Surgery 1 Flash Cards

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Title:	Surgery 1
Description:	Surgery 1
Number of Cards:	38
Save Count:	0
Author:	belz0008
Created:	2011-12-19
Tags:	surgery
Private	No

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- Question
- Answer
- Side 3

- Hesselbach's triangle
- Inguinal ligament (sup)
  Inferior epigastric triangle
  Lateral border cuts abdominus
  (medial border or triangle)
- Femoral triangle
- Inguinal ligament (inf)
  Femoral vein
  Ramus of pubis
- Femoral hernia
  Epi
- Acquired
  More common in women
  (larger femoral ring)
- Femoral hernia
  Internal opening
  External opening
- Femoral ring
  Below inguinal ligament
  
  Saphenous hiatus
- Femoral hernia
  Course
- Sac passes through
  Femoral canal
  Below fascia lata
  Lateral to pubic tubercle
- Indirect inguinal hernia
  Internal opening
  
  External opening
- Deep inguinal ring
  Above inguinal ring
  Lateral to inf epigastric art
  
  Out superficial inguinal ring
- Direct inguinal hernia
  Internal opening
  
  External opening
- Hesselbach triangle
  Above inguinal ligament
  Medial to inf epigastric art
  
  Out superficial inguinal ring
- Indirect inguinal hernia
  Epi
  Course
- Congenital or acquired
  Most common inguinal hernia
  More in men
  Often enters scrotum, labium
  
  Through inguinal canal in spermatic canal
- Direct inguinal hernia
  Course
- Sac perpendicular to abdominal wall
  Rarely enters scrotum
- Indirect vs direct
  Path
- INdirect
  through INternal inguinal ring
  And external ring
  INto scrotum
  
  Direct
  Through Hesselbachs triangle
  Through external inguinal ring only
- Indirect vs direct
  Layers
- Indirct
  All 3 layers of spermatic fascia
  (INto spermatic cord)
  
  Direct
  External spermatic fascia only
- Indirect vs direct vs femoral
  Epi
- INdirect
  INfants (patent processes vaginalis)
  
  Direct - Older men
  Femoral - women
- Direct vs indirect
  Inferior epigastric artery
- Direct - medial
  
  Indirect - lateral
- Somatostatin
  Source
  Action
  Regulation
- D cells
  (pancreatic islets, GI mucosa)
  Decr gastric acid, pepsinogen
  Decr gallbladder cxn
  Decr pancreatic, small int secretions
- Somatostatin
  Regulation
- Incr by acid
  Decr by Vagal stimulation
- Somatosttin
  Type of hormone
  Used to treat ?
- Inhibitory and antigrowth hormone
  
  Tx VIPoma, carcinoid tumors
  Decr pancreas and small int output
- Crohns
  Colitis
  Sites
- Crohns - entire GI
  Distal ileum most common
  Skip lesions
  Colitis - starts rectum
  As far as distal ileum
- Crohns
  Colitis
  Layers of bowel
- Crohns - entire wall
  Colitis - mucosa, submucosa only
- Crohns
  Colitis
  Symptoms
- Crohns - watery diarrhea
  Colitis - bloody diarrhea
  Tenesmus, emesis
  
  Both - Abdl pain, wt loss
- Crohns
  Colitis
  Labs
- Crohns - ANCA +
  pANCA rarely +
  
  Colitis - pANCA +
  ANCA rarely +
- Crohns
  Colitis
  Extra intestinal
- Crohns - nephrolithiasis
  Colitis - erythema nodosum, pyoderma gangrenosum
  
  Arthritis, anklyosing spondylitis, uveitis, primary sclerosing cholangitis
- Crohns
  Colitis
  Physical exam
- Crohns - perianal fissures, fistulas
  Oral ulcers, RLQ mass
  Colitis - gross bld rectal exam
  
  Fever, abd tenderness
- Crohns
  Colitis
  Radiology
- Crohns - cobbles toning, skip lesion
  Fissures, ulcers, edema, strictures
  
  Colitis - continuous
  Pseudo cysts, friable mucosa
  Decr haustra
- Crohns
  Colitis
  Complications
- Crohns - abscesses, fistulas, fissures, toxic mega colon
  
  Colitis - sig incr risk colon ca
  Crypt abscesses
  Obstruction, more toxic mega colon
- Crohns
  Colitis
  Treatment
- Mesalamine (5-ASA)
  
  Systemic corticosteroids (prednisone) for acute exacerbation
  
  Immunosuppresants for refractory dx (azathioprine, 6-mercaptopurine)
  (imuran = azathioprine)
  
  Surgery curative for colitis (proctocolectomy)
- Postoperative infection
  Common causes
  5
- Wind - atelectasis 48 h
  Water - UTI
  Walking - DVT
  Wound - infection
  Where - abscess
- Hinchey classification
- Diverticulitis
  1- small confined abscess
  2- large abscess into pelvis
  3- perforated, purulent peritonitis
  4- ruptured, fecal peritonitis
- Renal output
  Minimal for hemodynamic stability
- 1/2 ml / hr / kg
- Hartmann procedure
- Proximal colostomy
  Distal stapled off colon or rectum,
  Left in peritoneal cavity
- Psoas sign
- Appendicitis
  Extending hip with knee in full extension, lying on side
- Obturator sign
- Appendicitis
  Internal rotation of leg
  Hip and knee flexed
  Foot to opp knee
- Merkel's diverticulum
- Rule of 2s
  2% of the popn, 2% symptomatic
  2 ft from ileocecal valve, 2" long
  2 yrs old common presentation
  2x more in boys
  2 ectopic tissues- pancreatic, gastric
  Presents like acute appendicitis if strangulated
  Remnant of vitelline duct yolk stalk
- Spleen attachments
  4
- Splenophrenic
  Splenorenal
  Splenocolic
  Gastrosplenic
- Alkaline phosphatase
  Where from
  Elevated when
- From bile duct epithelium
  Elevated in bike duct obstruction
- Enterohepatic circulation
- Bile acids
  Liver - gut - liver
  Absorbed in terminal ileum
- Stimulus for gall bladder emptying
- Cholecystokinin
  Vagal input
- Cholecystokinin
  Source
  Stim, inhib of release
- From duodenal mucosal cells
  
  Stim by fat, Prot, aa's. HCl
  Inhib by trypsin, chymotrypsin
- Cholecystokinin
  Actions
- Empty gallbladder
  Open ampulla of Vater
  Slow gastric emptying
  Release exocrine pancrease products
  Pancreas acinar cell growth