Surgery Recall

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Ballance's sign: dullness LUQ, resonant RUQ
Beck's triad: JVD
Decreased, muffled heart sounds
decreased bp

cardiac tamponade
bergman's triad: fat emboli

mental status changes
petechiae
dyspnea
Blumer's shelf: mets to the rectouterine
boas sign: right subscapular pain from cholelithiasis
Borchardt's triad: emesis then no emesis
epigastric distension
failure to pass an NgTube

gastric volvulus
Carcinoid: flushing
diarrhea
right sided heart failure
Charco's triad: Fever
Jaundice
RUQ pain
Chvostek's sign: twitching of facial muscles
Courvoisier's law: enlarged non-tender gallbladder seen w/ obstruction of the common bile duct most commonly w/ pancreatic cancer
Cullen's sign: blu periumbilical area- retroperitoneal hemorrhage tracking aroudn to the ant abdominal wall through fascial planes- acute hemorrhagic pancreatitis
Cushing's triad: HTN
Bradycardia
Irregular respirations
Danc'e sign: Empty right lower quadrant in kids w/ ileocecal intussusception
Fothergill's sign: differentiate intra-abdominal mass from 1 in the ab wall if mass is felt while there is tension on the musculature.
Fox's sign: ecchymosis of inguinal ligament seen w/ retroperitoneal bleeding
Hamman's sign/crunch: crunching on auscultation of the heart from emphysematous mediastinum, seen w/ oerhaave's syndrome, pneumomediastinum
Homan's sign: falf pain on forced dorsiflexion of the foot in DVT
Howship-Romberg sign: Pain along the inner aspect of the thigh; seen w/ obturator hernia as result of nerve compression.
Kehr's sign: severe shoulder pain in pts w/ splenic rupture- referred from diaphragm
Krukenberg tumor: mets to the ovary
Kelly's sign: visible peristalsis of the ureter
Laplace's law: Wall tension = pressure x radius
McBurney's point: 1/3rd distance form the ant iliac spine to the umbilicus on a line connecting the two
tenderness here is a sign of appendicitis.
Meckel's diverticulum rule of 2s: 2% of population
2 of those are symptomatic
2 ft of the ileocecal valve
Mittleschmerz: low quadrant pain in ovulation
Reynold's pentad: Fever
Jaundice
RUQ pain
Mental Status changes
Shock/sepsis
Rovsing's sign: palpation of the LLQ-> pain in RLQ- appendicitis
Saint's triad: cholelithiasis
Hiatal hernia
Diverticular disease
Silk glove sign: indirect hernia sac in peds; sac feels like a finger of a silk glove when rolled.
Sister Mary Joseph's sign: Mets to umbilical lymph nodes
Virchow' snode: mets to left supraclavicular cancer
Virchow' striad: risk factors for thrombosis
stasis
abnl endothelium
hypercoagulability
Trousseau's sign: carpal spasm after occlusion of blood.
Valentino's sign: RLQ pain from perfed peptic ulcer from succus/pus draining into RLQ
Westermark's sign: decreased pulm vasc marking on CXR in pt w/ pulmonary embolus
Whipple's triad: hypoglycemia
CNS and vasomotor symps
Relief of symps w/ admin of glucose
Wha is afferent loop syndrome: afferent loop of billroth II gastrojejunostomy
ARDS?: acute resp distress syndrome
what is blind loop syndrome: bacterial overgrowth of intestine caused by stasis
what is boerhaave's syndrome: esophageal perf
what is budd-chiari?: thrombosis of hepatic veins
dumping syndrome?: hyperosmolar chyme into the small bowel after vagotomy and a gastric drainage proccedure.
What is Fitz-Hugh-Curtis syndrome: perihepatic gonorrhea infection
what is gardner's syndrome: GI polyps
SOD- sebaceous cysts, Osteomas, and Desmoid tumors.
What is mendelson's syndrome?: chemical pneumonitis after aspiration of gastric contents
What is mirizzi's syndrome: extrinsic obstruction of the common hepatic bile duct from a cystic duct gallstone
What is ogilvie's syndrome: nonobstructive colonic dilation
what is peutz-Jeghers: benign polyps
what is plummer-vison syndrome: esophageal web
iron-deficiency anemia
dysphagia
spoon-shaped nails
atrophic oral and tongue mucosa

elderly, 10%- squamous cell carcinoma
what is RED reaction syndrome: skin erythema from vancomycin infusion
refeeding syndrome: hypoK, hypoMg, hypophos
What is Rendu-Osler-Weber syndrome: GI tract telangiectasia
what is short-gut?: malnutrition from 100cm of viable small bowel
what is sipple syndrome?: MEN II
what is tietze's syndrome?: costochondritis of rib cartilage; aseptic
what is trousseau's syndrome: DVT w/ carcinoma
Wermer's syndrome?: MEN I
What is another name for Crohn's: regional enteritis
What are common extra-intestinal manifestations of IBD?: A PIE SACK
Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholngitis
Arthritis, ankylosing spondylitis
Clubbing of fingers
kidney- amyloid, nephrotic syndrome
Crohn's epi: incidence populations sex distribution: 3-6/100,000
jew, low in black;
F>M
25-40; 50-65
UC: incidence populations sex distribution: 10/100,000
Jews, low in AA, + FHx in 20%
M>F
20-35; 50-65
What are the initial symptoms of Crohn's and UC?: Crohn's- ab pain, diarrhea, feer, weight loss, anal disease

UC- bloody diarrhea, fever, weight loss
what is backwash ileitis?: mild inflammation of the terminal ileum in UC;
which involves the anus? UC or crohn's: crohn's
which involves the rectum? UC or crohn's: UC
what are the mucosal findings in crohn's?: aphthoid ulcers
granulomas
linear ulcers
transverse fissues
swollen mucosa
Full thickness wall invovlement
what are the mucosal findings in UC?: granular, flat mucosa
Ulcers
Crypt abscess
Dilated mucosal vessels
Pseudopolyps
what meds are used for IBD?: sulfasalazine
roids
metronidazole
azathioprine, infliximab
what is infliximab?: TNF-alpha antibody
what looks like a lead pipe on barium enema?: chronic UC
what are the intraop findings in crohn's?: fat creeping onto the antimesenteric border of the small bowel
short and thick mesentery
thick bowel wall
fistula
abscess
what is teh operation for short strictures of the small bowel in crohn's?: stricturoplasty.
what is pouchitis?: inflammtion of the pouch of an ileoanal pull through.
what do you need for crohn's resection?: grossly negative margins
What is an anal fistula?: rectum to perianal skin
what causes an anal fistula?: crypt/gland infection
what are the signs and symps of anal fistula?: perianal drainage, perirectal abcess, "diaper rash, itching
what disease should be considered with fistula in ano?: Crohn's
how is the dx made?: exam, proctoscope
what is goodsall's rule?: ant. fistulas go straight
post. curl like a tail
What is the management of anal fistula?: define the anatomy, marsupialization of the tract
- sitz baths and dressing changes
- seton placement if fisutla is through the sphincter muscle
what is a aseton?: thick suture placed through fistula tract to slow transection of sphincer muscle- allow scar tissue formed to hold sphincter muscle in place. allow for continence
what % develop abcess after a fistula?: 50%
how do you find an opening to the fistula in the OR?: methylene blue- look for bubbles.
what are the signs of a perirectal abscess?: rectal pain, drainage of pus, fever, perianal mass
what is the cause of a perianal abcess?: crypt abscess in dentate line w/ spread.
what is an inflammatory polyp?: pseudo polyp in UC
what is a hamartomatous polyp?: normal tissue in abnormal configuration
what is a hyperplastic polyp?: normal, benighn
what are the neoplastic polyps?: tubular adenomas
tubulovillous adenomas
villous adenomas
what determines malignant potential of a polyp?: size, histo, atypia?
what is the most common type of adenomatous polyp?: tubular
what is the size cut off for a polyp to have tumor potential?: 2cm is high risk
33-55%
What is the cancer potential of a polyp?: villous > tubovillous > tubular
What is the % of carcinomas found in the polyps?: tubular- 5%
tubulovillous 20%
Villous- 40%
where are polyps found?: rectosigmoid
what are the signs/symps of rectal polyps?: bleeding, change in bowel habits, mucus per rectum, electrolyte loss, totally asymptomatic
what are teh diagnostic tests for polyps?: fecal occult blood, CBC, BE, endoscopy; all suspect tissue should be biopsied and sent to path.
what is the Rx of polyps?: endoscopic resection;
What gene is affected in FP?: APC gene
What are teh signs/ symps of SBO?: ab discomfort, cramping, nausea, ab distention, emesis, high-pitched bowel sounds
What labs should be ordered w/ an SBO?: E-lytes, CBC, type and screen, urinalysis
what are classic electrolyte/acid-base findings w/ proximal obstruction?: hypovolemic, hypochloremic, hypokalemic, alkalosis
what must be ruled out on an SBO exam?: hernia incarceration
what major AXR findings are associated w/ SBO?: distended loops of bowel, air fluid levels on upright film
what is the danger of complete SBO?: closed loop strangulation of the bowel-> necrosis
what is the initial management of all pts w/ SBO?: NPO, NGT, IVF, Foley
what are the tests that can differentiate partial from complete SBO?: CT w/ oral contrast, small bowel follow through.
what are teh causes of SBO?: ABC
GIVES BAD CRAMPS

Adhesions
Bulge- hernia
Cancer

Gallstone ileus
intussusception
Volvulus
External compression
SMA syndrome

Bezoars, Bowel wall hematoma
Abcesses
Diverticuliltis

Crohn's disease
Radiation enteritis
Annular pancreas
Meckel's diverticulum
Peritoneal adhesions
Stricture

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Deck Info

Number of cards 109