wild type viral infection
radishes, horseradish, cauliflower
VITAMIN C, NSAIDS, ASA
(MC in sigmoid colon)
(MC location = head)
indicates obstruction of distal CBD due to mass.
+ if secretin does NOT inhibit gastrin secretion
Tx: PPI, sx, chemo
altered mental status
(SOC = SIGMOIDOSCOPY b/c you can diagnose and TREAT at the same time!)
(“currant jelly sools” & “sausage like mass”)
Hallmarks: transmural tear causing esophageal perforation due to vomiting and retching that presents w/ UGI bleed
TOC: EMERGENT surgical treatment
massive GI bleed, hematemesis, liver disease, cirrhosis
TOC: hemodynamic stabilization, *endoscopic hemastasis*
ex: drinking around holidays
S&S: HA, diaphoresis, palpitations, severe HTN
Tx: high dose prednisone and high dose fluids
decrease in cortisol & aldosterone
TOC: hydrocortisone sodium succinate/phosphate
*steroid replacement for life*
nearly all testicular cancers are of GERM CELL origin.
almost half are seminomas
MC kind = adenocarcinomascored with Gleason Staging Sx
monitors coumadin therapy
Factors V, VII, X
normal is 30 – 40 seconds
monitors Heparin therapy
give TDaP if they have never had vaccine before
*Hallmarks*: profound dyspnea, labored breathing, diffuse infiltrates sparing the costophrenic angles
loud, harsh holosystolic murmur @ LLSB
if not, give another today.
receive next vaccine per schedule.
trauma @ surgical site. painful, swelling, dark skin.
Tx: debride (if really bad might need amputation, PCN, clinda)
% BSA x weight (kg) x 4
give 1/2 fluids in first 8 hours.
remaining 1/2 in last 16 hours.
movement of GE junction and stomach into the mediastinum
Tx: antacids per GERD
loss of esophageal motility & failure of LES relaxation
S&S: dysphagia, weight loss
increase risk of esophageal cancer
Tx: dilation of proximal esophagus with endoscpoe cures 80%
involves ONLY the mucosa between thryopharyngeal & cricopharyngeal mm
S&S: dysphagia, regurg solid fodo, choking, bad breath
Dx: clinical, barium swallow
Tx: myotomy, removal diverticulum
(alcohol x tobacco use)
grows rapidly. no Ca risk. no tx required. f/u in 1 mo.
smooth borders on mammogram – same density as nl breast tissue.
pt will c/o multiple small bumps and lumps that are tender during the menstrual cycle.
mammogram: no calcifications, cystic on U/S
usually on gastric side of GE junction.
80% stop spontaneously.
may be caused by fosamax (alendronate), KCl, abx, NSAIDs, quinidine
UGIB (location proximal to ligament of treitz) accounts for 80% of ALL significant GI bleeding
endoscopy establishes dx 90% of the time.
from RIGHT colon
UC – rectum is often involved.
MC hernia is right indirect inguinal hernia
(VAS is also in inguinal canal)
(round ligament is in inguinal canal of females)
(air within abdominal cavity)
mets to liver early
(MCC worldwide = hernias)
enormous dilation of right side of colon w/o obstruction
tx: bowel rest, IVF, rectal decompression tube via colonoscopy
note: no surgery for carotids that are 100% occluded
acute MI and perioperative stroke are 2 MC severe complications following carotid CEA.
false. almost NEVER.
usually experience TIA sxs like shade coming over eye, weakness of arm, hand or foot on one side.
saccular (berry) aneurysms
fuisform (uniform on both sides) have less risk
Hct by 3%
hypotensionrecommend surg for > 5.5 cm in males (and some sources recommend > 5 cm in females)
rupture is rare.
tx if the pt has sxs or if it is > 2 cm.
reveals size and extent.
hip claudication, gluteal mms affected, impotence.
Renal Cell Carcinoma
S&S: pain, weight loss, flank mass, HTN
classic triad: flank pain, hematura, palpable mass
PAINLESS, large, shallow, contain bleeding granulation tissue.
cool pale swollen leg with impalpable pulses.
PAINFUL. absent pulses, pallor, may have “blue toes”
*chronic*: usually supportive
*acute*: afib, following surgery
Tx: Laparotomy is the GOLD STANDARD.
acute mesenteric ischemia / ischemic colitis
S&S: rapid onset pain that is OUT OF PROPORTION TO EXAM
transitional cell carcinoma.
smoking is major risk factor.
classic S&S: painless hematuria
irritability, diaphoresis, weakness, palpitations, tremulousnesstx: surgery
*recurrent laryngeal nerve* – causes hoarseness if unilateral and airway obstruction if bilaterally damaged.
*superior laryngeal nerve* – if damaged, pt will have deep and quite voice.
(T4 –> liver –> T3)
risk is radiation exposure.
closes by re-epithelialization and wound contraction.
wound is contaminated.might close appendectomy site like this if an abscess has formed.
contaminated wound may be initially tx with debridement or abx for several days.
close after several days.
S&S: pain, tenderness, swelling, redness.
may first present as an enlarged hair folicle in otherwise normal skin.
technical problem in wound closure — excess tension, ischemia, wrong knot tying, increased abd pressure.
MC after age 60.
5 – 8 post operative day
“serosanguinous discharge” common
serious condition when organs begin to push outside the open incision.
5 – 10 P.O.D.
(note: clostridium and strep may be within 24h)
MC gram negative.
rupture is rare.
bx is dangerous due to hemorrhage risk.
(note: *hepatoma* INCORRECTLY implies a benign tumor).labs show increase in AFP.
Dx with U/S. Confirm with HIDA scan or nucleotide study.
tubular adenoma –> tubulovillous adenoma –> Villous Adenoma
90% polyps are hyperplastic and benign
MC complaint is intermittent rectal bleeding
entire breast, and all lymph nodes are removed.
occurs with contracture of mm fibers to halothane or caffeine
weight loss may be seen in association with malabsorption secondary to exocrine insufficiency.
autosomal recessive condition
*intermittent jaundice in the absence of hemolysis or underlying liver disease*
(most commonly encountered diverticulum of the small intestine)
(rotation of the large intestine on its mesenteric axis; twisting can promote ischemic bowel, gangrene, perforation).
followed by cecum (MUST ALWAYS TX CECAL VOLVULUS SURGICALLY!)
MC organ of metastasis is the liver.
90% of fissures are located posterior midline
risks: fistulas, abscess, infection, crohn’s disease
(right sided in asian populations).BLEEDING!
absence of familial pattern of hypercalcemiatx for primary hyperparathyroidism = surgery
tx: amoxicillin, clarithromycin, omeprazole
tx gastric ulcer for 8 to 12 weeks and then eval for healing.
intractable pain (considered intractable if persists for more than 3 mos despite tx)
risk of carcinoma.
considered borderline malignant b/c of potential spread and local invasion
tx: surgical resection via median sternotomy.
tx: surgery (radical orchiectomy) with possible chemotherap.
“painless scrotal mass”
BCG and AFP may be elevated
grade 2: prolapse, reduce spontaneously
grade 3: manual reduction required
grade 4: not reducible
sitz baths, bulking agents, stool softener, nitroglycerin ointment (as vasodilator for improving blood flow)
chronic? injection of botulinum toxin or operative tx to reduce resting sphincter tone (lateral internal sphincterotomy)
requires permanent TPN therapy.
improve quality of life in those with severe med side effects.
risk of colorectal cancer.
soft tissue erythema
increased local skin temperature
vasculogenic ulcers on the tips of digits.
360* wrap of the stomach around the GE junction.
creates valve effect.
also S&S: should pain, dyspnea, mid epigastric pain
tx: night time splint & NSAIDs
pts will c/o increases sxs @ night.
lap chole prior to hospital d/c.
probably viral gastroenteritis.
best management = insertion of chest tube or needle aspiration to allow lung reexpansion.
no significant CXR findings
lack of submucosal layer allows for easy wall access and implantation of fertilized ovum.
(warning: clonidine may cause rebound HTN)
cause CENTRAL vertigo.
4 – spontaneous
3 – opens to verbal command
2 – opens to pain
1 – noneVERBAL
5 – oriented
4 – confused
3 – inappropriate
2 – incomprehensible
1 – none
6 – obeys commands
5 – movement to pain
4 – withdrawl from pain
3 – flexion
2 – extension
1 – none
score 3 to 8 = coma
MCC = e coli
possible catheter suction embolectomy.
SECOND – stomach
THIRD – colon
MCC staph aureus.
HIGHEST risk of strangulation with FEMORAL HERNIAS.
2. decreased end tidal CO2
3. “mill wheel” murmur
food increases gastric ulcer pain.