DU PA GI Surgery Word Scramble
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Question | Answer |
implies severe abdominal pain arising rather suddenly and of less than 24 hours duration | acute abdomen |
pain arising from the foregut (stomach, pancrease, duodenum and biliary tree) localizes to the | epigastrum |
pain from structures arising from the midgut (small bowel, and right transverse colon) localizes to the | periumbilical region |
pain from structures arising from the hindgut (left colon, sigmoid colon, rectum) localizes to the | hypogastric region |
intermittent colicky, poorly localized abdominal pain is found with | GI Tract obstruction |
steady, well localized pain usually occurs after | perforation, ischemia, inflammation, or hemorrhage |
classic signs and symptoms are mild fever and focal right lower quadrant pain with rebound tenderness | appendicitis |
commonly occurs in women between the ages of 40-60 who are overweight and have a previous history of pregnancy | acute cholecystitis |
patients will have right upper quadrant pain that is accentuated on inspiration, and is accompanied by nausea and vomiting | acute cholecystitis |
Murphy's sign | acute cholecystitis |
McBurney point | appendicitis |
laparoscopic approach has been proven safe in both acute and chronic settings | cholecystitis |
pain that localizes to right lower quadrant accompanied by anorexia, nausea, and vomiting is classic | appendicitis |
the normal anatomic position of the appendix | anterior intraperitoneal |
results in an increased risk of perforation due to delayed diagnosis | hidden position of appendix |
during the 5th month of pregnancy the appendix may rise as high as the | right upper quadrant |
in western populations the lifetime risk of appendicitis is __% | 7 |
appendicitis is primarily a disease of | adolescents and young adults |
incidence of ____ declines after age 30 | appendicitis |
____ is seen in approximately 70% of appendicitis cases | obstruction of the appendiceal lumen |
the appendiceal lumen can be obstructed by | fecaliths, foreign bodies, tumors, parasites, and lymphoid hyperplasia |
the number of ___ in the vermiform appendix peaks between the ages of 10-30 | lymphoid follicles |
rare causes of appendicitis | diverticula, and duplications |
after obstruction of the appendiceal lumen ___ continue | mucosal secretions of lining cells |
___ follows appendiceal obstruction | bacterial overgrowth and increased intraluminal pressure |
___ which ultimately leads to ulceration, necrosis, gangrene, and perforation | increased intraluminal pressure causes vascular congestion |
____ alone should make the diagnosis of acute appendicitis in most patients | history and physical exam |
after 1-12 hours of diffuse mild to moderate pain, appendicitis pain will usually | migrate to the right lower quadrant and become more intense |
Vomiting and diarrhea may be present in acute appendicitis but ___ | are usually not excessive |
if vomiting precedes abdominal pain or if anorexia is not present ____ | the diagnosis of appendicitis should be questioned |
___ should be present in 75%-85% of all patients with acute appendicitis | fever |
a temperature will rarely be highter than __ unless the appendix is grossly perforated | 38 degrees |
with appendicitis vital signs are | usually normal with slight tachycardia due to pain, fever, or dehydration |
patients with acute appendicitis prefer to | lie motionless |
patients with colicky-type pain may appear | restless |
palpation of left lower quadrant causing right lower quadrant pain | Rovsing's sign |
deep palpation of right lower quadrant followed by a sudden release | rebound examination |
asessing for rebound tenderness can lead to a | false positive |
a positive ___ sign may indicate an inflamed appendix lying anterior to the ___ muscle | psoas |
this sign is best demonstrated by extension of the hip or flexion against resistance | psoas sign |
___ is produced by stretching this muscle with passive internal rotation of the thigh, with the hips in a flexed position | obturator sign |
both the obturator and psoas signs are | non-specific and only present on occasion |
a ___ exam is also important in evaluating any patient with abdominal pain | rectal |
tenderness with a rectal exam is most commonly seen when the inflamed appendix lies | within the pelvis |
____ on fecal exam should be quite rare and lead to the consideration of a diagnosis other than appendicitis | gross blood |
administer prophylactic antibiotics | before incision |
the base of the appendix is located at | the junction of the three tenia |
the ___ lies posterior to the cecum or terminal ileum | appendiceal artery |
after incision if appendicitis is not present | a thourough search for other pathology is important |
consider ___ of the wound for advanced and perforated appendicitis | open packing |
the gold standard for the treatment of appendicitis is | exploratory laparotomy, and appendectomy |
laparotomy can be accomplished through a ____ incision | McBurney |
this is an oblique incision, which divides the fascia parallel to its fibers, and a muscle splitting technique is used (used for appendicitis) | McBurney incision |
a right-lower-quadrant transverse ___ incision is preferred by many for appendicitis | Rocky-Davis |
in the elderly where other disease processes may be encountered, many surgeons would prefer a ____ incision | lower midline laparotomy |
____ are usually indicated if a well-formed intraabdominal or pelvic abcess is encountered | intraabdominal drains |
if a case of perforated appendicitis with generalized peritonitis is encountered, the wound should be considered grossly contaminated and | packed open for closure by second intention or a delayed primary closure |
incindental appendectomy should not be performed if ___ is found to be affecting the cecum, as the incidence of fistulization may be quite high | Chron's Disease |
as a diagnostic procedure ____ is by far the most accurate, but it is invasive | laparoscopy |
laparoscopic appendectomy is especially useful | when the diagnosis is in question |
laparoscopic appendectomy is especially useful | in women of reproductive age |
laparoscopic appendectomy is especially useful | in obese patients |
laparoscopic appendectomy is especially useful | in the elderly |
antibiotic therapy in early appendicitis | should be of short duration |
in uncomplicated appendectomy patients should be moved to a diet and discharged within ___hours | 24-48 |
___ complications are by far the most frequently seen problem after appendectomy | septic |
once a wound infection is diagnosed the primary treatment is | to open the wound and to allow drainage of the purulent material |
if cellulitis is present in an infected wound | antibiotics are indicated |
early recognition, aggressive surgical debridement, and administration of broad spectrum antibiotics are critical in | necrotizing fasciitis |
___ is the result of the abdominal host defenses attempting to wall off an infectious threat | abscess |
drainage and antibiotics are the treatments for | postoperative abscess |
an abscess after appendicitis most commonly occurs in the | right paracolic gutter, pelvis, or intraloop position |
the most common treatment for postoperative abscess is | CT-guided catheter drainage |
the radiographic finding of air in the portal vein | pylephlebitis |
this is a rare presentation of an advanced septic process due to gas-forming organisms | pylephlebitis |
is often seen in the elderly, immunocompromised, or in advanced sepsis, and is often a preterminal finding | pylephlebitis |
appendicitis is seen in approximately 1 in ___ pregnancies | 2000 |
the most common nonobstetric emergency in pregnant women | appendicitis |
WBC count in a pregnant woman is unreliable, however a ___ can be seen in appendicitis | left shift |
the risk of conventional diagnostic radiographs such as a KUB or CT scans is ___ after the first trimester | negligible |
abdominal wall hernias occur in __% of the United States population | 1.5 |
a cleft in the anterior abdominal wall that is bound anteriorly by the external oblique aponeurosis and posteriorly by the transversalis fascia | the inguinal canal |
the spermatic cord in males and the round ligament in females enter ____ through the transversus abdominis fascia at the interanl inguinal ring | the inguinal canal |
the spermatic cord travels the length of the inguinal canal and exits through the | external oblique aponeurosis at the external inguinal ring |
____ hernias come through the internal inguinal ring and enter the inguinal canal | indirect inguinal |
with time indirect inguinal hernias may extend along the canal and exit through the internal ring into | the scrotum |
____ are usually caused by a lack of obliteration by the processus vaginalis during development | indirect inguinal hernias |
____ hernias come through the posterior wall of the inguinal canal and are a defect in the transversalis fascia | direct inguinal |
direct inguinal hernias infrequently enter | the scrotum |
the main etiologic factor in direct inguinal hernias is | any maneuver that increases intraabdominal pressure, such as frequent heavy lifting |
risk factors for direct inguinal hernias | cigarette smoking, advanced age, chronic illness |
____ hernias are more common in women | femoral |
because of the risk of ____ nonsurgical management of hernias is not recommended | incarceration and strangulation |
wearing a ___ does NOT gaurentee that a hernia will remain reduced and not incarcerate or strangulate | truss |
___ is a surgical emergency | acutely incarcerated hernia |
the ___ approach is best for recurrent hernias (open or laparoscopic) | posterior or preperitoneal |
the recurrence rate for direct inguinal hernias is __% | 5-10 |
the recurrence rate for indirect inguinal hernias is __% | 1-5 |
the us of a prosthesis for herniorrhaphies is mandatory | only when a suture repair would be under undue tension |
Ventral, incisional hernias frequently occur because of | wound infection, obesity, or malnutrition |
when mesh prosthesis is used in inguinal hernia repair, the mesh is sutured to | cooper's ligament, the iliopubic tract, and or the inguinal ligament inferiorly, and the conjoined tendon or internal oblique aponeurosis superiorly |
the results of ____ in inguinal hernia repair have been very good | various plug techniques |
a large peice of material is fixed with only a few sutures | Stoppa technique |
the anterior boundry of the inguinal canal | external oblique aponeurosis |
the posterior boundry of the inguinal canal | transversalis fascia and transversus abdominis aponeurosis |
the inferior boundry of the inguinal canal | inguinal and lacunar ligaments |
the superior boundry of the inguinal canal | internal oblique and transversus abdominis muscle and aponeuroses |
___ come through the posterior wall of the inguinal canal | direct inguinal hernias |
___ come through the internal or deep inguinal ring | indirect inguinal hernias |
inguinal herniorrhaphy in which the transversus abdominis aponeurosis and the internal oblique aponeurosis superiorly are sutured to the inguinal ligament | Bassini repair |
inguinal herniorrhaphy in which the conjoined tendon superiorly is sutured to Cooper's ligament inferiorly | McVay (Cooper's ligament repair) |
the transversus abdominus aponeurosis, and the internal oblique aponeurosis | conjoined tendon |
the anterior boundry of the femoral canal | iliopubic tract and inguinal ligament |
posterior boundry of the femoral canal | Cooper's ligament |
medial boundry of the femoral canal | lacunar ligament |
lateral boundry of the femoral canal | femoral vein |
hematomas and infections occur in __% of inguinal herniorrhaphies | 1-2 |
the only acceptable approach to the treatment of femoral hernias is | operative |
congenital umbilical hernias usually close spontaneously by age | 2 |
umbilical hernias are usually | congenital |
____ umbilical defects should be repaired | those that persist beyond age 4 or those larger than 2cm at an earlier age |
recurrence of umbilical hernia is | very uncommon |
umbilical hernias have ___ complications | very few |
if a hernia bulges with a valsalva maneuver it will reduce when the patient | exhales |
if a primary repair can be accomplished without excessive tension, yet the tissues appear weak ____ | an onlay of polypropylene mesh should be performed |
inflammation of the gallbladder | acute cholecystitis |
in the vast majority of cases (>90%) of acute cholecystitis ___ is the initiating event | obstruction of the cystic duct by a stone |
acute cholecystitis is distinguished from an attack of biliary colic by | persistant RUQ pain, fever, elevated WBCs, and alteration in liver chems. |
acute cholecystitis is associated with ___ in 50-75% of cases | bacterial pathogens |
if cholecystitis is left untreated ___ may develop (most often seen in diabetic patients) | severe gangrenous cholecystitis |
____ leads to increased morbidity and mortality from perforation of the gallbladder or overwhelming sepsis | severe gangrenous cholecystitis |
patients suspected of having acute cholecystitis should | be admitted to the hospital, made NPO, and started on intravenous fluids |
contraindications to cholecystectomy | myocardial ischemia, pancreatitis, cholangitis |
unless contraindications exist, ___ should be performed in the first 24-36 hours after admission | cholecystectomy |
the inflammatory process of cholecystitis is the most severe between ____ of the onset of symptoms, the technical challenge of successful laparascopic removal is greatest during this period | 72 hours to 1 week |
if the patient is diagnosed with choecystitis 4-5 days after onset of symptoms | there may be some benefit in managing with antibiotics and deferring definitive treatment to 6 weeks |
the success rates with this technique where low, and the complications high. Therefore this procedure has been abandoned | Extracorporeal shock wave lithotripsy for gallstones |
contraindications for laparoscopic cholecystectomy | portal hypertension, cirrhosis, previous RUQ surgery |
the treatment of choice for most patients with symptomatic gallstones | laparoscopic cholecystectomy |
after laparoscopic cholecystectomy, N/V and increasing abdominal pain are often early warning signs of | postoperative biles leak |
____ in an otherwise healthy patient is carcinoma of the biliary system until proven otherwise | painless jaundice |
after laparoscopic cholecystectomy patients should have | minimal pain and be able to eat |
what are the 4 F's of gall stones | female, fertile, fat, forty |
cholelithiasis | gallstones in the cystic duct |
choledocholithiasis | gallstones in the common bile duct |
__% of gallstones are radioopaque | 15 |
inflammation of the common bile duct | cholangitis |
cholecystectomy is performed for | cholelithiasis, cholecystitis, gallstone pancreatitis, gallbladder cancer |
now the procedure of choice for gallbladder disease | laparoscopic cholecystectomy |
causes less pain, shorter hospital stay | laparoscopic cholecystectomy |
complications of laparoscopic cholecystectomy | abscess, bile leak, common bile duct injury, bowel injury, wound infection |
what do you want to see on the critical view for cholecystectomy | the cystic aretery and cystic duct both going into the gallbladder |
common bile duct injury is ___ with lap approach | more common |
___ hernias go through Hasselbach's triangle | direct |
It is defined by the following structures:Rectus abdominis muscle (medially), Inferior epigastric vessels (superior and laterally). Inguinal ligament, sometimes referred to as Poupart's ligament (inferiorly) | Hesselbach's triangle |
which is a recurrent hernia by definition | incisional hernia |
male:female ratio of inguinal hernia __:1 | 10 |
hernia below the inguinal ligament | femoral hernia |
elements of both direct and indirect hernia | pantaloon hernia |
____ is especially useful for obese patients when the differential diagnosis includes simple weakness of the abdominal wall in addition to an incisional or epigastric hernia | Computed tomography (CT) scan |
inability to reduce hernia contents | incarceration |
compromise of intestinal vascular supply secondary to incarceration | strangulation |
no mesh hernia repair | Bassini |
most common hernia repair using mesh | Lictenstein |
the only time you want to do a laparoscopic hernia repair | recurrent hernia (failed repair), or bilateral hernia |
Laparoscopic hernia repair has not been shown ___ than open repair | more cost-effectiveor less morbid |
function of the colon | absorption (water, electrolytes/carbohydrates), storage, propulsion, digestion |
Most common colonic bacteria | Bacteroides fragilis |
most common aerobes in colon | E. coli, Klebsiella |
outpouching of the wall of a hollow viscus | diverticula |
true diverticula (13%) | contain all layers of colon wall, congenital, usually solitary, and uncommon |
pseudodiverticula (87%) | herniation of submucosa and mucosa through circular muscle |
presence of multiple diverticula, present in majority of people >70 years, >90% in sigmoid, usually asymptomatic, common cause of massive lower GI bleed from right-sided location | diverticulosis |
inflammation or microperforation of diverticula, fever, LLQ pain, palpable mass, may produce abscess/colonic obstruction, does not usually cause bleeding | acute diverticulitis |
surgery for acute diverticulitis is indicated for | peritonitis, obstruction, intractable disease, recurrence, presence of fistula |
Non-operative management for diverticulitis | bowel rest, IV fluids, IV antibiotics, abscess drainage if present |
communication between colon and bladder | colovesical fistula |
torsion of redundant sigmoid colon on itself | sigmoid volvulus |
classical clinical picture of ____: elderly patients with a history of chronic constipation | sigmoid volvulus |
bright red blood per rectum | hematochezia |
most common cause of hematochezia | upper GI bleed |
most common cause of lower GI bleed hematochezia | diverticulosis |
signs of hypovolemia | tachycardia, hypotension, orthostatic hypotension |
Inflammatory disorder of unknown etiology with non-caseating granulomas in submucosa | Crohn’s Disease |
Discontinuous involvement --> skip lesions, Transmural (full-thickness) inflammation | Crohn's disease |
Clinical Presentation: abdominal pain is most common symptom, frequent bowel movements - diarrhea, abdominal distention with nausea and vomiting, rarely blood in stool, symptoms caused by eating --> weight lossComplications: fistula, stricture | Crohn's disease |
most common area affected by Crohn's disease | terminal ileus |
Crohn's diseas is a medical disease managed by __ | surgeons |
mainstay of medical treatment for Chron's disease | antiinflammatories-sulfasalazine, steroids, immunosuppressants, monoclonal antibodies, antibiotics |
indications for surgery in Crohn's | obstruction, perforation, fistula, cancer, perianal disease, failure of medical therapy, failure to thrive (pediatrics) |
Surgery cannot cure __ | Crohn's disease |
Goal of surgery for Crohn's disease | treat complications, and palliate symptoms |
Superficial inflammatory process involving mucosa of colon | ulcerative colitis |
Involves the rectum and moves proximally | ulcerative colitis |
Surgery can cure __ | ulcerative colitis |
colorectal cancer is the __ leading cause of death in the US | 3rd |
colorectal cancer risk factors | excess fat and alcohol intake, obesity, and sedentary lifestyle |
colorectal cancer screening recommendations include and annual DRE and FOBT starting at age | 50 |
Family History or Inherited Colon Cancer SyndromeAnnual screening with colonoscopy beginning at __ years of age younger than the earliest detected familial cancer | 10 |
Presentation of ___ includes: Change in Bowel Habits (pencil thin stool), Rectal Bleeding, Change in Stool Caliber, Colon Obstruction, Perforation and Abscess Formation, Fistula Formation, Abdominal Pain, Weight Loss, Jaundice | Colorectal cancer |
four types of colon polyps | submucosal, hyperplastic, hamartomatous, adenomatous(premalignant lesion) |
staging for colorectal cancer involves | abdominal CT, Chest X-ray, Endorectal Ultrasound |
Result from sliding downward of anal cushions | hemorrhoids |
Predisposed by age, gravity, shear forces, increased abdominal pressure | hemorrhoids |
below dentate line & covered by squamous epithelium, more common in women due to enlargement during pregnancy, large skin tags usually remain & may become inflamed, may thrombose | External hemorrhoids |
above dentate line & covered by columnar epithelium, may prolapse, bleed, and/or thrombose | internal hemorrhoids |
internal hemorrhoidal disease without significant external disease or other benign anorectal disease, can be | banded |
____ use for large mixed hemorrhoids or when other benign anorectal diseases present | Surgical hemorrhoidectomy |
Created by:
bwyche
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