General Surgery EOR Topics Questions and Answers
what are the 2 conditions under the inflammatory
bowel disease umbrella? - ANSWER -1. what medications are used to treat ulcerative
ulcerative colitis colitis and crohn's dz? - ANSWER -1. 5-
2. crohn's dz aminosalicylic acids (anti-inflammatory) *oral
mesalamine* best for maintenance, topical
mesalamine (rectal suppositories & enemas),
in comparing ulcerative colitis and crohn's dz, *sulfasalzine* (give w/ folic acid); *all of these
which is: work best in the colon- so are better for tx'ing
-limited to the colon w/ rectum always involved UC*
*VS* mouth to anus 2. *corticosteroids* in *acute flares* only
-transmural *VS* mucosa/submucosa involved 3. immune modifying agents: 6-mercaptopurine,
-LLQ *VS* RLQ pain azathioprine and MTX
-bloody diarrhea *VS* non 4. anti-TNF agents- adalimumab, infliximab
-complications of perianal dz, strictures, fistulas certolizumab
& granulomas *VS* colon cancer & toxic
megacolon
-colonoscopy showing "skip lesions" & barrett's esophagus (from prolonged/untreated
cobblestoning *VS* ulceration & pseudopolyps GERD) involves transition of _________ cells to
-barium studies showing "stovepipe sign" (loss of _________ cells (nml to precancerous); what
haustral markings) *VS* "string sign" narrowing kind of cancer can GERD => barrett's turn into? -
through scarred areas ANSWER --*squamous* epithelium to
-(+)P-ANCA *VS* (+)ASCA (anti saccharomyces metaplastic *columnar*
cerevisiae Ab) -esophageal *adenocarcinoma*
-curative *VS* noncurative - ANSWER -1.
*ulcerative colitis*- colon/rectum,
mucosa/submucosa, LLQ pain, bloody diarrhea, tx for intermittent/mild vs mod/severe GERD -
comps of colon cancer & toxic megacolon, ANSWER -besides lifestyle changes
colonoscopy w/ ulcerations & pseudopolyps, (food/drink avoidance, avoiding recumbency, wt
"stovepipe sign" (loss of haustral markings), loss, smoking cessation
(+)P-ANCA, curative -int/mild: OTC antacids (tums, MOM, maalox,
2. *crohn's dz*- mouth to anus, transmural, RLQ mylanta) & H2 receptor antagonists/blockers
pain, nonbloody diarrhea, comps of perianal dz, (ranitidine, cimetidine, famotidine)
strictures, fistulas, granulomas, "skip lesions" & -mod/severe: H2RAs, PPIs (omeprazole,
"cobblestoning", "string sign", (+)ASCA, esomeprazole, pantoprazole), & prokinetic
noncurative agents (cisapride), nissen fundoplication if
refractory
what are the best studies of choice for ulcerative
colitis vs crohn's dz in acute dz? - DDx for hematemesis - ANSWER -MC is
ANSWER --UC: *flex sigmoidoscopy* in *PUD* (gastric > duodenal), varices,
acute dz (colonoscopy and barium enema angiodysplasia, masses (adenocarcinoma,
CONTRAINDICATED in acute dz bc can cause polyps), & mallory-weiss tears
perf or toxic megacolon)
-crohn's dz: *upper GI series* (barium swallow)
in acute dz dx/tx? vomiting blood after a night of heavy
drinking or in a bulimic pt; what is seen on EGD?
,General Surgery EOR Topics Questions and Answers
- ANSWER --dx: mallory-weiss intrahepatic portosystemic shunt) connects portal
syndrome/tears (d/t sudden rise in intragastric vein to hepatic vein to drain to IVC
pressure)
-tx: supportive unless severe bleeding may need
epi inj, band ligation or balloon tamponade what is the tx for type I/sliding hiatal hernia vs
-EGD: superficial longitudinal mucosal type II/rolling hiatal hernias? - ANSWER --
erosions/lacerations type I/sliding: (MC type 95%) tx: none except
manage GERD it causes
-type II/rolling: (paraesophageal) tx: surgical
dx? dysphagia, esophageal webs, IDA, glossitis, repair to avoid complications (strangulation)
angular cheilitis, koilonychias - ANSWER -
plummer-vinson syndrome
in comparing squamous cell vs adenocarcinoma
test of choice is barium swallow of the esophagus, which is:
tx: dilation -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*
dx? lower esophageal webs/constrictions at tobacco/EtOH use, exposure to noxious stimuli,
squamocolumnar junctions MC associated w/ AA - ANSWER --squamous cell: MC
sliding hiatal hernias but also can be s/p worldwide (90%), upper 1/3, RF: tobacco/EtOH
corrosive injury - ANSWER -schatzki ring use, exposure to noxious stimuli, AA
-adenocarcinoma: MC in US, lower 1/3, RF:
test of choice is barium sallow untx'd GERD/barrett's
tx: dilation
what are the 2 most common causes of gastritis?
esophageal varices are MC d/t? tx to prevent how are they diagnosed and treated? -
rebleeds? - ANSWER --cirrhosis as a ANSWER -1. H. pylori MC- stool antigen or
complication of portal venous HTN urea breath test; tx: triple therapy: "CAP"
-long term tx: *clarithromycin + amoxicillin + PPI* or
1. nonselective BB: *propranolol, nadolol* 1st metronidazole if PCN allergic; if macrolide
line (reduces portal pressure) but not used in resistance suspected do quad therapy: PPI +
acute bleeds bc pt may already be hypovolemic bismuth subsalicylate + tetracycline +
2. *isosorbide*: long acting nitrate (vasodilator) metronidazole
2. NSAIDs/ASA- clinically dx but EGD gold std;
tx: acid suppression (PPI, H2RA, antacids)
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! - is a *gastric* or *duodenal* ulcer more associated
ANSWER -1. 2 large bore IV lines, IVF, +/- with relief of epigastric pain (dyspepsia) with
blood transfusion eating? which type always needs a Bx and
2. *endoscopic ligation* is tx of choice endoscopic monitoring 2-3 mos later to r/o
3. pharmacologic vasoconstrictors- *octreotide* malignancy and document healing? -
1st line (somatostatin analog), vasopressin ANSWER --duodenal ulcer (area becomes
4. balloon tamponade more basic when you eat in preparation for
5. surgical decompression *TIPS* (transjugular acid/food later on); these are 4x more common
,General Surgery EOR Topics Questions and Answers
that GUs *adenocarcinoma* MC (90%)
-gastric ulcer bc higher risk of malignancy -stomach is MC site of extranodal non-hodgkin
lymphoma
PPIs block the _______ pump of the ________ -RF: *H. pylori*, foods containing nitrites/nitrates
cell reducing acid secretion; taken _____ min -s/sx: dyspepsia, wt loss, early satiety, IDA,
before meals and can result in diarrhea, HA, supraclavicular LN (virchows), umbilical LN
hypomagnesemia, _____ deficiency, and (sister mary joseph's)
hypocalcemia; which PPI causes CP450 -tx: gastrectomy, chemo, XRT (prognosis poor)
inhibition? - ANSWER --H/K ATPase pump
-parietal cells
-30 min what are the 5 F's of RF for cholelithiasis? -
-B12 deficiency ANSWER --fat
-omeprazole causes CP450 inhibition (can inc -fair
levels of theophyllin, warfarin, phenytoin, etc.) -female
-forty
-fertile
which H2RA/H2 blocker causes CP450 inhibition
(can inc levels of theophyllin, warfarn, phenytoin,
etc.) and can also cause anti-androgen s/e what medicine can be used to dissolve gallstones
(gynecomastia, impotence, dec libido)? - in symptomatic cholelithiasis pts? -
ANSWER -cimetidine/Tagamet ANSWER -ursodeoxycholic acid (Ursodiol) -
but elective cholecystectomy usually done
what PUD tx is best for treating NSAID induced -in nonsymptomatic pts: observation
ulcers because it is a prostaglandin E1 analog
that increases bicarb & mucus secretion? what
pts is this drug contraindicated in? - choledocholithiasis is a gallstones stuck in the
ANSWER --misoprostol __________ duct whereas cholelithiasis is stuck
-CI: premenopausal women bc abortifacent and in the __________ duct - ANSWER --
causes cervical ripening choledocholithiasis: common bile duct
-cholelithiasis: cystic duct
what PUD treatments are cytoprotective (forms
viscous adhesive ulcer coating that promotes what is the tx for choledocholithiasis? -
healing and protects stomach mucosa)? what s/e ANSWER --ERCP w/ stone extraction
can they have? - ANSWER --bismuth (diagnostic and therapeutic)
compounds (pepto-bismol, kaopectate): also
antibacterial; s/e: darkening of stool/tongue,
constipation what are the s/sx's in charcot's triad and reynold's
-sucralfate/Carafate: s/e: may reduce pentad for acute cholangitis? - ANSWER -
bioavailability of H2RA charcot's triad:
1. fever/chills
2. RUQ pain
what is the MC type of gastric carcinoma? risk 3. jaudice
factors? s/sx? tx? - ANSWER --
, General Surgery EOR Topics Questions and Answers
reynold's pentad: accompanied by what other 2 manifestations?
4. shock/hypotension and occurs w/i ____ weeks of onset of liver injury
5. AMS in a pt that was previously healthy prior to onset
of symptoms - ANSWER --rapid liver failure
+ hepatic *encephalopathy* + *coagulopathy*
what are the MC infectious agents seen in acute -w/i *8* weeks
cholangitis and cholecystitis? what is the tx? -
ANSWER --(gram neg organisms
ascending from GI tract) *E. coli* MC, followed what are some common causes of fulminant
by *Klebsiella*, *Enterococci* hepatitis aka acute liver failure? -
-tx options: ampicillin/sulbactam, ANSWER --*acetaminophen* overuse or
piperacillin/tazobactam, OD MC
ceftriaxone/metronidazole, FQ/metronidazole, or -*drug rxns* (isoniazid, purazinamide, rifampin,
ampicillin/gentamicin antiepileptics, abx)
-can also have ERCP w/ stone extraction for -*viral hepatitis* (A-E)
cholangitis or cholecystectomy for cholecystitis -liver ischemia
after 72h afebrile on IV abx -*Reye syndrome* (*ASA* use in kids)
-budd-chiari syndrome
-autoimmune hepatitis
what is the difference between acute cholangitis -fatty liver w/ pregnancy
vs acute cholecystitis? gold std diagnostic -mushroom poisoning
studies for each? tx for cholecystitis? -
ANSWER -although cholecystitis can be
just inflammation both can be d/t infxns s/sx's and labs seen in fulminant hepatitis aka
ascending from same bacteria in GI tract (E. coli, acute liver failure? - ANSWER --
Klebsiella, Enterococci) w/ fever, RUQ pain, inc *encephalopathy* (vomiting, coma, AMS,
WBCs BUT cholangitis is 2ndary to obstruction in seizures, *asterixis* (flapping tremor of hand w/
*biliary tract* (from stone or malignancy) and wrist extension) from buildup of *ammonia levels*
cholecysitis is 2ndary to obstruction in *cystic (liver can't convert to urea anymore)
duct* (& will also have *constant* RUQ) -coagulopathy (*inc PT/INR ≥1.5*) from dec
production of clotting factors
-this is why you see *inc bili, alk phos, and LFTs* -hepatomegaly
more with cholangitis! -jaundince
-US to diagnose both but gold std for cholangitis: -inc LFTs
*angiography* whereas cholecystitis: *HIDA -*hypoglycemia* (liver can't breakdown glycogen
scan* anymore)
-tx is same for both (except surgical)- options:
ampicillin/sulbactam, piperacillin/tazobactam,
ceftriaxone/metronidazole, FQ/metronidazole, or what is the tx for fulminant hepatitis aka acute
ampicillin/gentamicin liver failure? - ANSWER -1. encephalopathy
-surgical: *ERCP w/ stone extraction* for tx: *lactulose* (neutralizes ammonia), *rifaximin,
cholangitis & *cholecystectomy* for cholecystitis neomycin* (dec bacteria in GI tract producing
after 72h afebrile on IV abx ammonia), *protein restriction* (protein breaks
down into ammonia)
2. *liver transplant* is only definitive tx
fulminant hepatitis aka acute liver failure is
what are the 2 conditions under the inflammatory
bowel disease umbrella? - ANSWER -1. what medications are used to treat ulcerative
ulcerative colitis colitis and crohn's dz? - ANSWER -1. 5-
2. crohn's dz aminosalicylic acids (anti-inflammatory) *oral
mesalamine* best for maintenance, topical
mesalamine (rectal suppositories & enemas),
in comparing ulcerative colitis and crohn's dz, *sulfasalzine* (give w/ folic acid); *all of these
which is: work best in the colon- so are better for tx'ing
-limited to the colon w/ rectum always involved UC*
*VS* mouth to anus 2. *corticosteroids* in *acute flares* only
-transmural *VS* mucosa/submucosa involved 3. immune modifying agents: 6-mercaptopurine,
-LLQ *VS* RLQ pain azathioprine and MTX
-bloody diarrhea *VS* non 4. anti-TNF agents- adalimumab, infliximab
-complications of perianal dz, strictures, fistulas certolizumab
& granulomas *VS* colon cancer & toxic
megacolon
-colonoscopy showing "skip lesions" & barrett's esophagus (from prolonged/untreated
cobblestoning *VS* ulceration & pseudopolyps GERD) involves transition of _________ cells to
-barium studies showing "stovepipe sign" (loss of _________ cells (nml to precancerous); what
haustral markings) *VS* "string sign" narrowing kind of cancer can GERD => barrett's turn into? -
through scarred areas ANSWER --*squamous* epithelium to
-(+)P-ANCA *VS* (+)ASCA (anti saccharomyces metaplastic *columnar*
cerevisiae Ab) -esophageal *adenocarcinoma*
-curative *VS* noncurative - ANSWER -1.
*ulcerative colitis*- colon/rectum,
mucosa/submucosa, LLQ pain, bloody diarrhea, tx for intermittent/mild vs mod/severe GERD -
comps of colon cancer & toxic megacolon, ANSWER -besides lifestyle changes
colonoscopy w/ ulcerations & pseudopolyps, (food/drink avoidance, avoiding recumbency, wt
"stovepipe sign" (loss of haustral markings), loss, smoking cessation
(+)P-ANCA, curative -int/mild: OTC antacids (tums, MOM, maalox,
2. *crohn's dz*- mouth to anus, transmural, RLQ mylanta) & H2 receptor antagonists/blockers
pain, nonbloody diarrhea, comps of perianal dz, (ranitidine, cimetidine, famotidine)
strictures, fistulas, granulomas, "skip lesions" & -mod/severe: H2RAs, PPIs (omeprazole,
"cobblestoning", "string sign", (+)ASCA, esomeprazole, pantoprazole), & prokinetic
noncurative agents (cisapride), nissen fundoplication if
refractory
what are the best studies of choice for ulcerative
colitis vs crohn's dz in acute dz? - DDx for hematemesis - ANSWER -MC is
ANSWER --UC: *flex sigmoidoscopy* in *PUD* (gastric > duodenal), varices,
acute dz (colonoscopy and barium enema angiodysplasia, masses (adenocarcinoma,
CONTRAINDICATED in acute dz bc can cause polyps), & mallory-weiss tears
perf or toxic megacolon)
-crohn's dz: *upper GI series* (barium swallow)
in acute dz dx/tx? vomiting blood after a night of heavy
drinking or in a bulimic pt; what is seen on EGD?
,General Surgery EOR Topics Questions and Answers
- ANSWER --dx: mallory-weiss intrahepatic portosystemic shunt) connects portal
syndrome/tears (d/t sudden rise in intragastric vein to hepatic vein to drain to IVC
pressure)
-tx: supportive unless severe bleeding may need
epi inj, band ligation or balloon tamponade what is the tx for type I/sliding hiatal hernia vs
-EGD: superficial longitudinal mucosal type II/rolling hiatal hernias? - ANSWER --
erosions/lacerations type I/sliding: (MC type 95%) tx: none except
manage GERD it causes
-type II/rolling: (paraesophageal) tx: surgical
dx? dysphagia, esophageal webs, IDA, glossitis, repair to avoid complications (strangulation)
angular cheilitis, koilonychias - ANSWER -
plummer-vinson syndrome
in comparing squamous cell vs adenocarcinoma
test of choice is barium swallow of the esophagus, which is:
tx: dilation -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*
dx? lower esophageal webs/constrictions at tobacco/EtOH use, exposure to noxious stimuli,
squamocolumnar junctions MC associated w/ AA - ANSWER --squamous cell: MC
sliding hiatal hernias but also can be s/p worldwide (90%), upper 1/3, RF: tobacco/EtOH
corrosive injury - ANSWER -schatzki ring use, exposure to noxious stimuli, AA
-adenocarcinoma: MC in US, lower 1/3, RF:
test of choice is barium sallow untx'd GERD/barrett's
tx: dilation
what are the 2 most common causes of gastritis?
esophageal varices are MC d/t? tx to prevent how are they diagnosed and treated? -
rebleeds? - ANSWER --cirrhosis as a ANSWER -1. H. pylori MC- stool antigen or
complication of portal venous HTN urea breath test; tx: triple therapy: "CAP"
-long term tx: *clarithromycin + amoxicillin + PPI* or
1. nonselective BB: *propranolol, nadolol* 1st metronidazole if PCN allergic; if macrolide
line (reduces portal pressure) but not used in resistance suspected do quad therapy: PPI +
acute bleeds bc pt may already be hypovolemic bismuth subsalicylate + tetracycline +
2. *isosorbide*: long acting nitrate (vasodilator) metronidazole
2. NSAIDs/ASA- clinically dx but EGD gold std;
tx: acid suppression (PPI, H2RA, antacids)
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! - is a *gastric* or *duodenal* ulcer more associated
ANSWER -1. 2 large bore IV lines, IVF, +/- with relief of epigastric pain (dyspepsia) with
blood transfusion eating? which type always needs a Bx and
2. *endoscopic ligation* is tx of choice endoscopic monitoring 2-3 mos later to r/o
3. pharmacologic vasoconstrictors- *octreotide* malignancy and document healing? -
1st line (somatostatin analog), vasopressin ANSWER --duodenal ulcer (area becomes
4. balloon tamponade more basic when you eat in preparation for
5. surgical decompression *TIPS* (transjugular acid/food later on); these are 4x more common
,General Surgery EOR Topics Questions and Answers
that GUs *adenocarcinoma* MC (90%)
-gastric ulcer bc higher risk of malignancy -stomach is MC site of extranodal non-hodgkin
lymphoma
PPIs block the _______ pump of the ________ -RF: *H. pylori*, foods containing nitrites/nitrates
cell reducing acid secretion; taken _____ min -s/sx: dyspepsia, wt loss, early satiety, IDA,
before meals and can result in diarrhea, HA, supraclavicular LN (virchows), umbilical LN
hypomagnesemia, _____ deficiency, and (sister mary joseph's)
hypocalcemia; which PPI causes CP450 -tx: gastrectomy, chemo, XRT (prognosis poor)
inhibition? - ANSWER --H/K ATPase pump
-parietal cells
-30 min what are the 5 F's of RF for cholelithiasis? -
-B12 deficiency ANSWER --fat
-omeprazole causes CP450 inhibition (can inc -fair
levels of theophyllin, warfarin, phenytoin, etc.) -female
-forty
-fertile
which H2RA/H2 blocker causes CP450 inhibition
(can inc levels of theophyllin, warfarn, phenytoin,
etc.) and can also cause anti-androgen s/e what medicine can be used to dissolve gallstones
(gynecomastia, impotence, dec libido)? - in symptomatic cholelithiasis pts? -
ANSWER -cimetidine/Tagamet ANSWER -ursodeoxycholic acid (Ursodiol) -
but elective cholecystectomy usually done
what PUD tx is best for treating NSAID induced -in nonsymptomatic pts: observation
ulcers because it is a prostaglandin E1 analog
that increases bicarb & mucus secretion? what
pts is this drug contraindicated in? - choledocholithiasis is a gallstones stuck in the
ANSWER --misoprostol __________ duct whereas cholelithiasis is stuck
-CI: premenopausal women bc abortifacent and in the __________ duct - ANSWER --
causes cervical ripening choledocholithiasis: common bile duct
-cholelithiasis: cystic duct
what PUD treatments are cytoprotective (forms
viscous adhesive ulcer coating that promotes what is the tx for choledocholithiasis? -
healing and protects stomach mucosa)? what s/e ANSWER --ERCP w/ stone extraction
can they have? - ANSWER --bismuth (diagnostic and therapeutic)
compounds (pepto-bismol, kaopectate): also
antibacterial; s/e: darkening of stool/tongue,
constipation what are the s/sx's in charcot's triad and reynold's
-sucralfate/Carafate: s/e: may reduce pentad for acute cholangitis? - ANSWER -
bioavailability of H2RA charcot's triad:
1. fever/chills
2. RUQ pain
what is the MC type of gastric carcinoma? risk 3. jaudice
factors? s/sx? tx? - ANSWER --
, General Surgery EOR Topics Questions and Answers
reynold's pentad: accompanied by what other 2 manifestations?
4. shock/hypotension and occurs w/i ____ weeks of onset of liver injury
5. AMS in a pt that was previously healthy prior to onset
of symptoms - ANSWER --rapid liver failure
+ hepatic *encephalopathy* + *coagulopathy*
what are the MC infectious agents seen in acute -w/i *8* weeks
cholangitis and cholecystitis? what is the tx? -
ANSWER --(gram neg organisms
ascending from GI tract) *E. coli* MC, followed what are some common causes of fulminant
by *Klebsiella*, *Enterococci* hepatitis aka acute liver failure? -
-tx options: ampicillin/sulbactam, ANSWER --*acetaminophen* overuse or
piperacillin/tazobactam, OD MC
ceftriaxone/metronidazole, FQ/metronidazole, or -*drug rxns* (isoniazid, purazinamide, rifampin,
ampicillin/gentamicin antiepileptics, abx)
-can also have ERCP w/ stone extraction for -*viral hepatitis* (A-E)
cholangitis or cholecystectomy for cholecystitis -liver ischemia
after 72h afebrile on IV abx -*Reye syndrome* (*ASA* use in kids)
-budd-chiari syndrome
-autoimmune hepatitis
what is the difference between acute cholangitis -fatty liver w/ pregnancy
vs acute cholecystitis? gold std diagnostic -mushroom poisoning
studies for each? tx for cholecystitis? -
ANSWER -although cholecystitis can be
just inflammation both can be d/t infxns s/sx's and labs seen in fulminant hepatitis aka
ascending from same bacteria in GI tract (E. coli, acute liver failure? - ANSWER --
Klebsiella, Enterococci) w/ fever, RUQ pain, inc *encephalopathy* (vomiting, coma, AMS,
WBCs BUT cholangitis is 2ndary to obstruction in seizures, *asterixis* (flapping tremor of hand w/
*biliary tract* (from stone or malignancy) and wrist extension) from buildup of *ammonia levels*
cholecysitis is 2ndary to obstruction in *cystic (liver can't convert to urea anymore)
duct* (& will also have *constant* RUQ) -coagulopathy (*inc PT/INR ≥1.5*) from dec
production of clotting factors
-this is why you see *inc bili, alk phos, and LFTs* -hepatomegaly
more with cholangitis! -jaundince
-US to diagnose both but gold std for cholangitis: -inc LFTs
*angiography* whereas cholecystitis: *HIDA -*hypoglycemia* (liver can't breakdown glycogen
scan* anymore)
-tx is same for both (except surgical)- options:
ampicillin/sulbactam, piperacillin/tazobactam,
ceftriaxone/metronidazole, FQ/metronidazole, or what is the tx for fulminant hepatitis aka acute
ampicillin/gentamicin liver failure? - ANSWER -1. encephalopathy
-surgical: *ERCP w/ stone extraction* for tx: *lactulose* (neutralizes ammonia), *rifaximin,
cholangitis & *cholecystectomy* for cholecystitis neomycin* (dec bacteria in GI tract producing
after 72h afebrile on IV abx ammonia), *protein restriction* (protein breaks
down into ammonia)
2. *liver transplant* is only definitive tx
fulminant hepatitis aka acute liver failure is
