IV abx of choice for cholangitis
BS--- like piperacillin-tazobactam
| a****and ERCP*****
157
When should vitamin K be administered to patients with acute cholangitis?
If the patient has hypoprothrombinemia as a result of liver damage secondary to cholangitis.
158
hital hernia
- define
- list types
- GS for dx
proximal portion of the stomach protrudes thru dia into the esophageal space
TYPES
1. sliding---more common--95%--present with sx of GERD,
2. paraesophageal--sx more substernal pain, n/v, aka more signficiant sx than sliding
GS for dx is barium swallow
159
which virus has been assoc with incr risk of gastric CA
EBV
160
what does this upright cxr show
sx: abd pain sudden in nature, tachy, cool extrems, low temp, marked broad like rigidity, abd distention, hypovolemia, peritonitits
TX
- NGT
- IVF
- IV PPI
- BS ABX
- OP vs NON OP management
161
What is Zollinger-Ellison disease?
gastrin-secreting cancer that results in acid hypersecretion in the stomach.
162
acute abdominal pain, diarrhea, rectal bleeding, tachycardia, dehydration, and fever.
toxic megacolon
| -can be compliaction of UC
163
how to dx toxic megacolon
radiographic evidence of colonic distention plus at least 3:
- fever >38 C
- HR >120
- WBC > 10.5
- anemia
PLUS at least one of the following:
- dehydration
- ams
- electro disturb
- hypotension
164
____is the recommended initial treatment for sigmoid volvulus without signs of perforation or bowel ischemia.
sigmoidoscopy---to reduce volvulus
| --SURGERY to prevent recurruance
165
sigmoid volvulus
| ****bent inner tube apperance****or U shaped
166
RF for sigmoid volvulus
nursing home pt
bed bound
elderly
chronic constipation
167
What is the 3-6-9 rule?
Bowel is considered dilated when dilation is > 3 cm, 6 cm, and 9 cm for the small bowel, large bowel, and cecum, respectively.
168
Definitive tx for BPH
surgical---transurethral resection of the prostate. aka TURP
****remove excess prostate tissue to relieve onstruction
169
enteral nutrition =
feeding tube---directly into stomach or SI
<4 weeks= naso tube
>4 weeks =percutaneous tube
170
indication for parenteral nutrition
* if patient does not hve a functional gut or if enteric access not safe AKA A PARTIALLY FUNCTIONING OR NON-FUNCTIONAL GI TRACT IS MAIN INDICATION*******
- burns
- malabsorption
- severe malnutrition
- paralytic ileus
- sm bowel ischemia
- necrotizign endocarditis
- GI surgery
post-liver transplantation, short-bowel syndrome, comatose patients who are critically ill, prolonged ileus, significant gastrointestinal bleeding, significant gastrointestinal ischemia, or a high-output fistula.
171
Which stones are associated with chronic urinary tract infec
struvite sotnes
172
what timing post op is a fever greatest concern
| -causes?
late.... 4-30 days
DVT
drug fever
inflammatory rxns
infectiouns related to surgical procedure itself ****abd abscess for ex
173
what is a consistent PE finding for right sided colorectal CA
melana
174
what is consistent PE fidnig for left sided colorectal CA
change in bowel haits
hematocheiza
thin stools
175
apple core lesion
finding for colorectal CA
176
what is used to prevent gallstone formation in pts with rapid wt loss
ursodeoxycholic acid--- a bile salt
177
medical management for GERD
1. H2 antagonist
2. increase dose of H2
3. trial low dose PPI and stop using H2
4. fundopliction is indicatd for cases refractory to med management
178
MCC for SBO
| LBO--bengin and non-benign causes
SBO=adhesions
| LBO= CA (non-benign) and volvulus is MC bengin cause
179
mc location for LBO
at or below transverse colon
| ***sigmoid colon
180
What signs are characteristic of volvulus on plain radiography?
coffee bean sign
| northern exposure sign
181
postprandial pain
fear of eating
weight loss
chronic mesenteric ischemia
182
major concern for surgical repair of anal fissure
| *when is surgery indicated
irreversible fecal incontinence
| ****surgery reserved for pt who has sx >8 weeks or failed supportive tx
183
________ulcers tend to cause pain shortly after eating, while _______ ulcers tend to cause pain 1–2 hours after meals or during the night
gastric
| duodenal
184
another word for rapid urease testing
campylobacter-like organism test
| *this diagnoses H. pylori
185
first line tx for H pylori
10-14 days of triple therapy
- clarithromycin
- amoxicillin
- PPI (-azole)
**metronidazole replace for amoxicillin PCN allergy
10-14 days QUAD therapy
1. bismuth subsalicylate
2. tetracycline
3. metronidazole
4. PPI
186
supraclavicular node
virchow node--- gastric CA
187
left axillary node
irish node
188
periumbilical node
sister mary joseph node
189
PE shows Howship-Romberg sign
obturator hernia
190
whats in Hsselback triangle
***dierct hernias***
1. inferior epigastric vessel-->lateral
2. rectus abdominis muscle-->medial
3. inguinal ligament-->inferior
191
MC type of stone found in primary choledoco
pigmented stone
PRIMARY=stones originat in CBD--result from biliary stasis-- why they look brown
SECONDARY=stones originate in GB
192
appropriate diagnostic test to determine if h pylori was eriadicated
1. stool angient test
| 2. breath urease test
193
mc anatomical site for UC
rectum
194
hallmark location for crohn dz
terminal ileum
195
screening for colorectal CA with colonscopy done every ____ years
10
196
screening for colorectcal ca with CT colonography every ____ years
5
197
what is more specific amylase or lipase
lipase
198
anal fistuals are assoc with what dz
crohn dz
199
only complaint is painless hematochezia
meckles diverticulum
200
scan of choice after dx of Meckles
uclear medicine scan, known as the technetium-99m pertechnetate scan
201
TOC for meckels diverticulum
diverticulectomy
202
cause of meckles
incomplete obliteration of the vitelline duct
203
__________is needed to confirm the diagnosis of achalasia
manometery
204
Heller myotomy
An incision of the circular muscle layer of the lower esophageal sphincter aimed at treating achalasia
205
classification for hemrroids
| 1st-4th
1st= does not proture through anus
2nd=prolapse but reduce spontaenously
3rd=prolapse and require manual reduction
4th=cannot be reduced and may strangulate
206
tx for anal fissure
```
topical nifedipine or nitro
topical analgesic
stool softenr
sitz bath
incr fiber intake
```
207
which type of volvulous presents in younger patients
cecal
208
Markedly elevated fasting serum gastrin levels are associated with
gastrinoma or zollinger-ellison syndrome
209
what type of adenomatous polyp has greatest risk of malignancy
villous
210
history of vomiting, coughing, or retching followed by hematemesis or melena with epigastric abdominal pain or back pain
Mallory Weiss syndrome
| **forecul retching
211
What makes up the classic triad of chronic pancreatitis?
Steatorrhea, diabetes mellitus, and calcifications on imaging.
**only seen in advance dz
212
triad for intusussception
colicky abd pain (comes and goes----comes and goes)
vomiting (sausace shaped mass in abd)
bloody red currant jelly stools
213
_____ grading system is used to eval patients with prostate CA
gleason
214
MDs dont LIe
Medical to IEA: dierct
| Lateral to IEA: indirect
215
internal hemorroids arrise from and are _____ the _____ line
superior hemorrhoidal cushion
ABOVE or proximal to dentate line
216
_______ recc surgical procedure for toxic megacolon
subtotal colectomy with end-ileostomy
217
target sign with transverse view in RUQ
pyloric stenosis
218
mcc LGIB
diverticulosis
| **painless rectal bleeding**
219
tx option for pt with recurrent nonsevere CDIFF
Fidaxomicin 200 mg PO every 12 hrs
220
3 or 4 unformed stoools in 24 hours
| -watery diarrhea
Cdiff
221
colonic ischema MC affects what part of colon
watershed areas
- -spenic flexure
- rectosigmoid junction
222
CEA stands for
carcinoembryonic antigen
| ****colorectcal ca
223
melena= U or L GIB
UGIB
