GI surgery

Gastric Cancer

Most common histology for gastric cancer is adenocarcinoma.

Risk Factors for Gastric Adenocarcinoma

Includes smoked foods, high salt diet, gastritis, H. Pylori, family history, pernicious anemia, smoking, and low Vitamin C.

Diagnostic test of choice for Cholelithiasis

Ultrasound.

Cholangitis Pentad

Fever, RUQ pain, jaundice, hypotension, and shock (AMS).

Leading cause of Cholelithiasis

Gallstones caused by cholesterol.

Pathophysiology of Cholangitis

Gallstone obstruction in common bile duct and hepatic duct.

Boas sign

Pain radiating to right shoulder associated with cholilithiasis.

Best treatment for Cholangitis

Endoscopic Retrograde Cholangiopancreatography (ERCP).

Diet recommended for Chronic Pancreatitis

Low fat diet.

Highest risk factor for Chronic Pancreatitis

Alcohol abuse.

Symptoms associated with Chronic Pancreatitis

Pancreatic calcification, steatorrhea, and diabetes mellitus.

Diagnosis of Acute Pancreatitis

Ultrasound first, followed up with ERCP.

Disposition for Acute Pancreatitis

Admit; severe cases may require aspiration or surgical debridement.

Screening recommendations for Pancreatic Cancer

CT or MRCP if family history exists.

Tumor marker for Pancreatic Cancer

CA-19-9.

Risk factors for Pancreatic Cancer

Includes diabetes mellitus, tobacco use, gastric ulcers, and arsenic exposure.

Best treatment for Pancreatic Cancer

Whipple procedure (pancreaticoduodenectomy).

Which part of pancreas is most likely to develop cancer?

Pancreatic head.

Courvoisier's sign

Painless jaundice with palpable gallbladder associated with pancreatic cancer.

Most common cause of Acute Appendicitis

Fecolith.

First line treatment for SBO (Small Bowel Obstruction)

Keep NPO and do nasogastric decompression.

Clinical presentation of SBO

Nausea, vomiting of partially undigested foods, high-pitched bowel sounds, cramping abdominal pain.

How to diagnose bowel obstruction?

CT with contrast or abdominal X-ray showing free air levels and dilated loops of bowel.

First line for gallbladder imaging

Ultrasound.

Gold standard for gallbladder imaging

HIDA scan.

Crohn’s disease characteristics

Characterized by transmural inflammation with skip lesions and loud borborygmi.

How to diagnose Crohn’s disease?

CT with contrast; granulomas on colonoscopy are highly suggestive.

How to diagnose Ulcerative Colitis?

Sigmoidoscopy is preferred; can use CT with contrast.

Supplements for Crohn’s disease patients

Vitamin D and B12.

Supplement for Ulcerative Colitis

Iron.

Complications associated with Ulcerative Colitis

Toxic megacolon, anemia, fulminant colitis, osteoporosis, cancer.

Complications associated with Crohn’s

Aphthous ulcers, anterior uveitis, erythema nodosum, DVT, gallstones, cancer.

Medications for Ulcerative Colitis flare-up

Aminosalicylates like sulfasalazine or mesalamine; can use steroids or infliximab.

Medications for Crohn’s flare-up

Steroids like budesonide or prednisone; consider monoclonal antibodies like infliximab.

Screening recommendations for Colon Cancer in Crohn's patients

Annual screening for patients with Crohn's for 8 or more years.

Imaging findings of Ulcerative Colitis

Lead-pipe appearance and diffuse friability and erosions in colon.

Diagnosis of Anal Fissure

Severe dyschezia and hematochezia with a linear ulcer at the posterior midline.

Treatment for Anal Fistula

Surgery.

Treatment for perforated viscus

IV antibiotics and surgical repair.

Preferred treatment for external hemorrhoids

Stool softeners and sitz baths.

Preferred treatment for internal hemorrhoids

Rubber band ligation or electrocautery.

First line treatment for Anal Fissures

Bulking agents and Sitz baths; topical nitroglycerin or botox injections.

Contraindications to laparoscopic hernia repair

Incarceration or strangulation, active infection, ascites, prior pelvic history.

Next best step for GERD diagnosis with dysphagia and odynophagia

Barium swallow study.

Gastric ulcer presentation

60 y/o male experiencing hematemesis after meals.

Virchow’s node

Palpable supraclavicular lymph node from gastric cancer.

Primary sclerosing cholangitis

Autoimmune fibrosis in hepatic ducts, associated with UC, can progress to cholangiocarcinoma.

Diagnostic workup for pancreatic pseudocysts

CT with contrast.

Treatment for pancreatic pseudocysts

Usually benign; can do endoscopic or percutaneous drainage.

Diagnosis of Pancreatic Cancer

CT with contrast.

Common cause of upper GI bleed in alcoholics

Esophageal varices.

Procedures to treat Esophageal Varices

Banding, sclerotherapy, or TIPS.

Risk factors for Esophageal Cancer

Smoking, alcohol use, GERD.

Esophageal cancer type associated with Barrett’s esophagus

Adenocarcinoma.

Diagnosis of esophageal strictures

Barium swallow followed by endoscopy.

Age for Pyloric Stenosis

2-5 weeks.

Diagnosis of Zollinger-Ellison syndrome

Fasting serum gastric level >150; confirm with endoscopy and biopsy.

Derm condition associated with Hepatocellular carcinoma

Seborrheic keratosis.

Tumor marker for Hepatocellular carcinoma

Alpha-fetoprotein (AFP).

Leading cause of Hepatocellular carcinoma

Viral cirrhosis from Hepatitis B or C.

Diagnosis of Volvulus

Abdominal X-ray.

Infant with bilious vomiting and dilated loop of bowel treatment

NG decompression and endoscopic detorsion.

Free air on X-ray indicates

Perforated viscus.

Recurrent vomiting is associated with which electrolyte abnormalities?

Low potassium and chloride.

Difference between conjugated and unconjugated bilirubin

Conjugated is past the liver and associated with infections. Unconjugated is the majority and associated with genetic causes.

Diagnosis of Hepatocellular Carcinoma

Ultrasound is first line, CT is preferred; biopsy is definitive.

Diagnosis of Toxic Megacolon

Abdominal X-ray shows colon dilation >6 cm and loss of haustra.

Treatment for Toxic Megacolon

Bowel rest, IV antibiotics, and NG decompression; colectomy if no improvement after 72 hours.

Thin stools should raise concern for which diagnosis?

Colorectal cancer.

Post-bariatric surgery complications include

Tachycardia (anastomotic leak), infection, ulceration, bleeding, refeeding syndrome, and thiamine deficiency.

What is Sentinel pile?

Skin tag lesion on outside of rectum; associated with anal fissure.

How to confirm diagnosis of inguinal hernia?

CT with contrast; ultrasound in children or pregnant women.

Recommended antibiotics prior to abdominal surgeries

Metronidazole with Ciprofloxacin or Ceftriaxone.

How many lymph nodes required to stage colon cancer?

12 lymph nodes.

Medications that may cause Pyloric Stenosis

Macrolides like azithromycin.

Most common cause of hereditary jaundice

Gilbert syndrome; isolated jaundice from excess unconjugated bilirubin.

Best treatment of complex diverticulitis

IV antibiotics and consult surgery.

Difference between strangulated and incarcerated hernia

Incarcerated cannot be reduced; strangulated is ischemic and necrotic.