Duke PA Gastrointestinal Surgery
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| implies severe abdominal pain arising rather suddenly and of less than 24 hours duration | show 🗑
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| show | epigastrum
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| pain from structures arising from the midgut (small bowel, and right transverse colon) localizes to the | show 🗑
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| pain from structures arising from the hindgut (left colon, sigmoid colon, rectum) localizes to the | show 🗑
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| show | GI Tract obstruction
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| show | perforation, ischemia, inflammation, or hemorrhage
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| classic signs and symptoms are mild fever and focal right lower quadrant pain with rebound tenderness | show 🗑
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| show | acute cholecystitis
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| show | acute cholecystitis
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| show | acute cholecystitis
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| McBurney point | show 🗑
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| laparoscopic approach has been proven safe in both acute and chronic settings | show 🗑
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| pain that localizes to right lower quadrant accompanied by anorexia, nausea, and vomiting is classic | show 🗑
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| the normal anatomic position of the appendix | show 🗑
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| show | hidden position of appendix
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| show | right upper quadrant
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| in western populations the lifetime risk of appendicitis is __% | show 🗑
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| show | adolescents and young adults
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| show | appendicitis
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| show | obstruction of the appendiceal lumen
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| show | fecaliths, foreign bodies, tumors, parasites, and lymphoid hyperplasia
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| the number of ___ in the vermiform appendix peaks between the ages of 10-30 | show 🗑
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| show | diverticula, and duplications
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| after obstruction of the appendiceal lumen ___ continue | show 🗑
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| show | bacterial overgrowth and increased intraluminal pressure
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| show | increased intraluminal pressure causes vascular congestion
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| ____ alone should make the diagnosis of acute appendicitis in most patients | show 🗑
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| show | migrate to the right lower quadrant and become more intense
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| show | are usually not excessive
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| show | the diagnosis of appendicitis should be questioned
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| show | fever
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| a temperature will rarely be highter than __ unless the appendix is grossly perforated | show 🗑
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| with appendicitis vital signs are | show 🗑
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| show | lie motionless
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| patients with colicky-type pain may appear | show 🗑
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| palpation of left lower quadrant causing right lower quadrant pain | show 🗑
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| deep palpation of right lower quadrant followed by a sudden release | show 🗑
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| show | false positive
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| a positive ___ sign may indicate an inflamed appendix lying anterior to the ___ muscle | show 🗑
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| show | psoas sign
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| ___ is produced by stretching this muscle with passive internal rotation of the thigh, with the hips in a flexed position | show 🗑
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| both the obturator and psoas signs are | show 🗑
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| show | rectal
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| show | within the pelvis
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| ____ on fecal exam should be quite rare and lead to the consideration of a diagnosis other than appendicitis | show 🗑
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| show | before incision
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| show | the junction of the three tenia
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| the ___ lies posterior to the cecum or terminal ileum | show 🗑
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| after incision if appendicitis is not present | show 🗑
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| show | open packing
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| show | exploratory laparotomy, and appendectomy
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| laparotomy can be accomplished through a ____ incision | show 🗑
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| this is an oblique incision, which divides the fascia parallel to its fibers, and a muscle splitting technique is used (used for appendicitis) | show 🗑
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| a right-lower-quadrant transverse ___ incision is preferred by many for appendicitis | show 🗑
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| in the elderly where other disease processes may be encountered, many surgeons would prefer a ____ incision | show 🗑
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| ____ are usually indicated if a well-formed intraabdominal or pelvic abcess is encountered | show 🗑
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| if a case of perforated appendicitis with generalized peritonitis is encountered, the wound should be considered grossly contaminated and | show 🗑
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| show | Chron's Disease
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| show | laparoscopy
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| show | when the diagnosis is in question
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| show | in women of reproductive age
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| show | in obese patients
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| show | in the elderly
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| show | should be of short duration
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| show | 24-48
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| show | septic
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| once a wound infection is diagnosed the primary treatment is | show 🗑
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| if cellulitis is present in an infected wound | show 🗑
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| show | necrotizing fasciitis
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| ___ is the result of the abdominal host defenses attempting to wall off an infectious threat | show 🗑
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| show | postoperative abscess
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| an abscess after appendicitis most commonly occurs in the | show 🗑
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| the most common treatment for postoperative abscess is | show 🗑
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| show | pylephlebitis
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| this is a rare presentation of an advanced septic process due to gas-forming organisms | show 🗑
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| show | pylephlebitis
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| appendicitis is seen in approximately 1 in ___ pregnancies | show 🗑
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| the most common nonobstetric emergency in pregnant women | show 🗑
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| WBC count in a pregnant woman is unreliable, however a ___ can be seen in appendicitis | show 🗑
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| the risk of conventional diagnostic radiographs such as a KUB or CT scans is ___ after the first trimester | show 🗑
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| abdominal wall hernias occur in __% of the United States population | show 🗑
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| a cleft in the anterior abdominal wall that is bound anteriorly by the external oblique aponeurosis and posteriorly by the transversalis fascia | show 🗑
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| the spermatic cord in males and the round ligament in females enter ____ through the transversus abdominis fascia at the interanl inguinal ring | show 🗑
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| the spermatic cord travels the length of the inguinal canal and exits through the | show 🗑
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| show | indirect inguinal
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| with time indirect inguinal hernias may extend along the canal and exit through the internal ring into | show 🗑
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| show | indirect inguinal hernias
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| ____ hernias come through the posterior wall of the inguinal canal and are a defect in the transversalis fascia | show 🗑
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| direct inguinal hernias infrequently enter | show 🗑
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| the main etiologic factor in direct inguinal hernias is | show 🗑
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| show | cigarette smoking, advanced age, chronic illness
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| ____ hernias are more common in women | show 🗑
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| because of the risk of ____ nonsurgical management of hernias is not recommended | show 🗑
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| show | truss
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| ___ is a surgical emergency | show 🗑
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| the ___ approach is best for recurrent hernias (open or laparoscopic) | show 🗑
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| the recurrence rate for direct inguinal hernias is __% | show 🗑
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| the recurrence rate for indirect inguinal hernias is __% | show 🗑
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| show | only when a suture repair would be under undue tension
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| show | wound infection, obesity, or malnutrition
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| when mesh prosthesis is used in inguinal hernia repair, the mesh is sutured to | show 🗑
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| the results of ____ in inguinal hernia repair have been very good | show 🗑
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| show | Stoppa technique
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| the anterior boundry of the inguinal canal | show 🗑
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| the posterior boundry of the inguinal canal | show 🗑
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| the inferior boundry of the inguinal canal | show 🗑
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| the superior boundry of the inguinal canal | show 🗑
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| ___ come through the posterior wall of the inguinal canal | show 🗑
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| ___ come through the internal or deep inguinal ring | show 🗑
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| show | Bassini repair
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| show | McVay (Cooper's ligament repair)
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| the transversus abdominus aponeurosis, and the internal oblique aponeurosis | show 🗑
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| the anterior boundry of the femoral canal | show 🗑
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| show | Cooper's ligament
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| show | lacunar ligament
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| show | femoral vein
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| show | 1-2
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| show | operative
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| show | 2
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| show | congenital
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| ____ umbilical defects should be repaired | show 🗑
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| show | very uncommon
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| show | very few
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| show | exhales
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| show | an onlay of polypropylene mesh should be performed
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| inflammation of the gallbladder | show 🗑
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| in the vast majority of cases (>90%) of acute cholecystitis ___ is the initiating event | show 🗑
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| show | persistant RUQ pain, fever, elevated WBCs, and alteration in liver chems.
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| acute cholecystitis is associated with ___ in 50-75% of cases | show 🗑
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| if cholecystitis is left untreated ___ may develop (most often seen in diabetic patients) | show 🗑
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| ____ leads to increased morbidity and mortality from perforation of the gallbladder or overwhelming sepsis | show 🗑
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| show | be admitted to the hospital, made NPO, and started on intravenous fluids
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| contraindications to cholecystectomy | show 🗑
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| unless contraindications exist, ___ should be performed in the first 24-36 hours after admission | show 🗑
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| 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 | show 🗑
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| show | there may be some benefit in managing with antibiotics and deferring definitive treatment to 6 weeks
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| the success rates with this technique where low, and the complications high. Therefore this procedure has been abandoned | show 🗑
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| show | portal hypertension, cirrhosis, previous RUQ surgery
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| show | laparoscopic cholecystectomy
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| show | postoperative biles leak
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| show | painless jaundice
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| show | minimal pain and be able to eat
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| what are the 4 F's of gall stones | show 🗑
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| show | gallstones in the cystic duct
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| choledocholithiasis | show 🗑
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| __% of gallstones are radioopaque | show 🗑
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| show | cholangitis
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| cholecystectomy is performed for | show 🗑
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| show | laparoscopic cholecystectomy
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| show | laparoscopic cholecystectomy
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| complications of laparoscopic cholecystectomy | show 🗑
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| what do you want to see on the critical view for cholecystectomy | show 🗑
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| common bile duct injury is ___ with lap approach | show 🗑
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| ___ hernias go through Hasselbach's triangle | show 🗑
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| show | Hesselbach's triangle
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| which is a recurrent hernia by definition | show 🗑
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| male:female ratio of inguinal hernia __:1 | show 🗑
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| show | femoral hernia
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| show | pantaloon hernia
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| show | Computed tomography (CT) scan
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| inability to reduce hernia contents | show 🗑
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| compromise of intestinal vascular supply secondary to incarceration | show 🗑
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| show | Bassini
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| show | Lictenstein
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| show | recurrent hernia (failed repair), or bilateral hernia
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| show | more cost-effectiveor less morbid
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| function of the colon | show 🗑
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| show | Bacteroides fragilis
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| most common aerobes in colon | show 🗑
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| outpouching of the wall of a hollow viscus | show 🗑
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| true diverticula (13%) | show 🗑
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| pseudodiverticula (87%) | show 🗑
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| show | diverticulosis
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| show | acute diverticulitis
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| surgery for acute diverticulitis is indicated for | show 🗑
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| show | bowel rest, IV fluids, IV antibiotics, abscess drainage if present
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| show | colovesical fistula
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| show | sigmoid volvulus
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| show | sigmoid volvulus
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| bright red blood per rectum | show 🗑
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| show | upper GI bleed
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| most common cause of lower GI bleed hematochezia | show 🗑
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| signs of hypovolemia | show 🗑
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| show | Crohn’s Disease
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| show | Crohn's disease
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| 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 | show 🗑
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| show | terminal ileus
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| show | surgeons
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| mainstay of medical treatment for Chron's disease | show 🗑
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| indications for surgery in Crohn's | show 🗑
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| Surgery cannot cure __ | show 🗑
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| show | treat complications, and palliate symptoms
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| Superficial inflammatory process involving mucosa of colon | show 🗑
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| Involves the rectum and moves proximally | show 🗑
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| show | ulcerative colitis
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| show | 3rd
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| colorectal cancer risk factors | show 🗑
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| show | 50
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| Family History or Inherited Colon Cancer SyndromeAnnual screening with colonoscopy beginning at __ years of age younger than the earliest detected familial cancer | show 🗑
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| show | Colorectal cancer
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| show | submucosal, hyperplastic, hamartomatous, adenomatous(premalignant lesion)
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| show | abdominal CT, Chest X-ray, Endorectal Ultrasound
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| show | hemorrhoids
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| Predisposed by age, gravity, shear forces, increased abdominal pressure | show 🗑
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| show | External hemorrhoids
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| show | internal hemorrhoids
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| internal hemorrhoidal disease without significant external disease or other benign anorectal disease, can be | show 🗑
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| ____ use for large mixed hemorrhoids or when other benign anorectal diseases present | show 🗑
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