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Surgery I - GI
I
| Question | Answer |
|---|---|
| Incidence of appendicitis is highest in which population? | Teenagers |
| What is the most common symptom of appendicitis? | Anorexia |
| Where is McBurney's point located? | 2/3 of the way from the umbilicus to the ASIS |
| What is the gold standard of diagnosis for appendicitis? | CT scan |
| What is the treatment for ruptured appendix? | Percutaneous drainage and antibiotics appendectomy 4 wks later |
| Name the most significant complication following cholecystectomy * | Common bile duct injury |
| An abdominal hernia is a protrusion of viscera through a defect in which abdominal layer? | Tranversalis fascia |
| What causes an area of weakness to convert into a hernia? | Incraese in intra-abdominal pressure |
| What are the borders of Hasselbach's triangle? | Inguinal ligament, inferior epigastric arter, rectus abdominus muscle |
| Describe the formation of an indirect hernia * | Abdominal viscera passes through the internal ring within a patent processus vaginalis |
| Describe the formation of a femoral hernia * | Bowel passes medial to the femoral vein, underneath the inguinal ligament |
| What maneuver will help to accentuate a hernia? | Valsalva |
| What type of imaging is useful in obese patients in the diagnosis of a hernia? | CT scan (>90% sensitive, >90% specific) |
| What is the difference between an incarceration and strangulation? | Incarceration - inability to reduce hernia contents Strangulation - compromise of intestinal vascular supply |
| What is the standard of care for inguinal hernia repair? * | Polypropylene mesh |
| What is the standard of care for femoral hernia repair? * | Cooper's pectineal ligament repair |
| What is the recurrence for hernia after open repair? * | <5% |
| At what age, in children, can an umbilical hernia be repaired? * | Age 4 |
| Name two physical exam findings in scrotal hernia | 1. bowel sounds on auscultation of scrotum 2. peristalsis |
| In comparison of laproscopic vs. open hernia repair, which is: 1. more $$$ 2. a longer surgery 3. has a higher risk of serious complications 4. causes the most post-op pain 5. Highest recurrence * 6. quickest recovery | 1. Lap 2. Lap 3. Lap 4. Open 5. equivalent * 6. Lap |
| What functions of the colon is supplied by the :* 1. sympathetic NS 2. parasympathetic NS | 1. Sphincter tone 2. Intestinal motility and secretions (rest and digest) |
| Identify the most common colorectal: * 1. anaerobic organisms 2. aerobic organisms | 1. Bacteroides fragillis 2. E. coli and Klebsiella |
| A true diverticula (type II) contains how many layers of the colon wall? * | All layers |
| Which of the diverticula is most common? * | Pseudodiverticula (Type I) - herniation of submucosa through circular muscle only |
| *Differentiation between: 1. Diverticulosis 2. Diverticulitis | 1. erosion of the blood vessels 2. herniation of the submucosa causing inflammation an often abscess |
| What is a common cause of massive lower GI bleed from right-sided location?* | Diverticulosis |
| Most commonly associated symptom of acute diverticulitis? | Left lower quadrant pain |
| How is an acute diverticulitis diagnosis made? | Clinical suspicion confirmed by CT scan |
| Colovesical fistula:* 1. Definition 2. Most common symptom | 1. communication between the colon and bladder 2. pneumaturia - gas/stool coming out of the urethra |
| What is the most common cause of hematochezia? * | Upper GI bleed |
| * Name the two most important aspects of initial management for a patient with a massive lower GI bleed | 1. ABC's and vital signs 2. Placement of 2 large bore IV lines |
| * What 2 findings are characteristics of Crohn's disease? | 1. non-caseating granulomas in submucosa 2. transmural (full-thickness) inflammation of the colon |
| Discuss operative management for Crohn's disease | Incurable: goal is to treat cdomplications (obstruction, fistula, perforation) and palliate symptoms |
| *Define ulcerative colitis | Superficial inflammatory process involving mucosa of colon |
| * What histologic finding is characteristic of ulcerative colitis? | Crypt abscesses and inflammatory pseudopolyps |
| Discuss operative management for ulcerative colitis | Removal of the entire colonic mucosa is curative |
| Incidence of colon cancer | Third leading cause of death in US |
| What food groups are protective again colon cancer? | Fiber, Carbs and plant foods |
| Discuss screening recommendations for colon cancer in the general population | 1. annual digital rectral exam and fecal occult blood tests starting at age 50 OR 2. Flexible sigmoidoscopy every 3-5 yrs starting at age 50 OR 3. colonoscopy every 10 years |
| Discuss screening recommendations for patients with a family history of colon cancer | Annual screening with colonoscopy beginning at 10 yrs of age younger than the earliest detected familial cancer |
| Which type of colon polyp is considered a premalignant lesion? | Adenomatous |
| What is the first line of treatment in adenocarcinoma of the colon? | Pre-operative work-up for metastatic disease |
| When shoudl oral antibiotics be given in bowl surgery? | 30 minutes prior to incision |
| Dysfunction of the puborectalis muscle is associated with what? | Fecal incontinence |
| * In patients >40 yo with hemorrhoids, what further testing should be done? | Colonscopy to rule out proximal disease |
| What is the treatment for symptomatic: 1. internal hemorrhoids 2. external hemorrhoids | 1. rubber band ligation 2. excisional hemorrhoidectomy. |
| What is the most common cause of appendicitis in children? | Hyperplasia |
| What is the most common cause of appendicitis in adults? | Fecalith |
| What is a fecalith? And what is it the most common cause of? | A fecalith is a lunminal obstruction that causes distention, venous congestion, thombosis, ischemia, gangrene, necrosis and eventual rupture. Most common cause of Appendicitis in adults. |
| What is Rovsing's sign and what is it indicative of? | Pain in RLQ elicited with palpation of LLQ - indicated appendicitis |
| What is Obturator sign and what is it indicative of? | Pain with internal rotation - indicates appendicitis |
| What is Iliopsoas sign and what is it indicative of? | Pain on extension of right hip - appendicitis |
| What % of people with gallstones will never develop symptoms? | 60-80% |
| What is cholelithiasis? | gallstones in the cystic duct |
| What is Choledocholithiasis? | gallstones in the common bile duct |
| What are the 4F's of Gallstones? | Female, Fertile, Fat, Fourty |
| Is common bile duct injury more common with lap approach or open? | Laproscopic |
| What are the 4 major types of hernias? | Epigastric, Umbilical, Inguinal, Femoral |
| Are inguinal Hernias more common in men or women? | Men 10:1 (lifetime prevalence 25%) |
| Are Femoral hernias more common in men or women? | Women - 70% of these will occur in women and 25% become incarcerated/strangulated so repair early! |
| What can be an useful adjunct to PE in obese pts when suspect simple weakness of abdominal wall and incisional or epigastric hernia? | CT scan |
| What is incarceration in relation to hernias? | inability to reduce hernia contents |
| What is strangulation in relation to hernias? | compromise of intestinal vascular supply secondary to incarceration |
| Bassini repair is used on what? | Hernias |
| What are the functions of the sympathetic NS to the colon and where does is arise from? | arises from the superior mesenteric ganglion, increases sphincter tone, inhibits motility and secretions |
| What are the functions of the parasympathetic NS to the colon and where does is arise from? | arises from the vagus, increases intestinal motility, relaxes sphincter tone |
| Where are >90% of all diverticulosis? | |
| What is Goodsall's Rule concerning anal fistulas? | Fistulas with external opening anterior to midanal line usually connected to internal opening by short, straight tract. Posterior external openings follow curved course to internal opening in posterior midline. |
Created by:
eedavila
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