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Flashcards in Surgery Treatments Deck (68):
1

Cancer of the tongue

Partial glossectomy +

supraomohyoid dissection (N0)
MRND (N+)

With mandibular involvement:
composite resection (Partial glossectomy + floor of the mouth and mandibulectomy)

2

Cancer of the base of the tongue

Early: Surgery + RT + BND
Advanced: Total resection with or without laryngectomy

3

Cancer of the alveolus of gingiva

Resection of the tumor plus

marginal mandibular resection or segmental mandibular resection plus

ipsilateral supraomohyoid dissection (N0)
MRND (N+)

4

Cancer of the larynx (Supraglottic / Glottic)

Early lesion: RT
Advanced: Surgery plus RT

5

Cancer of the larynx (Subglottic)

total laryngectomy plus neck dissection regardless of status

6

Benign epithelial and non epithelial salivary gland tumor like Pleomorphic adenoma

Surgical excision
Parotid: superficial parotidectomy with facial nerve presevation
Enucleation is not recommended

7

Mucoepidermoid Cancer of the parotid gland

Lateral lobe: Superficial parotidectomy with facial nerve preservation
Deep lobe: Total parotidectomy with facial nerve preservation
Nerve sacrifice: if encased by tumor and non functional preoperatively

8

Mucoepidermoid cancer of the submandibular gland

En bloc resection of the gland and submental and submandibular LN
MRND (N+)

9

Graves disease drugs given prior to surgery

Lugol's solution: Decrease vascularity of thyroid thus decreased risk for thyroid storm
PTU, Methimazole

10

What is the Hartley-Dunhill or subtotal thyroidectomy procedure?

total lobectomy, isthmusectomy, and subtotal thyroidectomy on the other side.

11

Toxic adenoma

Unilateral lobectomy and isthmusectomy

12

Thyroid storm

beta blockers, oxygen supplementation, hemodynamic support, PTU, Lugol's iodine, and ipodate
Corticosteroids
non-aspirin compounds

13

Acute suppurative thyroiditis (Preceeded by URTI in children)

Parenteral antibiotics
Drainage of abscess

14

Subacute thyroiditis (Painful type) - preceeded by URTI

Symptomatic
Short term thyroid hormone replacement
Thyroidectomy reserved for medical failure

15

Subacute thyroiditis (Painless type) - autoimmune in origin

Short term thyroid replacement

16

Chronic thyroiditis (Hashimoto's / Lymphocytic thyroiditis)

Thyroid hormone replacement
Surgery only when CA is suspected

17

Reidel's thyroiditis (Invasive fibrous thyroiditis)

Wedge excision of the thyroid isthmus
L-thyroxine
Steroids

18

Solitary Thyroid nodule investigation pathway

1. TSH test (IF thyrotoxic -> Scan for either hot [Radioactive iodine or surgery] or cold)
2. FNAB

Either:
a. Observe for cystic that regresses
b. Thyroid lobectomy for benign or high clinical suspicion
c. Total or partial thyroidectomy for malignant

19

Simple thyroid cysts when do you do unilateral lobectomy

>3 attempts, >4 cm, complex cysts

20

Papillary carcinoma of the thyroid (Orphan Annie nuclei, Psammoma bodies)

TT / NTT

21

Follicular carcinoma (More common in iodine deficient areas)

Adenoma: lobectomy + Isthmusectomy
Older and > 4cm: TT/ NTT

22

Hurthle cell carcinoma (subtype of follicular carinoma)

Adenoma: Lobectomy + Isthmusectomy
Carcinoma: TT / NTT + Routine central neck node dissection

23

Medullary thyroid carcinoma (from the parafollicular cells located at the superolateral lobes of the thyroid gland)

Pheocromocytoma (Treat first)
TT + BCND

24

Thyroid Lymphoma

CHOP
Cyclophosphamide, doxorubicin, Vincristine, prednisone

25

Most common injury in thyroid surgery

Parathyroid injury

26

Most common location of ectopic parathyroids

Paraesophageal

27

Clinical manifestation of primary hyperparathyroidism

Kidney stones
Painful bones
abdominal groans
Psychic moans
Fatigue overtones

28

Parathyroid

adenoma: Resection
Hyperplasia: 3 1/2 Parathyroidectomy or total parathyroidectomy + Autotransplantation
Carcinoma: en bloc resection + Ipsilateral thyroid lobe

29

Preoperative localization test for parathyroid adenoma

Sestamibi

30

Secondary or tertiary hyperparathyroidism

3 1/2 parathyroidectomy or total parathyroidectomy + autotransplantation

31

Values of a defective LES

mean resting pressure <1 cm most common)

32

GERD

12 week antacid or PPI
Antireflux procedure: Nissel fundoplication

33

Diaphragmatic (Hiatal Hernia) Types

1. sliding - upward disclocation of the cardia (Most common)
2. rolling / paraesophageal - upward dislocation of the fundus
3. mixed
4. additional organ herniates

34

Borchardt's triad

Chest pain, retching with inability to vomit, and inability to pass an NGT

35

Diaphragmatic hernia treatment (Type II)

Asymptomatic: Observation
Symptomatic: Elective reduction surgery with repair of diaphragmatic defect +/- fundoplication

36

Zenker's diverticula (Found in the Killian triangle situated behind the esophagus at the level of the cricopharyngeus muscle)

2cm: diverticulectomy or diverticulopexy

37

Gold standard test for achalasia

Manometry

38

Treatment for achalasia

Heller's myotomy + Partial fundoplication

39

Most common primary esophageal motility disorder

Nutcracker esophagus

40

Phases of caustic injury

Acute necrotic phase (1-3 days)
Ulceration and granulation phase (3-5 days)
Cicatrization and scarring phase (3rd week)

41

Esophageal carcinoma

Trans-thoracid esophagectomy, trans-hiatal esophagectomy
Ivor Lewis procedure

42

Mallory weiss tear

Non-operative

43

Gastric outlet obstruction which presents as nonbillous vomiting leading to profound hypokalemic, hypochloremic, metabolic alkalosis

NPO, NGT, IVF, Acid suppression

44

Gastric Ulcer types

1. Antral lesser curvature
2. Antral plus duodenal
3. Pre-pyloric
4. High in lesser curvature
5. NSAID

45

Bleeding peptic Ulcer

1. Oversew
2. V&D or A (D) or Distal Gastrectomy (G)

46

Perforated peptic ulcer

1. Patch Graham's procedure (Both) + BX or wedge resection (G)
2. HSV or V&D or A (D) or Distal Gastrectomy (G)

47

Dumping syndrome - due to the destruction of the pyloric sphincter causing abrupt delivery of hyperosmolar load to the small intestines

Dietary: avoidance of liquids during meals & High fiber diet
Medical: Octreotide for early dumping, alpha glucosidase inhibitor for late

Surgical: Conversion to Roux-en-Y anastomosis

48

Passaro's triangle

Head of the pancreas
Junction of the hepatic and cystic duct
junction of the 2nd and 3rd portion of the duodenum

49

Gastric adenocarcinoma

Endoscopic mucosal resection for tumors <2cm limited to the mucosa or submucosa

The rest: resection of all tumor (R0) with 5cm grossly negative margins with enbloc removal of adjacent LN and involved organs.

Standard operation: Radical subtotal gastrectomy

50

Gold standard for the diagnostic evaluation of gastric adenocarcinoma

upper endoscopy and biopsy

51

Low grade vs High grade Gastric MALT lymphoma

Low grade: H. pylori eradication
High grade: Chemo and or radical subtotal gastrectomy

52

GIST tumor marker

c-KIT and CD34

53

Gastrointestinal Stromal Tumor

Wedge resection with negative margins
for unresectable: Imatinib

54

Appendicitis Stages

1. Congestion
2. Suppurative
3. Gangrene
4. Rupture

55

GI carcinoid of the appendix that will warrant a right hemicolectomy

Between 1-2 cm located at the base (mesoappendiceal invasion)

>2cm will also warrant a right hemicolectomy

56

Adenocarcinoma of the appendix

Right hemicolectomy

57

Sigmoid volvulus

Soft rectal tube for decompression

Resection with primary anastomosis (prepped bowel)

Resection of the sigmoid colon with construction of a colostomy Hartman's pouch for emergent operation

58

Acute diverticulitis

Uncomplicated: clear liquid diet and broad spectrum antibiotics
Generalized peritonitis: Urgent celiotomy
Diverticulitis with abscess: Drainage
Diverticulitis with fistula: Antibiotics, TPN, bowel rest, excision of diseased colon

59

Rectal prolapse

Low anterior resection
retrorectal sacral fixation
retrorectal sacral rectopexy
Thiersch procedure

60

Hemorrhoid

1st and 2nd: Medical management
3rd and 4th: Surgery
External hemorrhoid: Excision

61

Acute variceal bleeding

Vasopressin
Octreotide
Early endoscopy and vericeal ligation

Refractory bleeding: Surgical shunt or TIPS

62

Budd-Chiari syndrome

Systemic anticoagulation

63

Pyogenic Liver abscess

Broad spectrum antibiotic
Percutaneous aspiration

64

Liver hemangioma

Small: enucleation
Large: Resection

65

Liver adenoma

Resection

66

Hepatocellular & Cholangiocarcinoma

Resection

67

Choledochal Cyst Triad (This is due to pancreatic secretions backing up the bile duct)

Right upper quadrant pain, jaundice, mass

68

Sclerosing cholangitis
(Presents as weight loss, fatigue, intermittent jaundice, pruritus, abdominal pain)

Liver Transplantation