Sesap Gi

Front 1

Follow up for low grade dysplasia with barret's esophagus?

Back 1

yearly endoscopy with four quadrant biopsies every 2cm along the length of Barrett's segment for low grade

Front 2

Follow up for high grade dysplasia with barret's esophagus?

Back 2

every 3 months if focal; if multifocal needs intervention

Front 3

Treatment options of achalasia

Back 3

Botulin 85% but recurs
Dilation 90% not good in young
Myotomy + fundoplication 95%

Front 4

LGIB Surgery

Back 4

subtotal colectomy b/c segmental resections have 75% rebleed with 50% mortality

Front 5

Rates of bleeding detected by angio vs bleeding scan

Back 5

1.0ml/hr vs 0.1ml/hr

Front 6

MCC of death in FAP

Back 6

duodenal adenoCA

Front 7

Management of duodenal polyps in FAP showing only dysplasia

Back 7

Whipple

Front 8

Risk of malignancy in UC

Back 8

0.1-0.2%/year
2% @ 10 years
8% @ 20yrs
20% @ 30

Front 9

Rectal NETS

Back 9

10% of all GI NETs
more frequent and better prog than colon
usually <1cm (can be removed endoscopically)
<2cm have >70% mets
less likely to secrete vasoacitve

Front 10

Most common appendiceal malignancy

Back 10

1) Mucinous adenoCA
2) Carcinoid

Front 11

When is R hemicolectomy indicated in appendiceal malignancies?

Back 11

All non NET and NET >2cm

Front 12

Location and pathophysiology of gastric ulcers

Back 12

Type 1 - near angularis incisura on lesser curve
Type 2 - a/w duodenal ulcer
Type 3 - prepyloric
Type 4 - GE junction

Front 13

Gastric CA with + nodes should receive...

Back 13

fluorocil + XRT

Front 14

what type of fistulas can be managed with simple fistulotomy?

Back 14

intersphinteric

Front 15

contraindications to neostigmine

Back 15

Bradycardia
Renal impairment
History of bronchospasm

Front 16

Reasons for recurrent duodenal ulcer s/p highly selective vagotomy

Back 16

Spares branches to liver and biliary system
may miss criminal nerve of Grassi (right posterior vagus nerve)

Front 17

Anal margin vs anal canal CA

Back 17

WLE vs Nigro protocol

Front 18

gallbladder polyps

Back 18

remove if
>10 mm
symptomatic or
>50 yo

Front 19

Co-localization theory of pancreatitis

Back 19

cathepsin B mediated intra-acinar cell activation of digestive enzymes

Front 20

management of pancreatic pseudocysts

Back 20

2% of acute pancreatitis
85% single
leave alone if asymptomatic or not growing for at least 6-12 weeks (40% will spontaneous resolution)
to allow for maturation of wall

Front 21

Pancreatic solid cystic tumors

Back 21

almost exclusively in young
women
usually asymptomatic
pancreatic resxn TOC

Front 22

MC tumor of liver

Back 22

hemangioma
usually incidentally found
<5cm usually
homogeneous, hyperechoic, well circumscribed ass with posterior acoustic enhancement

Front 23

CT description of hemangioma

Back 23

hypoattenuation
early peripheral enhancement
progressive opacification toward center
complete isoattenuation fill in occurring

Front 24

Best imaging modality for hemangioma

Back 24

MRI

Front 25

treatent of desmoid tumors

Back 25

sulindac or tamoxifen

Front 26

Gene mutation in FAP

Back 26

APC

Front 27

Description of FNH lesion

Back 27

well circumscribed, nonencapsulated, nodular cirrhotic like mass
fibrous stellate central scar
early enhancement with washout on delayed

Front 28

Where are carcinoid derived from?

Back 28

amine precursor uptake and decarboxylation (APUD) neural crest (ectoderm)

Front 29

Intraductal papillary mucinous neoplasia of pancreas

Back 29

premalignant
15% have jaundice
hallmark is thick mucin *multiple cysts and ducts

Front 30

management of isolated gastric varices

Back 30

splenectomy if splenic vein thromobosis is cause

Front 31

Spigelian hernia

Back 31

usually b/n umbilicus and arcuate line

Front 32

Howship-Romberg sign

Back 32

50% present in obturator hernia
pain along medial thigh to knee
flexion of hip exacerbates pain

Front 33

Richter's hernia

Back 33

partial protrusion of antimesenteric intestine

Front 34

HCC

Back 34

initially low attenuation
enhance brightly with contrast
become hypodense on delayed images

Front 35

hepatic adenoma

Back 35

early peripheral enhancement
centripetal filling
hyperintense on T2

Front 36

role of octreotide in carcinoid syndrome

Back 36

controls diarrhea but does not prevent progression of carcinoid valvular dz

Front 37

Management of Zenker's vs epiphrenic divertculum

Back 37

esophageal myotomy is on the same side of diverticulectomy in Zenker's and opposite in epiphrenic

Front 38

Studies needed for GERD workup

Back 38

Endoscopy +/- biopsy
pH probe
Manometry

Front 39

all patients with Schatzki's rings have

Back 39

sliding hiatal hernia

Front 40

Follow up for Barrett's s/p Nissen

Back 40

lifetime EGD

Front 41

Three approaches to esophagectomy

Back 41

Transhiatal
Ivor Lewis
3 hole esophagectomy
all need pyloromyotomy

Front 42

chemo for esophageal cancer

Back 42

5FU and cisplatin

Front 43

Dysphagia with smooth filling defect and intact mucosa with normal histology

Back 43

GIST --> enucleation if >5cm or symptomatic

Front 44

Management of caustic esophageal injury

Back 44

no NGT, NPO, IVF, antibx
Endoscopy
Serial CXR/AXRs
Gastro->barium swallow on HD 2-3 for 2nd/3rd degree burns

Front 45

MC site of esophageal perforation

Back 45

cricopharyngeus

Front 46

Nutcracker vs DES

Back 46

single vs multiple prolonged, high amplitude contractions

Front 47

Gastrografin vs Barium in chest and abdomen

Back 47

Barium (inert) harmful to lungs so gastrografin first

Front 48

Management of esophageal perforations

Back 48

if not contained/systemic --> depends on time of dx/contamination
<24 hrs/clean --> primary repair, longitudinal myotomy, drains, buttress repair with flaps (pleura, pericardium, intercostal mm, omentum)
POD 10 gastro/barium swallow
For sick pts --> cervical esophagostomy, mediastinal washout, chest tubes, later G/J tube and esophagectomy

Front 49

Type I gastric Carcinoids

Back 49

70-80%
Chronic atrophic gastritis
Pernicious anemia
Hypergastrinemia --> trophic effect on ECL cells (oxyntic fundic mucosa)
F>M 2cm
Multicentric
<5% mets

Front 50

Type II gastric carcinoids

Back 50

Least common
A/W hypergastrinemia of ZE syndrome/MEN 1
M:F
Multicentric
<2cm
10% mets

Front 51

Type III gastric carcinoids

Back 51

15-20%
Sporadic
No hypergastrinemia
Most aggressive
Solitary
>5cm

Front 52

what do all gastric carcinoids stain for?

Back 52

Chromogranin A

Front 53

What imaging modality is useful gastric carcinoids?

Back 53

Somatostatin receptor scintigraphy

Front 54

Percentage of gastric carcinoids that p/w carcinoid syndrome

Back 54

10%
treat with somatostatin

Front 55

Effect of PPIs in UGIB

Back 55

prior to endoscopy reduces stigmata of recent hemorrhage but do NOT reduce mortality, re-bleeding, or need for surgery

Front 56

Where is bleeding duodenal ulcer usually?

Back 56

posterior in 1st portion (3 vessel ligations)

Front 57

What do you have to do with truncal vagotomy?

Back 57

pyloroplasty

Front 58

HSV vs truncal vagotomy

Back 58

decreased gastric atony, alkaline reflux, gastritis, dumping, diarrhea

Front 59

Incidence of biliary injuries in cholecystectomies

Back 59

0.2-2%

Front 60

Incidence of Duct of Luschka injuries

Back 60

0.04-0.2%

Front 61

Characteristics of colonic polyps that require rxn

Back 61

Poor diff
Haggitt level 4 invasion
<2mm margin
All sessile
Pedunculated polyps with stalk invasion

Front 62

Presentation of postpolypectomy syndrome

Back 62

pain, fever, high WBC
w/n 12 hrs-days
no free air
focal thickening of colonic wall

Front 63

Gastric carcinoid incidence of all gastric CA and all carcinoids

Back 63

2-5% of all gastric CA and 1-3% of all carcinoids

Front 64

How do gastric carcinoids usually present?

Back 64

abdominal pain or GI bleeding

Front 65

5YRS for Type I-III gastric carcinoids

Back 65

90>75>50

Front 66

% of colon CA that p/w obstruction

Back 66

15%

Front 67

% of colon CA that are R sided

Back 67

25%

Front 68

Colonic stenting

Back 68

FDA approved
>90% success
1/2 the mortality of sx

Front 69

AE of colonic stenting

Back 69

Perforation (4%)
Stent migration
Re-obstruction 10%
Pain & rectal tenesmus
Bleeding

Front 70

Long term survival in stenting vs emergency sx for obstructing colonic CA

Back 70

no difference

Front 71

Epiphrenic diverticula

Back 71

- Rare malignant mucosal transformation 0.3-3%
- A/w esophageal motility disorder (pulsion)
- Distal third of esophagus
- A/w mechanical obstruction of LES
- Dysphagia, regurgitation, reflux, chest pain, halitosis
- 45% risk of aspiration

Front 72

SBO more frequent in retro or antecolic

Back 72

retro

Front 73

Early vs Late SBO s/p gastric bypass

Back 73

nternal hernias caused by jejuj's mesenteric defects typically occur late

Early SBO usually @ jej-jej

Front 74

3 types of bile acid malabsorption

Back 74

Type I most common; ileal disease/rxn
Type II idiopathic
Type III s/p vagotomy or cholecystectomy

Front 75

Acute tachycardia & SOB s/p bariatric surgery

Back 75

usually normal exam and false negative CT

Front 76

What studies do you need before operating on GERD

Back 76

24H pH
Esophagoscopy
UGI
Esophageal manometry (partial vs 360 wrap)
gastric emptying studies in DM

Front 77

MC complication of EGD

Back 77

:Hypoxia (1.6%)

Front 78

MC benign esophageal neoplasm

Back 78

Leiomyoma
- Peak in 3rd-5th decades of life
- Distal 2/3 of esophagus (80% muscularis propria)
- Dysphagia, pain, weight loss
- C-KIT negative
- Mobile, nonobstructive mass projecting into lumen with normal overlying mucosa
- TOC for 2cm - thorascopic enucleation

Front 79

Most common GI carcinoid to produce malignant carcinoid syndrome

Back 79

ileum

Front 80

Where do carcinoid tumors arise from?

Back 80

enterochromaffin cells (kulchitsky)

Front 81

Where do GIST tumors arise from?

Back 81

Interstitial cells of Cajal

Front 82

Most common symptom in carcinoid syndrome?

Back 82

Flushing

Front 83

Surgical management in adult intussussception

Back 83

resection, lymphadenectomy and anastomosis

Front 84

Malrotation is found in 20% of people with?

Back 84

congenital diaphragmatic hernia

Front 85

Treatment for Crohn's perianal abscess above anal sphincter

Back 85

Surgical drainage
seton
antbix

Front 86

Peutz-Jegher's polyps are what type?

Back 86

hamartomas - not premalignant