Surgery Semester 1
Terms in this set (14)
What is the risk stratify peptic ulcer disease?
Low - flat spot, clean ulcer - PPI only
Intermediate - Ooze without clot or visible vessel - oral PPI
High - active bleed, non bleeding visible vessel w/clot - combo therapy - injection, clip or coagulation + PPI
What are the different types of ulcer?
Type I - along lesser curve of stomach
Type II - most common, 2 ulcers- 1 gastric, 1 duodenal
Type III - prepyloric
Type IV - proximal gastroesophageal ulcer
Type V - anywhere along body, NSAID induced
What are the different chemicals for injection therapy?
Epinephrine - vasoconstrictor, volume tamponade
Sclerosant (ethanolamine)- induces inflammation then fibrosis
Fibrin Sealant - instant formation of hemostatic clot by mimicking last step of coag. cascade
Saline - volume tamponade
How can you coagulate?
Heater probe - tissue coag via heated ceramic tip - higher risk of perforation
Multipolar probe - tissue desiccation prevents conduction to lower layers
Argon plasma coagulant - no contact, wider spray, less depth
What are signs and symptoms of perforation?
-sudden onset of severe pain
-rigid abdomen/peritoneal signs
-subphrenic air on upright CXR (chest xray)
What are the rules for surgery of perforation?
Primary closure with Graham patch
< 6 hours - vagotomy
> 6 hours - no vagotomy
What is a Billroth procedure?
surgical resection for refractory disease
Type I - antrectomy with gastroduodenostomy - used for type I ulcers
Type II - antrectomy with gastrojejunostomy usually has vagotomy - used for type II and III ulcers
What is dumping syndrome?
Early dumping - occurs ~ 15 min after ingestion of foods - small meals, avoid high osmolar foods, add fat
Late dumping - occurs ~ 3 hours after meal w/large bolus of glucose, no diarrhea
What are afferent and efferent limb syndrome?
What are risk factors for gastric cancer?
-H. Pylori infection
What is distal cancer related to?
Proximal - GERD/Barrett's esophagus
What are the four palpable areas he gave for gastric cancer?
Sister Mary Joseph's node - periumbilical
Blumer's shelf - peritoneal mets palpable during rectal exam
Virchow's node - left supraclavicular lymph node
Krukenberg's tumor - ovarian mass
What is the main way of dealing with gastric cancer?
surgical resection and lymph node removal
How do you treat gastric lymphoma?
radiation - no resection