Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
GI Surgery 2
Surgery
| Question | Answer |
|---|---|
| Areas of colon most likely injured by ischemia | Splenic flexure & sigmoid colon: |
| Most likely spot in colon for perforation | Cecum |
| colon: 2 nerve plexi | Meissner’s (submucosal); Auerbach’s (myenteric) plexus |
| colon: NS (symp & parasymp): | Symp: from sup mesenteric ganglion; Para: from vagus |
| colon flora | 99% anaerobe (bacteroides); aerobes = E coli / Klebs; colon much more bac than ileum |
| Diverticulitis etiology: | Outpouching of the wall of a hollow viscus; type I (pseudo; herniation thru circular mx); type II (all layers of colon wall; rare/congenital) |
| Diverticulitis dx | fever, LLQ pain / tender; palpable mass; abscess, colon obstructn?; dx w/ CT |
| Bleeding: diverticulosis vs diverticulitis | diverticulosis will bleed |
| Diverticulitis mgmt | usu in hosp; resection (w/ diversion?); return for colostomy takedown |
| etiology: colovesical fistula | complicn of diverticulitis, ca, * IBD (men); fistula) btw colon & bladder (or colovaginal) |
| dx: colovesical fistula | pneumaturia/ fecaluria; dx w/ CT +/- cystogram |
| mgmt: colovesical fistula | Etiology specific; bowel rest +/- surgery |
| etiology: lower GI hemorrhage | Diverticular; AV malform; post-procedure; ca; colitis; upper GI |
| dx: lower GI hemorrhage | proctoscopy, colonoscopy, tagged RBC scan |
| lower GI hemorrhage: s/s of Hypovolemia | Tachycardia, Hypotension, Orthostatic Hypotension |
| mgmt: lower GI hemorrhage | 2 lg bore IV, LR +/- PRBC; if persists: Total Abdominal Colectomy |
| etiology: colon volvulus | Torsion of redundant sigmoid colon on itself (elder constip pt) |
| dx: colon volvulus | abd distension, N&V, pain; obstructn / ischemia? Dx w/ KUB, gastrograffin enema (shows bird beak) |
| mgmt: colon volvulus | if peritonitis: explor laparotomy & resect w/ colostomy; if stable: colonic decompression, bowel rest; prep for sigmoid colectomy / anastomosis |
| etiology: Crohn’s colitis | non-caseating granulomas in submucosa; skip lesions; transmural inflam; anywhere in GI |
| dx: Crohn’s colitis | abd pain, diarrhea, distension, wt loss |
| mgmt: Crohn’s colitis | sulfasalazine; steroids |
| etiology: ulcerative colitis | Superficial inflam process involving colon mucosa; usu rectum; Crypt abscesses and inflammatory pseudopolyps |
| dx: ulcerative colitis | abd pain, wt loss, bloody diarrhea; dx w/ colonoscopy & bx |
| mgmt: ulcerative colitis | sim to Crohn dz; removal of entire colonic mucosa is curative |
| etiology: ischemic colitis | Acute: often post-AAA repair; |
| dx: ischemic colitis | acute: bloody diarrhea d/t mucosal slough; Dx: Emergent Flexible Sigmoidoscopy; chronic: episodic LLQ pain |
| mgmt: ischemic colitis | Maximize O2 Delivery; bowel rest; surg: tx comps only (perf / peritonitis) |
| etiology: hemorrhoids | sliding downward of anal cushions; external: below dentate & squamous epi; internal: above dentate & columnar epithelium |
| dx: hemorrhoids | 1st – 4th degree |
| mgmt: hemorrhoids | Tx only sx / int hemorrhoids; pt >40 eval by colonoscopy to r/o proximal dz; acute: poss topical hydrocortisone; surg if persists: banding or hemorrhoidectomy |
| etiology: anal fissure | elliptical ulcer or tear in anal canal; tearing of anoderm |
| dx: anal fissure | dx on PE (anoscope); always close to midline (usu posterior) of anal canal |
| mgmt: anal fissure | usu heal themselves; Botox; surg: lateral internal sphincterotomy |
| etiology: perianal abscess | Obstructed anal crypts leads to bac overgrowth in anal glands; M > F |
| dx: perianal abscess | pain, swelling, fever, pus: EUS & CT, needle aspirate |
| mgmt: perianal abscess | Abx; suspect gas-forming bac (esp w/ prosthetic / imm’compromised); I&D |
| Intersphincteric abscess: most common: | perianal (2nd most common: ischiorectal / lateral) |
| colorectal cancer prevalence | 60,000 d/yr; 3d leading COD |
| colorectal cancer risk factors | Smoking, EtOH, diet, obesity. Genetic: FAP, Gardner syndrome. IBD/UC, neoplastic polyps. HPV is RF for anal ca |
| Colon polyp types | Submucosal; Hyperplastic; Hamartomatous; Adenomatous (premalignant lesion) |
| Polyps: tx | Larger polyps or sessile polyps must be surgically resected as if early cancer |
| colorectal cancer: dx | CT (staging); CXR; Endo US; CEA |
| colorectal cancer screening | Annual DRE / FOBT at age 50 (or flex sigmoid q3-5 yr at 50; or colonoscopy q10 y) |
| Most common bowel prep used | Golytely |
| Pelvic floor mx | Iliococcygeous; Pubococcygeus; Puborectalis (most important): dysfn is assoc w/ fecal incontinence |
| General Layers of GI tract (4): | Serosa (outermost), Muscularis Propria, Submucosa, Mucosa (luminal / innermost) |
| Muscularis Propria contains: | [from outer to inner] - Longitudinal muscle, Auerbach (myenteric) plexus, Circula muscle |
| Submucosa contains: | Meissner (Submucosal) Plexus |
| GI Mucosa consists of: | Epithelium, lamina propria, muscularis mucosa |
| SBO clinical features | N/V, obstipation, crampy abd pain with crescendo-decrescendo pattern. Distention, high pitched metallic bowel sounds. |
| Ileus etiologies | Peritonitis, lyte imbalance, opioids, dysmotility disorders. |
| Carcinoid tumor locations | Tumors arise from neuroendocrine cells. Appendix is most common site; terminal ileus (no. 2) |
| Bronchospasm, flushing, diarrhea, right sided HF are clinical features of: | carcinoid tumor |
| SMA syndrome = | extensive ischemia/necrosis of small / lg intestines, from ligament of Trietz to mid-transverse colon |
| IMA syndrome = | extensive ischemia/necrosis of small / lg intestines, in left colon and sigmoid, Celiac artery is usually narrow or occluded (as in SMA syndrome) |
Created by:
Abarnard
Popular Medical sets