Paea general surgery eor Questions with Complete Solutions Rated A+

Paea general surgery eor Questions with Complete Solutions Rated A+ what are the 2 conditions under the inflammatory bowel disease umbrella? 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 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? -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? 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? -*squamous* epithelium to metaplastic *columnar* -esophageal *adenocarcinoma* tx for intermittent/mild vs mod/severe GERD 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 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? -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 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 schatzki ring test of choice is barium sallow tx: dilation esophageal varices are MC d/t? tx to prevent rebleeds? -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! 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? -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 -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? 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? -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? -H/K ATPase pump -parietal cells -30 min -B12 deficiency -omeprazole causes CP450 inhibition (can inc levels of theophyllin, warfarin, phenytoin, etc.)