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Surgery/ER Fall 2013 > Surgical Abdomen > Flashcards

Surgical Abdomen Flashcards

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1
Q

main reasons for emergent/urgent surgery

A

Obstruction, necrosis, perforation, and exsanguinating hemorrhage

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2
Q

“when I was riding to the hospital, going over the bumps in the car hurt a lot” sign of..

A

peritonitis

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3
Q

types of blockage in GI tract

A

GOO (gastric outlet obstruction), small bowel obstruction, and colonic obstruction

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4
Q

proximal obstruction hallmarks

A

frequent vomitting, non-feculent, less colicky, late obstipation

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5
Q

distal obstruction hallmark

A

late vomitting that smells feculent, MORE colicky, early obstipation

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6
Q

what is GOO caused by

A

pyloric/duodenal pathology- such as foreign body, tumor of antrum/pylorus/duodenum, or pyloric channel ulcer

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7
Q

GOO treatment

A

EGD with dilation or surgery, resection/bypass around tumor, or removal of FB

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8
Q

most common cause of small bowel obstruction

A

adhesion (mechanical cause)

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9
Q

most common cause of colonic obstruction

A

carcinoma (mechanical cause)

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10
Q

workup for SBO includes

A

AXR, SBFT, CT with oral contrast

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11
Q

tx for small bowel obstruction

A

IVF, NG tube for decompression, pain control, abx if indicated, and NPO

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12
Q

when is surgery indicated for SBO

A

if hernia, pain severe, or conservative management failed

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13
Q

preop surgery for SBO

A

NG tube for decompression, correct electrolytes (IVF), abx within 30 min of decompression, NPO, DVT prophylaxis, consent

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14
Q

types of surgery for SBO

A

adhesiolysis, small bowel resection, exploratory laparotomy

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15
Q

functional cause of obstruction

A

SBO- paralytic ileus. LBO- colonic pseudo obstruction or ogilve’s

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16
Q

tx of colonic obstruction

A

preoperative decompression (stent for stricture or tumor), resection of obstructed segment, or end colostomy/loop ileostomy

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17
Q

right sided vs left sided colon cancer

A

right sided- presents with anemia and liquid stood. left sided- presents with obstruction and solid stool

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18
Q

what can diverticulitis look exactly like on radiographic study and grossly?

A

tumor

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19
Q

types of volvulus

A

sigmoid, cecal, transverse, and cecal bascule

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20
Q

tx of volvulus

A

decompression colonoscopy or resection

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21
Q

segmental colon resection

A

diverticulitis, colon cancer, perforation, volvulus

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22
Q

hartman’s procedure

A

surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy.

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23
Q

subtotal colectomy indications (main)

A

pseudomembranous colitis with toxic megacolon, UC, ischemia of colon

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24
Q

total colectomy indications

A

UC

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25
2 finishes of total colectomy
end ileostomy and ileoanal anastomosis with j-pouch plus a temporary diverting ileostomy
26
LAR indications
high rectal tumor
27
LAR removes...
sigmoid colon and most of the rectum
28
abdominoperineal resection
removal of rectum and anus + end colostomy
29
abdominoperineal resection indication
low rectal tumor
30
tx of volvulus
decompression with colonoscopy, definitive surgery with sigmoidectomy with end colostomy
31
"dilated bird beak toward LLQ"
sigmoid volvulus
32
patient presents with noticeable bulge and severe pain in abdomen. Has N/V. Upon palpation, very tender. Bluish discoloration present on skin. Non-reducible bulge. Dx?
hernia
33
When is hernia repair emergent?
when there is strangulation of bowel within the hernia sac, otherwise its elective
34
what type of hernias are at low risk of strangulation?
very large hernias
35
If patient has hernia that causes strangulation of bowel resulting in death of bowel, what is next course of action?
emergent surgery- necessitates small bowel resection
36
landmark for differentiating direct vs indirect hernias?
inferior epigastric vessels
37
borders of hesselbach's triangle
epigastric vessels, rectus sheath, and inguinal ligament
38
graham patch used in tx of...
duodenal perforation
39
graham patch F/U for duodenal perforation
follow up EGD in 6-8 weeks to biopsy
40
perforated ulcer tx
broad spectrum abs plus antifungal. EMERGENT
41
gastric perforation tx
excision of the ulcer and repair of gastric wall or gastric resection (antrectomy) and reconnection (Billroth I, II, and Roux-en-Y)
42
Patient presents with RUQ pain that is severe, diarrhea, fever, Murphy's sign. LIpase and LFT normal. US shows thickened gallbladder wall. Suspect..
acute cholecystitis
43
If patient with acute cholecystitis but not good candidate for surgery, what are your other options?
cholecystostomy tube
44
patient presents with RUQ pain on palpation, jaundice, scleral icterus but no rebound. LFT elevated. suspect
choledocholithiasis
45
types of tx in choledocholithiasis
MRCP, ERCP, and PTC
46
what can be done at time of surgery to r/o choledocholithiasis?
intraoperative cholangiogram
47
patient presents with central abdominal pain that migrates to the RLQ, mild fever, N/V, tenderness at mcburney's point. suspect
acute appendicitis
48
most common causes of pancreatitis
alcohol or gallstones (in U.S.)
49
scorpion bite can cause..
pancreatitis
50
"sword through stomach" sensation - severe upper abdominal pain that radiates through to the back, N/V, dehydration, tachycardia. Decreased or absent bowel sounds, non-peritoneal tenderness. suspect
acute pancreatitis
51
lab findings in acute pancreatitis
lipase and amylase
52
criteria for acute pancreatitis
ranson's criteria
53
tx for acute pancreatitis
if cause is gallstones, allow pancreatitis to resolve then cholecystectomy. if no cause found, gallbladder removed
54
in which cases would you operate on pancreas itself?
pseudocyst, necrosis with infection, chronic pancreatitis, and pancreatic cancer
55
potential complication of pancreatic pseudocyst
chronic pancraticocutaneous fistula
56
management of large pancreatic pseudocyst
wait until "rind" forms, then do a cystgastrostomy, cystduodenostomy, or cystjejunostomy
57
if pancreatic pseudocyst becomes infected...
IR catheter drainage preferred over internal drainage
58
treatmetn of pancreatic necrosis
broad spectrum antibiotics. if signs of infection, necrosectomy is indicated
59
unrelenting pain in chronic pancreatitis. tx
surgical therapy- drainage procedures or pancreatectomy
60
drainage procedure vs. pancreatectomy in tx of chronic pancreatitis
drainage procedure best when duct is dilated (chain of lakes), puestow procedure. pancreatecomy best when duct looks normal
61
whipple procedure
pancreaticoduodenectomy
62
total pancreatectomy leads to
brittle DM
63
pancreatic cancer is treated surgically ONLY if
there is a chance of surgical cure
64
upper abdominal pain, jaundice, high transaminase. Normal gallbladder. NO fever.
hepatitis
65
patient presents with acute onset lower abdominal pain, well localized, change in bowel habits, fever
diverticulitis
66
what diagnostic test MUST you do if suspect diverticulitis
CT
67
3 categories of inpatient diverticulitis
unperforated, microperforated/abscess, freely perforated
68
tx of diverticulitis
po antibiotics
69
unperforated diverticulitis tx
IV abs, NPO, re-CT if worsening
70
microperforated diverticulitis
IV abs, NPO, IR drainage of abscess, interval CT's
71
freely perforated diverticulitis
IV abs, sugical management
72
to prevent recurrence of diverticulitis
high fiber diet and fiber supplements
73
surgical tx considered for GERD if
young patients on maximal medical therapy, patients with poor control of their symptoms, and patients with severe esophagitis
74
does surgical tx cure baretts esophagus?
NO, though regresion may occur. these patients still need surveillance every 2 years
75
gold standard for diagnosing GERD
ph monitoring using pH probe (obtain deMeester score)
76
GERD surgeries if indicated
nissen fudoplication, toupet, belsey mark IV, collis, endoscopic (TIF)
77
distinguish US and HIDA in acute vs. chronic cholecystitis
acute- US shows thickened gallbladder wall and pericholecystic fluid. HIDA shows non-filling of gallbladder. chronic- US shows no fluid or GB wall thickening, stones. HIDA- slow filling, low EF
78
what organ most commonly affected in nissen fundoplication in GERD tx?
spleen
79
chronic cholecystitis and biliary dyskinesia tx
laparoscopic cholecystecomy, intraoperative cholangiogram, possible open
80
if patient with biliary dyskinesia indicated for surgery, what do you warn them/
that 10% chance pain will not change after surgery
81
bacterial infection of bile ducts
bacterial cholangitis
82
bacterial cholangitis always signifies...
obstruction
83
causes of bacterial cholangitis
choledocholithiasis (most common), biliary stricture, and neoplasm
84
charcot's triad
biliary colic (RUQ abdominal pain), jaundice, fever/chills in bacterial cholangitis
85
severe form of bacterial cholangitis
suppurative cholangitis
86
diagnostic pentad of suppurative cholangitis
biliary colic, jaundice, fever, confusion/lethargy, and shock
87
patient presents with painless jaundice
pancreatic head cancer
88
tx bacterial cholangitis
IV abx, then decompression of the duct
89
common organisms in bacterial cholangitis
e. coli, klebsiella, pseudomonas, enterococcus
90
patient presents with anal pain, esp after bowel movment, BRBPR
anal fissure
91
patient with anal fissure treated medically with fiber suppleemtns, miralax, hydrocortisone suppositories and cream, sitz baths. no relief. what surgery do you consider/
lateral internal sphincterotomy - open, closed, or lateral position
92
types of surgeries in liver
wedge resection, hepatic segmentectomy, partial hepatectomy, RFA, needle biopsy, TIPS
93
RFA for liver surgery should not be used near...
large vessels (heat sink)
94
patient with cirrhosis with hypervascular mass larger than 2 cm, serum AFP larger than 400 ng/mL diagnostic of
hepatocellular carcinoma
95
TIPS =
transjugular intrahepatic portosystemic shunt - liver disease

Surgery/ER Fall 2013 (11 decks)

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