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Flashcards in surgery- pestanos Deck (50)
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1
Q

signs of mechanical intestinal obstruction

A

high pitched bowel sounds

distended loops of small bowel with air fluid levels

2
Q

signs of strangulation

A

fever
leukcystosis
constant pain
peritoneal irritation

3
Q

signs of strangulated hernia

A

hernia that was once reducible is no longer so

4
Q

presentation/treatment for R colon cancer

A

hypochromic Fe deficiency anemia, 4+ occult blood

R hemicolectomy

5
Q

presentation of L colon cancer

A

bloody stool, narrow stool caliber

6
Q

when do you surgically treat crohns

A

complications such as bleeding/ stricture/ fistula

7
Q

proper surgical treatment for UC

A

removal of rectal mucosa –> need stoma or ileoanal anastomosis

8
Q

medical therapy for anal fissure

A

diltiazem topical ointment TID for 6 weeks

higher success rate than botulinum toxin

9
Q

most common causes of GI bleeding

A

angiodysplasia
polyps
diverticulosis
cancer

10
Q

origin of GI bleed is always ______ when there is hemoptysis or blood recovered by NG tube

A

upper

11
Q

approach to lower GI bleed

A
1) EXCLUDE HEMORRHOIDS
Next:
-angiogram --> agnioembolization
-wait to stop, --> colonoscopy
-tagged red cell study
12
Q

blood per rectum in a child

A

meckel divertic –> technetium scan looking for ectopic gastric mucosa

13
Q

causes of acute abdomen

A

perf
obstruction
inflammation
ischemia

14
Q

acute abdomen: perf

A

sx: diffuse/ generalized pain, guarding, rebound, PT DOESN’T MOVE
dx: free air under diaphragm

ex: perf peptic ulcer

15
Q

acute abdomen: obstruction

A

think of a duct

sx: PT MOVES CONSTANTLY SEEKING COMFORT, typlica location of pain and radiation

16
Q

things to rule out in generalized acute abdomen before doing ex lap

A

MI
PE
lower lobe PNA
pancreatitis

17
Q

findings on xray for sigmoid volvulus

A

“parrot’s beak sign”

giant air filled loop from RUQ to LLQ

18
Q

hepatic adenoma

A

complication of birth controls pills?

can rupture and bleed into abdomen

19
Q

labs associated with obstructive jaundice

A

elevations of direct and indirect bili, inc AST/ALT,

INC ALP!!!!

20
Q

courvoisier terrier sign

A

malignant biliary duct obstruction (large and THIN WALLED with distended galbladder)

21
Q

MRCP vs ERCP

A

MR cholangiopancreatogram
Endoscopic retrograde “

MR is noninvase, only imaging
ERCP is functional

22
Q

cancers that cause obstructive jaundice

A

adeno of head of panc
adeno of ampulla of Vater
cholangocarcinoma of common duct

23
Q

surgical managment of acute cholecystitis

A

NPO, NG suction, IVF, abx –> elective chole

24
Q

option in non surgical patient needed emergent chole?

A

percutaneous transhepatic cholecystOSTOMY

25
Q

ranson’s criteria for acute hemorrhagic pancreatitis

A

inc WBC, bG

dec serum Ca, HCT

26
Q

hesselbachs triangle

A

inguinal lig= inferior
inf epigastric= lateral
rectus abdominus = medial

27
Q

excessive salivation after birth, or choking after first feeds

A

esophageal atresia

28
Q

what should you check for if you note esophageal atresia?

A

VACTER- vertebral, anal, cardiac, tracheal, esophageal, renal and radial

check for imperforate anus, echo for heart, xray for spine

29
Q

congenital diaphragmatic hernia

A

LEFT

  • -> hypoplastic lung with fetal type circulation
  • req intubation/sedation/low pressure vent/ NG suction
30
Q

when do you repair congenital diaphragmatic hernia

A

3-4 days after birth to allow lung maturation

31
Q

how do you fix large omphaloceles

A

construction of “silo” to protect bowel –> contents squeezed into belly piece wise over a week –> closure

32
Q

do babies with gastroschisis require nutrition?

A

yes, parenteral for ~1 month because bowel will not work

33
Q

gastroschisis vs omphalocele

A

gastro –> defect to RIGHT of cord, no covering

omphaloSEAL–> cord goes to defect, thing protective membrane

34
Q

differential for billious vomiting and “double bouble”

A

duodenal atresia
annular pancreas
malrotation

35
Q

how can you distinguish malrotation from duodenal atresia and annular pancreas? how do you dx it?

A

double bubble with minimal normal gas pattern beyond

surgical emergency!

dx with contrast enema, upper GI

36
Q

bililous vomiting, multiple air fluid levels, no double bubble

A

intestinal atresia

“vascular accident” in utero

37
Q

necrotizing enterocolitis: signs and tx

A
  • feeding intol, abd distention, rapid drop in plt

- stop feeds, IV abx, IV nutrition

38
Q

meconium ileus

A

CF

  • multiple dilated SB loops + ground glass appearance in low abd
  • gastrograffin= dx and tx
39
Q

nonbilious projectile vomiting after feeds in newborn

A

pyloric stenosis

  • olive mass
  • FIRST rehydrate, correct hypochloremic, hypokalemic metabolic alkalosis
40
Q

tx for pyloric stenosis (after electrolyte correction)

A

ramstedt pyloromyotomy

balloon dilation

41
Q

biliary atresia

A

6-8wk with progressive jaundice

  • stimulate with phenobarbital
  • liver transplant is definitive
42
Q

hirschprung (aganglionic megacolon) –> sx

A

chronic constipation

-explosive expulsion of stool and flatus on DRE –> relief of abdominal distention

43
Q

hirschprung on xray, dx

A

distended proximal colon (normal) –> “normal” distal colon (aganglionic)

dx with full thickness biopsy of rectal mucosa

44
Q

intussussception

A

colicky abd pain
currant jelly stools
RLQ

barium/air enema= dx and tx

45
Q

how do you tell appy from intussussception in kids

A

appy > age 3

46
Q

pediatric lower GI bleed

A

meckel’s

radioisotope scan to look for gastric mucosa

47
Q

three complications of GI fistula when draining freely (stable pt)

A
  1. fluidand lyte loss
  2. nutritional depletion
  3. erosion/digestion of abdominal wall

**feed past fistula + ostomy

48
Q

fistula FETID mnemonic (fistula will heal unless these are present)

A
Foreign body
Epithelialization
Tumor
Infection/Irradiation/IBD
Distal obstruction
49
Q

t/f steroids prevent fistula healing

A

TRUE

also remember FETID

50
Q

how to manage traumatic pelvic fracture

A

External fixation
give blood
look for urethral injury

***if CT shows bleeding only in pelvis. If its expanding to peritoneum –> OR