SURGERY PAEA COMPREHENSIVE
SURGICAL CARE REVIEW SHEET FULL
SOLUTIONS
●● 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
SURGICAL CARE REVIEW SHEET FULL
SOLUTIONS
●● 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
