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GI Surgery 1
Surgery
| Question | Answer |
|---|---|
| Appendicitis: Pathophysiology | hyperplasia (kids); fecalith (adults); also neoplasm, parasite |
| Appendicitis prevalence | 7% general (mostly teens); 20% mortality in elderly |
| Appendicitis: most common (first) sx | anorexia |
| Appendicitis: complications | Wound infxn; Dehiscence; Bowel obstruction; Peritoneal abscess; Stump appendicitis |
| Appendicitis: pt mgmt | Laparoscopic appendectomy; after 24-48 hr (prob ruptured): percutaneous drainage & Abx; interval appy after 4 wks |
| Gold standard for dx appendicitis | CT (>7 mm & >2mm thick = appy) |
| Imaging used for appy in kids: | US |
| Cholecystectomy: performed for: | cholelithiasis, cholecystitis, gallstone pancreatitis, GB cancer |
| Gall stones: Etiology related to: | increasing conc of cholesterol (chol stones: 80%) or bile salts (pigments stones: 15%) |
| Gall stones: 4 Fs | female, fertile, fat, forty |
| Cholecystectomy: prevalence | US: 10-20% of popn develop gallstones; 60-80% of pts w/ gallstones never develop sx |
| Gall stones: sx | Abd pain, jaundice, fever |
| Gall stones: dx imaging | US best; plain films only 15%; CT; HIDA (dye) |
| Cholecystitis = | stone in neck (cystic duct); GB cannot drain |
| Cholangitis = | obstr GB as well as fr L/R ducts (common bile duct cannot drain) |
| Gall stone Pancreatitis = | obstr ampulla; have obstruction of pancreas: both Panc duct and common bile duct (can be surg emergency) |
| Procedure of choice for GB dz | Laparoscopic Cholecystectomy |
| Cholecystectomy: complications | Common bile duct injury (often w/ lap); retained stones (ERCP); Bile leak; Hemorrhage; abscess, bowel injury, wound infection |
| Abd hernia defn | protrusion of extraperitoneal fat, peritoneum, omentum, bowel, or other viscera thru a defect in transversalis fascia |
| Abd wall anatomy (in order): | Skin; SubQ Tissue; Ext Oblique Fascia; Cremasteric Fibers; Spermatic Cord; Transversus Abdominus Aponeurosis; Transversalis Fascia; Preperitoneal Tissue; Peritoneum |
| Hesselbach triangle | rectus sheath, Inf epigastric vessels, Inguinal lig |
| Direct inguinal hernia: | From gradual weakening of transversalis fascia. Directly thru inguinal triangle (do not occur in infants). Defect is medial to internal ring & inside Hesselbach triangle. |
| Indirect inguinal hernia: | Congenital. Abd viscera pass thru internal ring within a patent processus vaginalis |
| Femoral hernia: | more common in elderly women; can become incarc / strangulated (repair early); medial to vessels, inferior to inguinal ligament |
| Epigastric hernia: | occur thru midline defects in fascia in upper abdomen |
| Sliding hernia: | a viscus forms an integral part of the wall |
| Incisional hernia: | recurrent by definition |
| Spigelian hernia: | lateral to rectus sheath |
| Grynfeltt’s/Petit’s hernia: | posterior hernias (lumbosacral area) |
| Internal hernia: | Rare; typically occurs thru openings in mesentery or ligaments within the peritoneum; usu strangulated (repair early) |
| Umbilical hernia: | Usuallycongenital. Also PG, obese, ascites |
| Hernia: imaging useful in obese pt | CT |
| Hernia: Incarceration | inability to reduce hernia contents |
| Hernia: Strangulation | compromise of intestinal vascular supply; secondary to incarceration |
| Open hernia repair: most common complications | wound related / infxn; testicular; urinary |
| Hernia post-op recurrence by type: | recurrent (5-35%); direct (4-10%); indirect, femoral (each 1-7%) |
| Purpose of onlay prosthetic mesh | when repair causes undue tension; bridges gap btw margins of hernia aperture |
| Laparoscopic vs open hernia repair | More expensive; longer op time; higher risk of rare serious comp; dec postop pain / numbness; quicker time back to work; equivalent recurrence |
| Bassini surg for: | direct / indirect inguinal |
| Coopers surg for: | direct, lg indirect, recurrent |
| Surg: femoral hernia | inguinal canal approach; open preperitoneal; or lap |
| Surg: incisional hernia | usu open |
| Type I hiatal hernia | Sliding hernia: GI junction is above hiatus of diaphragm. Most common type |
| Type II hiatal hernia | Paraesophageal or rolling hernia. GE junction remains intra-abdominal; stomach's fundus herniates |
| Mackler triad | Vomiting, lower chest pain, cervical subcutaneous emphysema; sx of esophageal perforation |
| Hamman sign | Crunching sound caused by heart beating against air-filled mediastinum; sx of esophageal perforation |
| Acalculous acute cholecystitis requires: | emergent surgery |
| Appendicitis clinical exam | RLQ pain with LLQ palpation (Rovsing sx), thigh extension (psoas sx), lateral hip rotation (obturator sx) |
| Dx studies for femoral hernia | US or CT. FNA bx ONLY IF fem hernia is excluded (otherwise risk bowel perf/abscess) |
| Hernia: direct vs indirect | Direct: through external inguinal ring / Hesselbach triangle. Indirect: through internal inguinal ring to inguinal canal (most common) |
| Direct inguinal hernia: | directly thru inguinal triangle (do not occur in infants) |
| Indirect inguinal hernia: | abd viscera pass thru internal ring within a patent processus vaginalis |
Created by:
Abarnard
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