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paea general surgery eor
what are the 2 conditions under the inflammatory b
ulcerative colitis colonrectum
crohns dz upper gi series barium swallow in
anti tnf agents adalimumab infliximab certolizu

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PAEA General Surgery EOR
what are the 2 conditions under the inflammatory bowel disease umbrella? - Answer-
1. ulcerative colitis
2. crohn's dz

in comparing ulcerative colitis and crohn's dz, which is:
-limited to the colon w/ rectum always involved *VS* mouth to anus
-transmural *VS* mucosa/submucosa involved
-LLQ *VS* RLQ pain
-bloody diarrhea *VS* non
-complications of perianal dz, strictures, fistulas & granulomas *VS* colon cancer &
toxic megacolon
-colonoscopy showing "skip lesions" & cobblestoning *VS* ulceration &
pseudopolyps
-barium studies showing "stovepipe sign" (loss of haustral markings) *VS* "string
sign" narrowing through scarred areas
-(+)P-ANCA *VS* (+)ASCA (anti saccharomyces cerevisiae Ab)
-curative *VS* noncurative - Answer-1. *ulcerative colitis*- colon/rectum,
mucosa/submucosa, LLQ pain, bloody diarrhea, comps of colon cancer & toxic
megacolon, colonoscopy w/ ulcerations & pseudopolyps, "stovepipe sign" (loss of
haustral markings), (+)P-ANCA, curative
2. *crohn's dz*- mouth to anus, transmural, RLQ pain, nonbloody diarrhea, comps of
perianal dz, strictures, fistulas, granulomas, "skip lesions" & "cobblestoning", "string
sign", (+)ASCA, noncurative

what are the best studies of choice for ulcerative colitis vs crohn's dz in acute dz? -
Answer--UC: *flex sigmoidoscopy* in acute dz (colonoscopy and barium enema
CONTRAINDICATED in acute dz bc can cause perf or toxic megacolon)
-crohn's dz: *upper GI series* (barium swallow) in acute dz

what medications are used to treat ulcerative colitis and crohn's dz? - Answer-1. 5-
aminosalicylic acids (anti-inflammatory) *oral mesalamine* best for maintenance,
topical mesalamine (rectal suppositories & enemas), *sulfasalzine* (give w/ folic
acid); *all of these work best in the colon- so are better for tx'ing UC*
2. *corticosteroids* in *acute flares* only
3. immune modifying agents: 6-mercaptopurine, azathioprine and MTX
4. anti-TNF agents- adalimumab, infliximab certolizumab

barrett's esophagus (from prolonged/untreated GERD) involves transition of
_________ cells to _________ cells (nml to precancerous); what kind of cancer can
GERD => barrett's turn into? - Answer--*squamous* epithelium to metaplastic
*columnar*
-esophageal *adenocarcinoma*

tx for intermittent/mild vs mod/severe GERD - Answer-besides lifestyle changes
(food/drink avoidance, avoiding recumbency, wt loss, smoking cessation

,-int/mild: OTC antacids (tums, MOM, maalox, mylanta) & H2 receptor
antagonists/blockers (ranitidine, cimetidine, famotidine)
-mod/severe: H2RAs, PPIs (omeprazole, esomeprazole, pantoprazole), & prokinetic
agents (cisapride), nissen fundoplication if refractory

DDx for hematemesis - Answer-MC is *PUD* (gastric > duodenal), varices,
angiodysplasia, masses (adenocarcinoma, polyps), & mallory-weiss tears

dx/tx? vomiting blood after a night of heavy drinking or in a bulimic pt; what is seen
on EGD? - Answer--dx: mallory-weiss syndrome/tears (d/t sudden rise in intragastric
pressure)
-tx: supportive unless severe bleeding may need epi inj, band ligation or balloon
tamponade
-EGD: superficial longitudinal mucosal erosions/lacerations

dx? dysphagia, esophageal webs, IDA, glossitis, angular cheilitis, koilonychias -
Answer-plummer-vinson syndrome

test of choice is barium swallow
tx: dilation

dx? lower esophageal webs/constrictions at squamocolumnar junctions MC
associated w/ sliding hiatal hernias but also can be s/p corrosive injury - Answer-
schatzki ring

test of choice is barium sallow
tx: dilation

esophageal varices are MC d/t? tx to prevent rebleeds? - Answer--cirrhosis as a
complication of portal venous HTN
-long term tx:
1. nonselective BB: *propranolol, nadolol* 1st line (reduces portal pressure) but not
used in acute bleeds bc pt may already be hypovolemic
2. *isosorbide*: long acting nitrate (vasodilator)

tx of an acute esophageal varices bleed? these have a 30-50% mortality rate w/ 1st
bleed and 70% recurrence rate w/i 1st yr! - Answer-1. 2 large bore IV lines, IVF, +/-
blood transfusion
2. *endoscopic ligation* is tx of choice
3. pharmacologic vasoconstrictors- *octreotide* 1st line (somatostatin analog),
vasopressin
4. balloon tamponade
5. surgical decompression *TIPS* (transjugular intrahepatic portosystemic shunt)
connects portal vein to hepatic vein to drain to IVC

what is the tx for type I/sliding hiatal hernia vs type II/rolling hiatal hernias? -
Answer--type I/sliding: (MC type 95%) tx: none except manage GERD it causes
-type II/rolling: (paraesophageal) tx: surgical repair to avoid complications
(strangulation)

,in comparing squamous cell vs adenocarcinoma of the esophagus, which is:
-MC worldwide (90%) *VS* MC in the US
-MC in upper 1/3 of esophagus *VS* lower 1/3
-RF of untreated GERD/barrett's *VS* tobacco/EtOH use, exposure to noxious
stimuli, AA - Answer--squamous cell: MC worldwide (90%), upper 1/3, RF:
tobacco/EtOH use, exposure to noxious stimuli, AA
-adenocarcinoma: MC in US, lower 1/3, RF: untx'd GERD/barrett's

what are the 2 most common causes of gastritis? how are they diagnosed and
treated? - Answer-1. H. pylori MC- stool antigen or urea breath test; tx: triple therapy:
"CAP" *clarithromycin + amoxicillin + PPI* or metronidazole if PCN allergic; if
macrolide resistance suspected do quad therapy: PPI + bismuth subsalicylate +
tetracycline + metronidazole
2. NSAIDs/ASA- clinically dx but EGD gold std; tx: acid suppression (PPI, H2RA,
antacids)

is a *gastric* or *duodenal* ulcer more associated with relief of epigastric pain
(dyspepsia) with eating? which type always needs a Bx and endoscopic monitoring
2-3 mos later to r/o malignancy and document healing? - Answer--duodenal ulcer
(area becomes more basic when you eat in preparation for acid/food later on); these
are 4x more common that GUs
-gastric ulcer bc higher risk of malignancy

PPIs block the _______ pump of the ________ cell reducing acid secretion; taken
_____ min before meals and can result in diarrhea, HA, hypomagnesemia, _____
deficiency, and hypocalcemia; which PPI causes CP450 inhibition? - Answer--H/K
ATPase pump
-parietal cells
-30 min
-B12 deficiency
-omeprazole causes CP450 inhibition (can inc levels of theophyllin, warfarin,
phenytoin, etc.)

which H2RA/H2 blocker causes CP450 inhibition (can inc levels of theophyllin,
warfarn, phenytoin, etc.) and can also cause anti-androgen s/e (gynecomastia,
impotence, dec libido)? - Answer-cimetidine/Tagamet

what PUD tx is best for treating NSAID induced ulcers because it is a prostaglandin
E1 analog that increases bicarb & mucus secretion? what pts is this drug
contraindicated in? - Answer--misoprostol
-CI: premenopausal women bc abortifacent and causes cervical ripening

what PUD treatments are cytoprotective (forms viscous adhesive ulcer coating that
promotes healing and protects stomach mucosa)? what s/e can they have? -
Answer--bismuth compounds (pepto-bismol, kaopectate): also antibacterial; s/e:
darkening of stool/tongue, constipation
-sucralfate/Carafate: s/e: may reduce bioavailability of H2RA

what is the MC type of gastric carcinoma? risk factors? s/sx? tx? - Answer--
*adenocarcinoma* MC (90%)

, -stomach is MC site of extranodal non-hodgkin lymphoma

-RF: *H. pylori*, foods containing nitrites/nitrates
-s/sx: dyspepsia, wt loss, early satiety, IDA, supraclavicular LN (virchows), umbilical
LN (sister mary joseph's)
-tx: gastrectomy, chemo, XRT (prognosis poor)

what are the 5 F's of RF for cholelithiasis? - Answer--fat
-fair
-female
-forty
-fertile

what medicine can be used to dissolve gallstones in symptomatic cholelithiasis pts? -
Answer-ursodeoxycholic acid (Ursodiol) -but elective cholecystectomy usually done

-in nonsymptomatic pts: observation

choledocholithiasis is a gallstones stuck in the __________ duct whereas
cholelithiasis is stuck in the __________ duct - Answer--choledocholithiasis:
common bile duct
-cholelithiasis: cystic duct

what is the tx for choledocholithiasis? - Answer--ERCP w/ stone extraction
(diagnostic and therapeutic)

what are the s/sx's in charcot's triad and reynold's pentad for acute cholangitis? -
Answer-charcot's triad:
1. fever/chills
2. RUQ pain
3. jaudice

reynold's pentad:
4. shock/hypotension
5. AMS

what are the MC infectious agents seen in acute cholangitis and cholecystitis? what
is the tx? - Answer--(gram neg organisms ascending from GI tract) *E. coli* MC,
followed by *Klebsiella*, *Enterococci*
-tx options: ampicillin/sulbactam, piperacillin/tazobactam, ceftriaxone/metronidazole,
FQ/metronidazole, or ampicillin/gentamicin
-can also have ERCP w/ stone extraction for cholangitis or cholecystectomy for
cholecystitis after 72h afebrile on IV abx

what is the difference between acute cholangitis vs acute cholecystitis? gold std
diagnostic studies for each? tx for cholecystitis? - Answer-although cholecystitis can
be just inflammation both can be d/t infxns ascending from same bacteria in GI tract
(E. coli, Klebsiella, Enterococci) w/ fever, RUQ pain, inc WBCs BUT cholangitis is
2ndary to obstruction in *biliary tract* (from stone or malignancy) and cholecysitis is
2ndary to obstruction in *cystic duct* (& will also have *constant* RUQ)

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