Surgery Rotation 12 Flashcards
(44 cards)
What is the tx for immune thrombocytopenia
Splenectomy
Spleen is what is producing the antibodies and also what is consuming the antibody-bound platelets
What are the two important medications to give to a post-op splenectomy
Aspirin - can have post-op thrombocytosis
Prophylactic penicillin
What is Kehr sign
L shoulder pain to due irritation of the diaphragm
When do you go to surgery in a pt with appendicitis
Always if we think they have appendicitis
Do not need imaging if there is a good clinical picture
How does management of appendicitis change if there is perforation or abscess
Drain abscess and give abx first, then appendectomy once stabilized
1 site for carcinoid tumor
appendix
Sx of carcinoid symdrome
BFDR
Bronchospasm
Flushing
Diarrhea
R-heart lesions
What else should you look for in a pt with carcinoid syndrome
Niacin (B3) deficiency
Because serotonin and niacin are both made from tryptophan; so if all tryptophan is being used for 5HT, none is used for Niacin
Presentation of Niacin deficiency
Pellagra = diarrhea, dermatitis, dementia
Tx of carcinoid tumor of appendix if >2cm, at base of appendix, or with + nodes
Hemicolectomy
Otherwise appendectomy is good enough
1st step in management of possible SBO
Upright CXR to look for free air
CT can show point of obstruction
Tx of SBO
IVF, NG tube
When do you do surgery for SBO
If peritoneal signs, increased WBC, or no improvements within 48 hr
Diagnose: dilation of both small and large bowel on XR
Post-op ileus
Most common location of Crohn’s
Terminal ileum
Tx of diverticulitis
NPO, NG suction, IVF, broad spectrum abx
When is surgery indicated for diverticulitis
Multiple episodes, age < 50
Sx of R-sided vs L-sided colon cancer
R-sided = bleeding
L-sided = obstruction
When is surgery indicated in AAA
> 5 cm
1 cause of death post-op AAA
MI
Post-op diarrhea after AAA repair
Ischemic colitis
Post-op weakness and decreased pain/sensation after AAA repair
ASA syndrome
Post-op AAA repair 1-2 yrs later if have brisk GI bleeding
Aortoenteric fistula
Diagnose: severe mid-epigastric pain after eating, food fear, weight loss
Pain out of proportion to exam
Mesenteric ischemia
