Absite prep for intern year
Heller myotomy - ANSa surgical procedure wherein the muscle tissues of the cardia (lower
esophageal sphincter or LES) are cut, allowing meals and beverages to skip to the belly;
treats achalasia
Killian triangle - ANSArea of potential weak point located at the back of the esophagus at the
level of the cricopharyngeus muscle
which vagus is anterior vs posterior? - ANSLARP
left anterior, right posterior
what does the proper vagus emerge as? - ANSposterior vagal trunk, celiac plexus, crook
nerve of Grassi
what does the left vagus grow to be? - ANSanterior vagal trunk, gastric plexus, liver
branches
crook nerve of Grassi - ANSfrom right vagus, causes persistently excessive acid ranges post
op if left after vagotomy, resources the posterior fundus
types of hiatal hernia - ANStype 1: sliding hiatal hernia (~ninety five%).
Type 2: paraesophageal hiatal hernia with the gastro-esophageal junction in a regular role.
Type 3: combined or compound kind, paraesophageal hiatal hernia with displaced
gastro-esophageal junction.
Type 4: blended or compound type hiatal hernia with extra herniation of viscera (maximum
normally colon).
Phi angle - ANSA normal phi attitude is ranging between four and 58 levels. The phi angle is
a beneficial degree in assessing of gastric lap band role. This patient is need to revise the
placement of the slipped band.
Remedy for slipped gastric band - ANSplain x-ray (degree phi perspective) or swallow take a
look at, deflate the band
ddx: tachycardic, fever, abdominal pain after gastric bypass - ANSleak until validated in any
other case (other complications = bleed, PE); if there's any suspicion of leak, move
immediately to the OR due to the fact swallow studies leave out 30% of leaks and CT misses
20% leaks (imaging not reliable sufficient)
where does a gastric sleeve typically leak? - ANSat the perspective of His or GE junction on
account that those regions are the least vascularized
whilst do gastric bypasses leak, if they are going to? - ANSusually submit op day 3
, when do gastric bypasses get internal hernias, if they may be going to? - ANSmonths to
years after the surgery, as soon as the patient has lost weight and the mesenteric closures
have loosened up
Peterson disorder - ANSinternal hernia within the mesentery of the roux limb whilst it's miles
made antecolic
swirl sign - ANSdilated bowl indicating an inner hernia, generally on the left side after gastric
pass
splenic ligaments and their contents - ANSsplenorenal - splenic vessels, pancreatic tail
gastrosplenic - brief gastrics, left gastroepiploic
colicosplenic
phrenocolic
region of the splenic vein and artery - ANSvein = posterior to the pancreas
artery = anterior to the pancreas (superior border)
elements of the spleen - ANSCapsule, trabeculae, white pulp (PALS and follicles), red pulp,
splenic cords, venous sinuses, significant artery.
PALS - ANSperiarteriolar lymphoid sheath; Part of the internal vicinity of the white pulp of the
spleen; it includes particularly T cells
spleen follicles - ANSPart of the white pulp. Primary splenic follicles are positioned
eccentrically in PALS and are normally composed of B lymphocytes. When exposed to
antigen, the splenic lymphoid follicles broaden germinal facilities. Provide protection towards
encapsulated organisms.
Red pulp - ANSthe region of the spleen composed of blood-crammed venous sinuses and
thin plates of splenic tissue (cords), which consist of crimson blood cells and diverse white
blood cells; provides mechanical filtration of old or broken RBCs
first step in splenectomy if spleen is simply too massive - ANSclip the artery, the spleen with
deflate a bit
hereditary spherocytosis - ANSautosomal dominant; RBC membrane illness in tethering
proteins: spectrin/band 3.1/ankyrin; causes hemolytic anemia, jaundice, and splenomegaly
regularly after URIs; RBCs = osmotically fragile; see spherocytes lacking critical pallor on
peripheral blood smear
ddx: younger youngster with gallstones - ANSa hematologic disease, such as hereditary
spherocytosis
while to immunize with splenectomy - ANSideally as a minimum 2 weeks before the surgical
treatment, but if a trauma scenario and unexpected, just immunize earlier than discharge
from the clinic
Heller myotomy - ANSa surgical procedure wherein the muscle tissues of the cardia (lower
esophageal sphincter or LES) are cut, allowing meals and beverages to skip to the belly;
treats achalasia
Killian triangle - ANSArea of potential weak point located at the back of the esophagus at the
level of the cricopharyngeus muscle
which vagus is anterior vs posterior? - ANSLARP
left anterior, right posterior
what does the proper vagus emerge as? - ANSposterior vagal trunk, celiac plexus, crook
nerve of Grassi
what does the left vagus grow to be? - ANSanterior vagal trunk, gastric plexus, liver
branches
crook nerve of Grassi - ANSfrom right vagus, causes persistently excessive acid ranges post
op if left after vagotomy, resources the posterior fundus
types of hiatal hernia - ANStype 1: sliding hiatal hernia (~ninety five%).
Type 2: paraesophageal hiatal hernia with the gastro-esophageal junction in a regular role.
Type 3: combined or compound kind, paraesophageal hiatal hernia with displaced
gastro-esophageal junction.
Type 4: blended or compound type hiatal hernia with extra herniation of viscera (maximum
normally colon).
Phi angle - ANSA normal phi attitude is ranging between four and 58 levels. The phi angle is
a beneficial degree in assessing of gastric lap band role. This patient is need to revise the
placement of the slipped band.
Remedy for slipped gastric band - ANSplain x-ray (degree phi perspective) or swallow take a
look at, deflate the band
ddx: tachycardic, fever, abdominal pain after gastric bypass - ANSleak until validated in any
other case (other complications = bleed, PE); if there's any suspicion of leak, move
immediately to the OR due to the fact swallow studies leave out 30% of leaks and CT misses
20% leaks (imaging not reliable sufficient)
where does a gastric sleeve typically leak? - ANSat the perspective of His or GE junction on
account that those regions are the least vascularized
whilst do gastric bypasses leak, if they are going to? - ANSusually submit op day 3
, when do gastric bypasses get internal hernias, if they may be going to? - ANSmonths to
years after the surgery, as soon as the patient has lost weight and the mesenteric closures
have loosened up
Peterson disorder - ANSinternal hernia within the mesentery of the roux limb whilst it's miles
made antecolic
swirl sign - ANSdilated bowl indicating an inner hernia, generally on the left side after gastric
pass
splenic ligaments and their contents - ANSsplenorenal - splenic vessels, pancreatic tail
gastrosplenic - brief gastrics, left gastroepiploic
colicosplenic
phrenocolic
region of the splenic vein and artery - ANSvein = posterior to the pancreas
artery = anterior to the pancreas (superior border)
elements of the spleen - ANSCapsule, trabeculae, white pulp (PALS and follicles), red pulp,
splenic cords, venous sinuses, significant artery.
PALS - ANSperiarteriolar lymphoid sheath; Part of the internal vicinity of the white pulp of the
spleen; it includes particularly T cells
spleen follicles - ANSPart of the white pulp. Primary splenic follicles are positioned
eccentrically in PALS and are normally composed of B lymphocytes. When exposed to
antigen, the splenic lymphoid follicles broaden germinal facilities. Provide protection towards
encapsulated organisms.
Red pulp - ANSthe region of the spleen composed of blood-crammed venous sinuses and
thin plates of splenic tissue (cords), which consist of crimson blood cells and diverse white
blood cells; provides mechanical filtration of old or broken RBCs
first step in splenectomy if spleen is simply too massive - ANSclip the artery, the spleen with
deflate a bit
hereditary spherocytosis - ANSautosomal dominant; RBC membrane illness in tethering
proteins: spectrin/band 3.1/ankyrin; causes hemolytic anemia, jaundice, and splenomegaly
regularly after URIs; RBCs = osmotically fragile; see spherocytes lacking critical pallor on
peripheral blood smear
ddx: younger youngster with gallstones - ANSa hematologic disease, such as hereditary
spherocytosis
while to immunize with splenectomy - ANSideally as a minimum 2 weeks before the surgical
treatment, but if a trauma scenario and unexpected, just immunize earlier than discharge
from the clinic
