Surgery GI/Nutrition Flashcards
(124 cards)
1
Q
Etiology of cholecystitis
A
Gallstones
2
Q
S/S of cholecystitis
A
RUQ pain
Radiate to shoulder
Precipitated by fatty meals
Murphy sign
3
Q
Diagnosis of acute cholecystitis
A
US showing wall thickening, stones may be visualized
4
Q
Treatment of cholecystitis
A
Lap chole
5
Q
Etiology of acute pancreatitis
A
Gallstones
Alcohol
6
Q
S/S of acute pancreatitis
A
Epigastric pain that radiates to back
N/V
Improves when leaning forward
Grey Turner sign
Cullens sign
7
Q
Diagnosis of acute pancreatitis
A
Elevated amylase and lipase
CT
Ranson’s criteria
8
Q
Treatment of acute pancreatitis
A
NPO
Fluids
Pain meds
9
Q
Etiology of chronic pancreatitis
A
Alcoholism
10
Q
S/S of chronic pancreatitis
A
LUQ pain that radiates to back
Malabsorption
Diabetes
11
Q
Diagnosis of chronic pancreatitis
A
Normal amylase and lipase
CT showing calcifications
12
Q
Treatment of chronic pancreatitis
A
Avoid alcohol
Pain management
Digestive enzymes
Puestow procedure
Whipple procedure
13
Q
Puestow procedure
A
Side-to-side anastomosis of the pancreas and jejunum (pancreatic duct is filleted open)
14
Q
Whipple procedure
A
A procedure in which the head of the pancreas and duodenum are removed
15
Q
Etiology of anal fissures
A
Constipation and straining
16
Q
S/S of anal fissures
A
Posterior midline
Pain with defecation
Bleeding
17
Q
Treatment of anal fissures
A
Proper toileting
18
Q
S/S of perianal abscess
A
Throbbing
Pain
Erythema
Swelling
Fluctuant
19
Q
Treatment of perianal abscess
A
I&D
20
Q
S/S of perianal fistula
A
Discharge
Itching
Pain
21
Q
Treatment of perianal fistula
A
Fistulotomy
22
Q
Etiology of appendicitis
A
Fecalith
23
Q
S/S of appendicitis
A
Periumbilical pain that migrates to teh RLQ
McBurney’s point tenderness
24
Q
Diagnosis of appendicitis
A
CT
25
Treatment of appendicitis
Lap appendectomy
Unasyn or cefoxitin pre-op
26
Bariatric surgical candidates
BMI > 40
BMI > 35 with obesity-related complications
Age 18-65
27
Roux-en-Y gastric bypass
Bariatric surgery that involves stapling the stomach to decrease its size and then shortening the jejunum and connecting it to the small stomach pouch, causing the base of the duodenum leading from the nonfunctioning portion of the stomach to form a Y configuration, which decreases the pathway of food through the intestine
28
Characteristics of roux-en-Y bypass
Restrictive and malabsorptive
29
Sleeve gastrectomy
Removal of the greater curvature of the stomach leading to a tubular-shaped stomach
30
Characteristics of sleeve gastrectomy
Restrictive
31
Laparoscopic adjustable gastric banding
Placement of a restrictive band on the upper portion of the stomach
32
Characteristics of laparoscopic adjustable gastric banding
Restrictive
33
Etiology of volvulus
Torsion of a segment of the bowel (MC sigmoid)
34
S/S of sigmoid volvulus
Slowly progressive abdominal pain, nausea, abdominal distention, and constipation
Vomiting several days after onset of pain
35
Diagnosis of sigmoid volvulus
CT
Whirl pattern
36
Management of sigmoid volvulus
Detorsion with rigid sigmoidoscopy
37
S/S of cecal volvulus
Abdominal pain
N/V
Diffusely distended
Tender to palpation
38
Diagnosis of cecal volvulus
X-ray: coffee bean and comma sign
CT: whirlwind
39
Treatment of cecal volvulus
Surgery
40
Etiology of small bowel obstruction
Post-surgical adhesions
41
S/S of small bowel obstruction
N/V
Colicky abdominal pain
Dehydration
Hyperactive bowel sounds early on, then hypoactive bowel sounds
42
Diagnosis of SBO
Ladder-like appearance of dilated bowel loops on X-ray
43
Treatment of SBO
GI decompression with NG tube
Surgery
44
Etiology of cholangitis
CBD obstruction of e. coli
45
S/S of cholangitis
RUQ pain
Fever
Jaundice
Hypotension
Mental status change
46
Diagnosis of cholangitis
ERCP
47
Treatment of cholangitis
ERCP with stone extraction and sphincterotomy
Lap chole after ERCP
Cipro and Flagyl
48
Etiology of cholelithiasis
Cholesterol
49
S/S of cholelithiasis
RUQ pain (biliary colic)
50
Diagnosis of cholelithiasis
Ultrasound
51
Treatment of cholelithiasis
NSAIDs for pain
Lap chole
52
Etiology of choledocholithiasis
Stone in the CBD
53
S/S of choledocholithiasis
Biliary colic
Jaundice
54
Diagnosis of choledocholithiasis
Elevated liver enzymes
US
55
Treatment of choledocholithiasis
ERCP with stone extraction and sphincterotomy
56
Colon polyp
Fleshy lesion protruding into intestinal lumen
57
What type of colon polyp are most likely to be cancerous?
Flat
58
Diagnosis/treatment of colon polyp
Colonoscopy with removal
59
Risk factors for colon cancer
Family hx
Age
Diet
Smoking
Obesity
60
S/S of colon cancer
Asymptomatic
Bowel changes
61
Diagnosis of colon cancer
Colonoscopy with biopsy
62
Treatment of colon cancer
Surgical resection
Chemo/radiation
63
Screening for colon cancer
Colonoscopy q10y
CT colonography q5y
Flexible sigmoidoscopy q5y
Flexible sigmoidoscopy with FIT q10 years plus FIT q1y
FIT-DNA q1-3y
FOBT q1y
FIT q1y
*from ROSH*
64
Etiology of diverticular disease
Chronic constipation
65
S/S of uncomplicated diverticulosis
Asymptomatic
66
Treatment of uncomplicated diverticulosis
High fiber diet
67
S/S of diverticulitis
LLQ pain
Fever
Bowel changes
Blood in stool
Palpable mass
68
Diagnosis of diverticulitis
CT
69
Treatment of diverticulitis
Clear liquid diet x 2-3d
Cipro + Flagyl, Bactrim + Flagyl, Augmentin, Zosyn
High fiber diet
Colonoscopy 4-8 weeks after resolution of symptoms
70
Risk factors for esophageal cancer
Smoking
Alcohol
Barrett esophagus
71
S/S of esophageal cancer
Weight loss
Dysphagia
72
Diagnosis of esophageal cancer
Endoscopy with biopsy
73
Treatment of esophageal cancer
Surgery, chemo, radiation
74
MC gastric cancer
Adenocarcinoma
75
S/S of gastric cancer
Dyspepsia
Vague epigastric pain
Weight loss
Anorexia
Masses
76
Signs of metastasis of gastric cancer
Virchow's node: left supraclavicular lymph node
Sister mary joseph nodule: umbilical nodule
Blumer shelf: rigid rectal shelf
77
Diagnosis of gastric cancer
EGD
78
Treatment of gastric cancer
Surgical resection, chemo, radiation
79
GERD treatment
Lifestyle modifications
Mild: H2 blockers
Severe or failed H2: PPI
80
Etiology of hemorrhoids
Increased venous pressure
81
S/S of hemorrhoids
Asymptomatic
Bleeding
82
Staging of hemorrhoids
I: confined to anal canal
II: protrude from anal canal, but redicable
III: require manual reduction after bowel movement
IV: chronically protruding and risk strangulation
83
Treatment of hemorrhoids
Stage 1-2: proper toileting
More severe or failure of conservative treatment: band ligation or injection sclerotherapy
Stage 4: hemorrhoidectomy
84
Etiology of liver cancer
Cirrhosis
85
S/S of liver cancer
Constitutional symptoms
Tender hepatomegaly
86
Diagnosis of liver cancer
Elevated liver enzymes
AFP
CT and MRI to identify mass
Biopsy to confirm
87
Patients that should be screened for liver cancer
Patients with cirrhosis or chronic HBV or HCV
Liver US and AFP q6m
88
Treatment of liver cancer
Resection of tumor
Liver transplant
89
Risk factors for umbilical hernia
Anything that increases the intra-abdominal pressure:
- Pregnancy
- Ascites
- Obesity
- Large abdominal tumor
90
S/S of umbilical hernia
Soft swelling covered by skin herniated area protrudes with coughing, crying, or straining
91
Treatment of umbilical hernia
Small: mesh repair laparoscopically
Large: open repair
92
Incisional hernia
Result of breakdown own fascial closure
93
Hernia patients that are not surgical candidates
Not urgent
Unwilling
Poor surgical risk
94
Indirect vs. direct vs. femoral inguinal hernia
Indirect: patient inguinal canal, above inguinal ligament, internal inguinal ring
Direct: external inguinal ring only, rarely into the scrotum
Femoral: below the inguinal ligament, inguinal canal is empty
95
S/S of hiatal hernia
Asymptomatic
GERD
96
Treatment of hiatal hernia
Lifestyle modifications
NISSEN fundoplication
Magnetic sphincter
97
MC location of Crohn's
Terminal ileum
98
S/S of Crohn's
RLQ pain
Nonbloody diarrhea
Malabsorption
Erythema nodosum
Pyoderma gangrenosum
Fistula formation
99
Diagnosis of Crohn's
Colonoscopy with biopsy
Skip lesions
Cobblestoning
100
Treatment of Crohn's
Steroids
Immunomodulators
TNF blockers
101
MC area of ulcerative colitis
Rectum and sigmoid colon
102
S/S of UC
Bloody diarrhea
Crampy lower abdominal pain
103
Diagnosis of UC
Sigmoidoscopy
104
Management of UC
Mild: topical mesalamine
Severe: oral mesalamine, steroids, or immunomodulators
Curative: proctocolectomy with placement of ileostomy
105
Mild vs. severe UC
Mild: mostly distal
Severe: extends past the sigmoid
106
MC type of pancreatic cancer
Adenocarcinoma of the pancreatic head
107
Greatest risk factor of pancreatic cancer
Smoking
108
S/S of pancreatic cancer
Vague epigastric pain with radiation to the back
Constitutional sx
Courvoisier sign
109
Courvoisier sign
Painless jaundice with palpable gallbladder
110
Diagnosis of pancreatic cancer
CT
ERCP if CT is inconclusive
111
Treatment of pancreatic cancer
Whipple
Resection of tumor
112
Pancreatic pseudocyst
Encapsulated collection of fluid with well-defined inflammatory wall
Occurs as a complication of acute pancreatitis
113
Treatment of pancreatic pseudocyst
If asx - nothing
If sx - drain
114
Etiology of PUD
H. pylori and NSAIDs
115
S/S of PUD
Dull, gnawing epigastric pain
Relief by eating
Nocturnal pain
116
Diagnosis of PUD
EGD
117
Treatment of H. pylori PUD
Omeprazole
Amoxicillin
Clarithromycin
EGD or breath test 4 weeks later
118
S/S of pyloric stenosis
Postprandial N/V
Epigastric pain
Distention
Olive-shaped mass
119
Diagnosis of pyloric stenosis
EGD for adults
US for kids
120
Management of pyloric stenosis
Conservative treatment first
Pyloromyotomy
121
Etiology of toxic megacolon
IBD (UC)
Infectious colitis
122
S/S of toxic megacolon
Bloody diarrhea
Abdominal pain and distention
Toxic
123
Diagnosis of toxic megacolon
CT
124
Treatment of toxic megacolon
IV steroids
Colectomy with ileorectal anastomosis
