Surgery Exam II Part 1

24hr pH Monitoring is considered the gold standard for the diagnosis of GERD. This test measures the amount of acid that flows back into the esophagus over a 24-hour period, providing an objective assessment of acid reflux. It helps to determine the frequency and severity of reflux episodes, which is crucial in diagnosing GERD accurately. Other tests like PET scan, esophageal manometry, and esophageal ultrasound may be used to complement the diagnosis but are not considered the gold standard.

Esophageal perforations are not typically spontaneous and due to an increase in intraluminal pressure. They are usually caused by trauma, such as from medical procedures or foreign objects, or by underlying conditions such as esophageal cancer or gastroesophageal reflux disease. Therefore, the correct answer is False.

Small bowel obstruction can be caused by various factors, including a gallstone or neoplasm (tumor). This means that the presence of a gallstone or tumor can lead to a blockage in the small intestine, causing small bowel obstruction. Other possible causes of small bowel obstruction include adhesions, hernias, and inflammation. Therefore, the statement "May be caused by a gall stone or neoplasm" is true in the context of small bowel obstruction.

Free air under the diaphragm is a sign of a perforated peptic ulcer. This occurs when there is a hole or rupture in the lining of the stomach or small intestine, allowing air to escape into the abdominal cavity. This can cause severe abdominal pain, tenderness, and a rigid abdomen. Prompt medical attention is necessary as a perforated peptic ulcer can lead to serious complications such as peritonitis and sepsis.

The patient presenting with postprandial abdominal heaviness, anorexia, and an epigastric mass is most likely to have Gastric Carcinoma. Gastric carcinoma refers to cancerous growth in the stomach, which can cause symptoms like abdominal discomfort, loss of appetite, and the presence of a mass. Other conditions like Gastric Volvulus, Gastric Ulcer, and Perforated Ulcer may present with similar symptoms, but the presence of an epigastric mass is more indicative of gastric carcinoma.

The statement is false because patients with Epiphrenic diverticulum may not always present with dysphagia of solids then foods. While dysphagia is a common symptom of Epiphrenic diverticulum, it may not always be limited to solids and can also include liquids. Therefore, the statement is incorrect.

Esophageal perforation is a condition where there is a tear or hole in the esophagus. The symptoms associated with esophageal perforation include Hamman's sign (a crunching sound heard with each heartbeat), tachycardia (rapid heart rate), and pneumothorax (collapsed lung). Hypertension, or high blood pressure, is not typically associated with esophageal perforation.

Most small intestine fistulas are the result of surgical procedures. This means that the majority of these fistulas occur as a complication of a surgical intervention in the small intestine. It is important to note that not all small intestine fistulas are caused by surgical procedures, but this is the most common cause. Understanding this can help in diagnosing and managing patients with small intestine fistulas, as surgical history can be an important factor to consider.

Given that the patient presents with Barrett's esophagus, it can be assumed that they had a long history of GERD (gastroesophageal reflux disease) because Barrett's esophagus is a complication of chronic GERD. Additionally, patients with Barrett's esophagus are at an increased risk for adenocarcinoma, a type of esophageal cancer. Therefore, it can be assumed that they are at risk for adenocarcinoma. Lastly, in some cases, patients with Barrett's esophagus may require esophagectomy, a surgical procedure to remove part or all of the esophagus. Hence, all of the above assumptions can be made based on the presence of Barrett's esophagus.

The initial management of Upper Gastrointestinal Hemorrhage involves several steps such as finding the responsible lesion, assessing circulatory status, and using ice water lavage to stop bleeding. However, the use of Beta Blockers for Portal Hypertension is not a step in the initial management of Upper Gastrointestinal Hemorrhage.

chronic form is asymptomatic

Patients presenting with small intestine obstruction most often are suffering from adhesions. Adhesions occur when scar tissue forms between the walls of the small intestine, causing them to stick together. This can be a result of previous surgeries, infections, or inflammation in the abdominal area. Adhesions can cause the small intestine to become twisted or blocked, leading to symptoms such as abdominal pain, bloating, and vomiting. Treatment for small intestine obstruction caused by adhesions may involve surgery to remove the scar tissue and restore normal bowel function.

this is Chron's

The statement is false because strictures are not considered functional abnormalities of the esophagus. Strictures refer to narrowings or constrictions in the esophagus that can be caused by various factors such as scar tissue, inflammation, or tumors. They are structural abnormalities rather than functional ones. Functional abnormalities of the esophagus typically refer to conditions that affect the movement and coordination of the muscles in the esophagus, such as achalasia or esophageal spasms.

If a patient presents with esophageal perforation, they should be given broad spectrum antibiotics IV for 48 hours followed by surgical closure. This statement is false. In the case of esophageal perforation, immediate surgical intervention is required. Antibiotics may be administered to prevent infection, but they should not be the primary treatment. Surgical closure is necessary to repair the perforation and prevent further complications.

Adhesions are bands of scar tissue that can form after abdominal surgery or inflammation. They can cause the small intestine to become twisted or kinked, leading to a condition called volvulus. This can result in a partial or complete obstruction of the small intestine. Therefore, it is true that adhesions may be worsened by a volvulus, leading to small intestine obstruction.

Bochdalek is left , morgagni is right

Laser therapy is used to treat Esophageal carcinoma. This treatment involves using a laser beam to destroy cancer cells in the esophagus. It is a minimally invasive procedure that can be used to remove or shrink tumors, relieve symptoms, and improve quality of life for patients with esophageal carcinoma.

Borchardt's triad is a set of symptoms that indicate a closed-loop obstruction of the intestine. It includes retching then inability to vomit, epigastric distention, and inability to pass an NG tube. Constipation and decreased flatus are not part of Borchardt's triad.

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Benign tumors in the esophagus typically do not cause symptoms unless they reach a size of approximately 5 cm. This means that when the tumor grows to around 5 cm, it can start causing symptoms such as difficulty swallowing, chest pain, or weight loss. However, it is important to note that this statement does not provide any information about the other options listed in the question.

Congenital atresia is a common pediatric cause of short bowel syndrome. This condition refers to the absence or narrowing of a portion of the small intestine, which can lead to malabsorption of nutrients and the need for parenteral nutrition. Radiation enteropathy and regional enteritis are not typically associated with short bowel syndrome in pediatric patients.

Manometry is the best test to confirm diffuse esophageal spasm. Manometry measures the pressure in the esophagus and can detect abnormal contractions or spasms. This test can help diagnose esophageal motility disorders, including diffuse esophageal spasm, by evaluating the coordination and strength of muscle contractions in the esophagus. Barium swallow and fluoroscopic studies may show abnormalities, but they cannot definitively confirm the diagnosis. Endoscopic ultrasound is not typically used to diagnose esophageal motility disorders.

When treating a patient with possible Zollinger Ellison syndrome, surgical resection is the preferred treatment. This means that removing the tumor causing the syndrome is the recommended approach. This is because Zollinger Ellison syndrome is caused by a gastrin-secreting tumor in the pancreas or duodenum, and surgical removal of the tumor can help alleviate symptoms and prevent complications. H2 blockers may be used to manage symptoms, but they are not considered sufficient as a standalone treatment. The presence of steatorrhea, which is the presence of excess fat in the stool, does not definitively rule out Zollinger Ellison syndrome and is not a determining factor in the treatment approach.

Nutcracker Esophagus is a condition characterized by abnormal contractions of the esophageal muscles, causing difficulty in swallowing (dysphagia). It is not associated with esophageal torsion, as mentioned in the second option. The condition can be treated with calcium channel blockers, which help to relax the esophageal muscles and alleviate symptoms. Surgery is not considered the most effective treatment for Nutcracker Esophagus. Therefore, the correct answer is that it is treated with calcium channel blockers.

Button batteries should be removed urgently because they can cause serious complications if left in the body. When ingested, button batteries can cause tissue damage, chemical burns, and even perforation of the gastrointestinal tract. Therefore, prompt removal is necessary to prevent further harm.

In this case, the patient's symptoms of epigastric discomfort, postprandial bloating, and dysphagia suggest a possible diagnosis of hiatal hernia. Hiatal hernia can cause these symptoms and may require a fundoplication procedure to correct. Additionally, the presence of anemia may be revealed through laboratory tests, which could be related to chronic bleeding from the hernia. Therefore, all of the given options (labs may reveal anemia, include hiatal hernia in Ddx, and fundoplication may be needed) can be expected in this case.

Achalasia is a condition that affects the esophagus and causes difficulty in swallowing. It is characterized by the inability of the lower esophageal sphincter to relax, leading to the accumulation of food and liquid in the esophagus. Regurgitation, which is the spontaneous return of swallowed food or liquid back into the mouth, is a common symptom of achalasia. Therefore, the statement that regurgitation is the second most common symptom of achalasia is true.

Based on the symptoms described, the patient is experiencing dysphagia (difficulty swallowing) and frequent regurgitation of undigested food. This suggests a problem with the esophagus or upper digestive tract. Halitosis (bad breath) is often associated with regurgitation of undigested food, indicating that the patient may have A (halitosis). Zenker's diverticulum is a type of esophageal diverticulum that can cause dysphagia and regurgitation of undigested food, which suggests that the patient may also have C (Zenker's diverticulum). Therefore, the correct answer is A & C.

GERD, or gastroesophageal reflux disease, is a condition in which stomach acid flows back into the esophagus, causing irritation and inflammation. This can lead to esophagitis, which is inflammation of the esophagus. Symptoms of GERD can include wheezing, as the acid can irritate the airways, and chest pain, which is a typical symptom. Therefore, all of the given statements are true concerning GERD.

The best step to take when treating a patient with a suspected Zenker's diverticulum is excision of the diverticulum. This is because excision is the definitive treatment for Zenker's diverticulum and can provide long-term relief of symptoms. Endoscopy may be used to confirm the diagnosis and assess the size and location of the diverticulum, but it is not a treatment option. Fundoplication of the cricopharyngeus is not indicated in the treatment of Zenker's diverticulum.

type 3 in the antrum and is caused by NSAIDs, type 2 is prepyloric, surgery is usually unnecessary, choice A indicates ZEsyndrome

Patients with short bowel syndrome typically experience malabsorption of nutrients, leading to weight loss. This can result in a reduction in body weight of up to 20%.

erythema multiforme is Ulcerative colitis

When treating a perforated ulcer, it is important to rule out pancreatitis and cholecystitis. This is because the symptoms of these conditions can mimic those of a perforated ulcer, and misdiagnosis can lead to incorrect treatment. By ruling out pancreatitis and cholecystitis, the healthcare provider can ensure that the appropriate treatment is given to the patient. Delaying surgery for antibiotics to take effect and being alert for Borchardt's triad are also important considerations, but they are not the most crucial when it comes to treating a perforated ulcer.

Peptic ulcers are characterized by the occurrence in the esophagus, jejunum, and duodenum. They can also be mistaken for pancreatitis and gastroesophageal reflux disease (GERD). This means that both options A and C are correct, as they accurately describe peptic ulcers.

Dumping syndrome and alkaline gastritis are commonly associated with the treatment of duodenal ulcer. Dumping syndrome occurs when food moves too quickly from the stomach to the small intestine, causing symptoms such as nausea, vomiting, and diarrhea. Alkaline gastritis is inflammation of the stomach lining due to an increase in alkaline secretions. Both of these conditions can occur as a result of surgical interventions or medications used to treat duodenal ulcers.

Proximal obstructions in the small bowel can lead to profuse vomiting. This is because when the obstruction is closer to the stomach, it prevents the passage of food and fluids, leading to a buildup and subsequent vomiting. In contrast, distal obstructions may cause well-localized pain but typically do not result in profuse vomiting. The presence of ladder-like air-fluid levels throughout the entire gastrointestinal (GI) system is not specific to simple obstruction of the small bowel and can be seen in other conditions as well. Therefore, the correct answer is profuse vomiting in proximal obstructions.

The correct answer is "involves skip lesions from the lips to the anus." Chron's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, from the mouth to the anus. It is characterized by the presence of skip lesions, meaning that there are areas of inflammation and damage alternating with normal healthy tissue. This can lead to a variety of symptoms and complications, including thinning of the bowel walls and strictures. The disease has a bimodal peak of incidence, meaning that it commonly affects individuals in two age groups: younger individuals between 15-30 years old and older individuals between 60-80 years old.

Pneumatic dilatation is the best treatment option for Achalasia. This procedure involves the insertion of a balloon into the lower esophageal sphincter (LES) and inflating it to stretch and widen the narrowed area. This helps to improve the movement of food and liquids through the esophagus. Myotomy of the esophagus and fundoplication of the LES are also treatment options for Achalasia, but pneumatic dilatation is considered the most effective and least invasive approach.