Surgery Halo-halo 4

Question 1

congestive hepatopathy characterized by obstruction to venous outflow

Answer 1

BUDD-CHIARI SYNDROME

• primary: endoluminal hepatic venous thromboses
• secondary: veins compressed / invaded by a neighboring lesion

Question 2

Factor V Leiden

Answer 2

AD
point mutation in Factor V
m/c inheritic thromboPHILIC condition among caucasians

normally, activated protein C inhibits Va
in FVL, factor Va is RESISTANT to inhibition by activated protein C
=THROMBOSIS

“Activated Protein C Resistance”

Question 3

Diagnostics in budd chiar syndrome

Answer 3

initial: abdominal US
definitive: HEPATIC VENOGRAPHY

Question 4

tx of budd-chiari syndrome

Answer 4

systemic anticoagulation

Question 5

noormal portal venous pressure

Answer 5

5-10 mmHg

Question 6

Banti’s syndrome

Answer 6

massive splenomegaly

-prehepatic portal hpn

Question 7

schistosomiasis is what type of portal hypertension

Answer 7

INTRAhepatic, PREsinusoidal obstruction

Question 8

gold standard for diagnosis of achalasia

Answer 8

manometry

• identifies EARLY diseaes before esophageal dilatation and food retion
• MOST SENSITIVE DIAGNOSTIC TEST
• endoscopy - to rule out malignancy
• bird’s beak esophagus - seen in esophagogram

Question 9

remarks on achalasia

Answer 9

“Second only to reflux disease, ACHALASIA is the most common functional disorder of the esophagus to require surgical intervention.”

Question 10

treatment of nutcracker esophagus

Answer 10

aimed at treatment of GERD

Question 11

Most common surgical tx for achalasia

Answer 11

[laparoscopic] HELLER MYOTOMY + partial fundoplication
-goood to excellent results in 62-100%

• pneumatic dilation
• most effective non-surgical (endoscopic)
• reported efficacy of 32-98%

Question 12

Leading cause of intestinal obstruction in the young child

Answer 12

intussusception

Question 13

idiopathic intussusception occurs in children between the ages of

Answer 13

6 and 24 months of age

Question 14

Dance’s sign

Answer 14

elongated mass in the RUQ or epigastrium with absence of bowel in the right lower quadrant

Question 15

management of intussusception

Answer 15

in the absence of peritonitis, the child should undergo radiographic reduction
AIR ENEMA: preferred method of DX and TX

(+) PERITONITIS / appears systemically ILL —> urgent LAPAROTOMY

Question 16

unless booth of what signs are observed, it cannot be assumed that the intussusception is reduced

Answer 16

free reflux of air into multiple loops of small bowel

symptomatic improvement

Question 17

of note, recurrent intussusception occurs in _____, independent of wheter the bowel is reduced radiographically or surgically

Answer 17

5-10%

Question 18

the ______ is a diagnostic black box

Answer 18

abdomen

Question 19

the presence of ________ is an undisputed indication for prompt surgical exploration

Answer 19

abdominal rigidity and hemodynamic compromise

Question 20

abdominal penetrating wounds that doesn’t require immediate surgery

Answer 20

RUQ or tangential GSW
do CT scan first

SW

• if anterior abd, do local wound exploration, then serial exam/lab
• if RUQ/back —> CT

Question 21

blunt abdominal trauma is now evaluated initially by

Answer 21

FAST
(Focused Assessment with Sonography for Trauma)
-sensitiv for detecting intraperitoneal fluid of >250 mL

Question 23

FAST is used to identify free intraperitoneal fluid in

Answer 23

Morrison’s pouch
-hepatorenal recess
LUQ
pelvis

Question 24

Diagnostic peritoneal aspiration is considered positive if ____ of blood is aspirated

Answer 24

> 10 mL

Question 29

if (+) FAST, what is the next step?

Answer 29

if stable, no evidence of peritonitis, unreliable PE
-CT to quantify injuries

if unstable
-LAPAROTOMY