Surgery Exam II part 2 focuses on colorectal issues, specifically large intestine obstructions and colon cancer. It assesses understanding of complications, least likely symptoms, treatment options, and the role of cancer in obstructions, particularly in elderly patients.
Deep crampy pain in hypogastrium
Vomiting indicating long standing obstruction
Pain anterior to sigmoid obstruction
Loud borborygmus
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Paralytic ileus' usually presents with cramping
Ogilvie's syndrome is caused by adhesion
Cancer is common in elderly patients without Hx of adhesions
First step in treatment is removal of obstruction
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Ulcerative Colitis is a risk factor
Gall stone increases risk in men
Symptomatic during first 5 years
All of the above
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Surgical resection except after metastases
Surgical resection of colon only
Palpation of tumors to determine malignancy
Surgical resection of colon and lymphnodes
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Palliative procedure: removal of colon
Treatment of choice: radiation therapy
Treatment of choice: low anterior resection
Palliative procedures: abdominperitoneal resection
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True
False
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Constipation relieved by passing flatus
Stranding of pericolic fat on CT
Not likely to have blood in the stool
Generalized abdominal pain
All of the above
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True
False
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Sigmoid volvuli include small bowel obstruction
Volvuli may cause vascular impairment
Cecal volvulus rises out of the pelvis on plain film
Sigmoid pain is colicky and begins in right abdomen
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Resection and anastamosis
Colonoscopy or rigid sigmoidoscope
Cecal decompression
All of the above
A & C
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True
False
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Cecal Volvulus
Ulcerative Colitis
Sigmoid Volvulus
Cancer of the Colon
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Ankylosing spondylitis
Pyoderma gangrenosum
Pericarditis
All of the above
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Moderate cases need IV drugs
First attack has high risk of perforation
Megacolon should be treated with resection
All patients with UC can be treated as outpatients
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Abdominal pain until abdominal contents discharged
Episodic diarrhea and pain with lassitude
Vague abdominal disconfored followed by nausea
1/3 are unsuspected before surgery
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True
False
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Perforations more likely in pregnant women
Delayed diagnosis may lead to peritonitis
Most easily diagnoses in women 20-40
May have periappendiceal inflammation
Mucoceles are usually non malignant
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True
False
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Referred
Somatic
Visceral
Inferred
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Is midline when pure
Obstruction is a common cause
Is crampy, colicky and intermittent
All of the above
A & C
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True
False
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Has aseptic and bacterial causes
Ischemic bowel presents with minor pain
Vascular causes are often catastrophic
Obstructions cause nausea then vomiting
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Dysuria
Polyphagia
Chest pain
Abnormal vitals
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Appendicitis
Ishemic bowel
Intususseption
Internal hemorrhage
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Radiographs
Sonograms
CT Scans
Binoculars
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True
False
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True
False
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