General Surgery test latest complete
update A+ graded
What is acute cholecystitis? - answer;-Inflammation and infection of the gallbladder due
to obstruction of the cystic duct by gallstones
What is the most common cause of acute cholecystitis? - answer;-E. coli
What are symptoms of acute cholecystitis? - answer;-RUQ and epigastric pain: usually
severe, steady, and continuous (prolonged > 4-6 hrs), progressive, may radiate to the
shoulder, interscapular area, right scapula, right shoulder, or back, may be aggravated
by movement, and is often precipitated by fatty foods or large meals
What are physical exam findings of acute cholecystitis? - answer;--Fever
-Enlarged palpable gallbladder; jaundice is NOT usually seen
-Positive Murphy's sign (RUQ pain or inspiratory arrest with palpation of the gallbladder
fossa)
-Positive Boas sign (referred pain to right shoulder subscapular area (due to phrenic
nerve irritation)
How is acute cholecystitis diagnosed? - answer;-Acute cholecystitis should be
suspected in a patient presenting with RUQ or epigastric pain (often continuous) + fever
+ leukocytosis:
--Increased WBCs
--LFTs are usually normal, alk phos and GGT are also usually normal
--*transabdominal U/S is initial test of choice to see gallbladder inflammation*
--*HIDA scan is criterion standard* (nonvisualization of the gallbladder due to stone
blocking the cystic duct)
What is the treatment of acute cholecystitis? - answer;-Nonoperative mgmt followed by
early cholecystectomy (laparoscopic preferred when possible), ideally w/in 72 hrs of
symptom onset:
,--NPO, IV fluids, pain control with NSAIDs, IV abx Metronidazole + either cephalosporin
(eg, Ceftriaxone, Cefazolin, Cefuroxime, Cefotaxime) or Fluoroquinolone
--then cholecystectomy
What is acute acalculous cholecystitis? - answer;-Acute necroinflammatory disease of
the gallbladder not due to gallstones; accounts for 10% of acute cholecystitis;
associated with high morbidity and mortality
What is the pathophysiology of acute acalculous cholecystitis? - answer;-*Gallbladder
stasis and ischemia* leading to a local inflammatory reaction in the gallbladder wall;
leads to concentration of bile salts, gallbladder distention, secondary infection,
perforation, or necrosis of gallbladder tissue
What are risk factors for acute acalculous cholecystitis? - answer;-Current
hospitalization, critically-ill patients
What are symptoms of acute acalculous cholecystitis? - answer;-fever, leukocytosis,
*jaundice*, sepsis, vague abdominal discomfort
How is acute acalculous cholecystitis diagnosed? - answer;--Based on clinical
symptoms in the setting of supportive imaging and the exclusion of alternative dx
-*U/S is initial test of choice* (distended gallbladder with thickened walls and
pericholecystic fluid w/o calcifications)
-Abdominal CT
-HIDA scan
What is the treatment of acute acalculous cholecystitis? - answer;-Supportive care w/
IV fluids, bowel rest, pain control, correction of electrolytes, broad spectrum abx
What is chronic cholecystitis? - answer;--Fibrosis and thickening of the gallbladder due
to chronic inflammatory cell infiltration of the gallbladder evident on histopathology
-the presence of chronic cholecystitis does not correlate with symptoms
-almost always associated with gallstones
What is the pathophysiology of acute pancreatitis? - answer;-Acinar injury -->
intracellular activation of pancreatic enzymes --> autodigestion of pancreas
What are causes of acute pancreatitis and which is most common? - answer;--
Gallstones and alcohol abuse are the 2 most common causes (with gallstones being
most common)
-Other causes: thiazides, protease inhibitors, exenatide, valproic acid
What are symptoms of acute pancreatitis? - answer;--Epigastric pain: steady, boring,
deep pain that often radiates to the back or other quadrant. Pain is exacerbated if
supine, eating and relieved with leaning forward, sitting or fetal position
-Fever, N/V, and abdominal distention (GI hypomotility)
, What are physical exam findings of acute pancreatitis? - answer;--Epigastric
tenderness
-Necrotizing, hemorrhagic: Cullen's sign (periumbilical ecchymosis) and Grey Turner
sign (flank ecchymosis)
What are the diagnostic criteria for acute pancreatitis? - answer;-The dx of acute
pancreatitis requires the presence of 2 of the following 3 criteria:
--acute onset of persistent, severe epigastric pain often radiating to the back
--elevation in serum lipase or amylase
--characteristic findings of acute pancreatitis on imaging
What are laboratory findings in acute pancreatitis? - answer;--Increased amylase and
lipase are best initial tests (lipase more specific than amylase)
-Hypocalcemia (necrotic fat binds to calcium, lowering serum calcium levels called
saponification)
What are imaging findings in acute pancreatitis? - answer;--Abdominal CT is dx
imaging of choice
-AXR: sentinel loop (localized ileus), Colon cutoff sign (abrupt collapse of the colon near
the pancreas)
What is the treatment of acute pancreatitis? - answer;--"Rest the pancreas"
-Supportive: NPO, IV fluid resuscitation, analgesia
-ABX are NOT routinely used
What criteria is used to determine the prognosis of acute pancreatitis? - answer;-
Ranson's criteria
What is chronic pancreatitis? - answer;-Progressive irreversible inflammatory changes
to the pancreas that lead to loss of pancreatic endocrine and exocrine function
What are causes of chronic pancreatitis and which is most common? - answer;--Heavy
alcohol use is most common
-Cystic fibrosis is most common in children
-Other: idiopathic
What is the clinical triad of chronic pancreatitis? - answer;-Calcifications + steatorrhea
+ DM are hallmark
What are symptoms of chronic pancreatitis? - answer;--Abdominal pain is most
common symptom
-Triad of calcifications, steatorrhea, and DM
-Fat maldigestion: steatorrhea (oily or floating stool) but may not have diarrhea
What are laboratory findings of chronic pancreatitis? - answer;-Serum amylase and
lipase levels are usually not strikingly elevated in chronic pancreatitis and may even be
low
update A+ graded
What is acute cholecystitis? - answer;-Inflammation and infection of the gallbladder due
to obstruction of the cystic duct by gallstones
What is the most common cause of acute cholecystitis? - answer;-E. coli
What are symptoms of acute cholecystitis? - answer;-RUQ and epigastric pain: usually
severe, steady, and continuous (prolonged > 4-6 hrs), progressive, may radiate to the
shoulder, interscapular area, right scapula, right shoulder, or back, may be aggravated
by movement, and is often precipitated by fatty foods or large meals
What are physical exam findings of acute cholecystitis? - answer;--Fever
-Enlarged palpable gallbladder; jaundice is NOT usually seen
-Positive Murphy's sign (RUQ pain or inspiratory arrest with palpation of the gallbladder
fossa)
-Positive Boas sign (referred pain to right shoulder subscapular area (due to phrenic
nerve irritation)
How is acute cholecystitis diagnosed? - answer;-Acute cholecystitis should be
suspected in a patient presenting with RUQ or epigastric pain (often continuous) + fever
+ leukocytosis:
--Increased WBCs
--LFTs are usually normal, alk phos and GGT are also usually normal
--*transabdominal U/S is initial test of choice to see gallbladder inflammation*
--*HIDA scan is criterion standard* (nonvisualization of the gallbladder due to stone
blocking the cystic duct)
What is the treatment of acute cholecystitis? - answer;-Nonoperative mgmt followed by
early cholecystectomy (laparoscopic preferred when possible), ideally w/in 72 hrs of
symptom onset:
,--NPO, IV fluids, pain control with NSAIDs, IV abx Metronidazole + either cephalosporin
(eg, Ceftriaxone, Cefazolin, Cefuroxime, Cefotaxime) or Fluoroquinolone
--then cholecystectomy
What is acute acalculous cholecystitis? - answer;-Acute necroinflammatory disease of
the gallbladder not due to gallstones; accounts for 10% of acute cholecystitis;
associated with high morbidity and mortality
What is the pathophysiology of acute acalculous cholecystitis? - answer;-*Gallbladder
stasis and ischemia* leading to a local inflammatory reaction in the gallbladder wall;
leads to concentration of bile salts, gallbladder distention, secondary infection,
perforation, or necrosis of gallbladder tissue
What are risk factors for acute acalculous cholecystitis? - answer;-Current
hospitalization, critically-ill patients
What are symptoms of acute acalculous cholecystitis? - answer;-fever, leukocytosis,
*jaundice*, sepsis, vague abdominal discomfort
How is acute acalculous cholecystitis diagnosed? - answer;--Based on clinical
symptoms in the setting of supportive imaging and the exclusion of alternative dx
-*U/S is initial test of choice* (distended gallbladder with thickened walls and
pericholecystic fluid w/o calcifications)
-Abdominal CT
-HIDA scan
What is the treatment of acute acalculous cholecystitis? - answer;-Supportive care w/
IV fluids, bowel rest, pain control, correction of electrolytes, broad spectrum abx
What is chronic cholecystitis? - answer;--Fibrosis and thickening of the gallbladder due
to chronic inflammatory cell infiltration of the gallbladder evident on histopathology
-the presence of chronic cholecystitis does not correlate with symptoms
-almost always associated with gallstones
What is the pathophysiology of acute pancreatitis? - answer;-Acinar injury -->
intracellular activation of pancreatic enzymes --> autodigestion of pancreas
What are causes of acute pancreatitis and which is most common? - answer;--
Gallstones and alcohol abuse are the 2 most common causes (with gallstones being
most common)
-Other causes: thiazides, protease inhibitors, exenatide, valproic acid
What are symptoms of acute pancreatitis? - answer;--Epigastric pain: steady, boring,
deep pain that often radiates to the back or other quadrant. Pain is exacerbated if
supine, eating and relieved with leaning forward, sitting or fetal position
-Fever, N/V, and abdominal distention (GI hypomotility)
, What are physical exam findings of acute pancreatitis? - answer;--Epigastric
tenderness
-Necrotizing, hemorrhagic: Cullen's sign (periumbilical ecchymosis) and Grey Turner
sign (flank ecchymosis)
What are the diagnostic criteria for acute pancreatitis? - answer;-The dx of acute
pancreatitis requires the presence of 2 of the following 3 criteria:
--acute onset of persistent, severe epigastric pain often radiating to the back
--elevation in serum lipase or amylase
--characteristic findings of acute pancreatitis on imaging
What are laboratory findings in acute pancreatitis? - answer;--Increased amylase and
lipase are best initial tests (lipase more specific than amylase)
-Hypocalcemia (necrotic fat binds to calcium, lowering serum calcium levels called
saponification)
What are imaging findings in acute pancreatitis? - answer;--Abdominal CT is dx
imaging of choice
-AXR: sentinel loop (localized ileus), Colon cutoff sign (abrupt collapse of the colon near
the pancreas)
What is the treatment of acute pancreatitis? - answer;--"Rest the pancreas"
-Supportive: NPO, IV fluid resuscitation, analgesia
-ABX are NOT routinely used
What criteria is used to determine the prognosis of acute pancreatitis? - answer;-
Ranson's criteria
What is chronic pancreatitis? - answer;-Progressive irreversible inflammatory changes
to the pancreas that lead to loss of pancreatic endocrine and exocrine function
What are causes of chronic pancreatitis and which is most common? - answer;--Heavy
alcohol use is most common
-Cystic fibrosis is most common in children
-Other: idiopathic
What is the clinical triad of chronic pancreatitis? - answer;-Calcifications + steatorrhea
+ DM are hallmark
What are symptoms of chronic pancreatitis? - answer;--Abdominal pain is most
common symptom
-Triad of calcifications, steatorrhea, and DM
-Fat maldigestion: steatorrhea (oily or floating stool) but may not have diarrhea
What are laboratory findings of chronic pancreatitis? - answer;-Serum amylase and
lipase levels are usually not strikingly elevated in chronic pancreatitis and may even be
low
