SURGERY FOR ORALS

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SURGERY FOR ORALS by Mind Map: SURGERY FOR ORALS

1. Critical Care

2. Head & Neck

2.1. Nodule

2.1.1. Midline

2.1.1.1. Thyroglossal Duct Cyst

2.1.1.1.1. US & FNA

2.1.1.1.2. Moves w tongue protrusion

2.1.1.2. Thyroid Nodule

2.1.1.2.1. US

2.1.1.2.2. TFTs

2.1.1.2.3. FNA

2.1.1.2.4. FHx or H/o Radiation

2.1.1.2.5. <4cm

2.1.2. H&P

2.1.2.1. H/o neck RTx

2.1.2.2. Fam Hx

2.1.2.2.1. Endocrinopathy

2.1.2.2.2. Cancers

2.1.2.3. LNs

2.1.2.4. Risk factors

2.1.2.4.1. Tobacco

2.1.2.4.2. EtOH

2.1.3. Work-Up

2.1.3.1. TSH/ TFTs/ Ca

2.1.3.2. FNA

2.1.3.2.1. US guided

2.1.3.2.2. Abnormal LN also

2.1.3.2.3. Indeterminate or NonDx

2.1.3.3. Voice Changes

2.1.3.3.1. Laryngoscopy

2.1.4. Parotid mass

2.1.4.1. Imaging

2.1.4.2. No FNA

2.1.4.2.1. Superficial Parotidectomy

2.2. Hyperthyroidism

2.2.1. Grave's Dz

2.2.1.1. ABs to TSHR

2.2.1.1.1. LATS and TSIs

2.2.1.2. Medical Tx

2.2.1.2.1. PTU

2.2.1.2.2. Methamizol

2.2.1.2.3. Propranolol

2.2.1.3. Surgery If

2.2.1.3.1. Recurrent

2.2.1.3.2. Severe Hyperthyroid

2.2.1.3.3. Age>55

2.2.1.3.4. Symptomatic goiter

2.2.1.3.5. Or Radioablation

2.2.2. Multinodular Goiter

2.2.2.1. Surgery vs. RIA

2.2.2.1.1. Surgery if compressive Sx

2.2.2.1.2. Awake fiberoptic intubation

2.2.2.2. Euthyroid

2.2.2.2.1. RIA works 50%

2.2.3. Toxic Adenoma

2.2.3.1. Hot on T-Scan

2.2.3.1.1. Resect

2.2.3.1.2. RIA if warranted

2.2.4. Thyroid Storm

2.2.4.1. Sx

2.2.4.1.1. Hyperthermia

2.2.4.1.2. MS Changes

2.2.4.1.3. Diarrhea, N/V

2.2.4.1.4. Tachycardia

2.2.4.2. Tx

2.2.4.2.1. Propranolol

2.2.4.2.2. PTU

2.2.4.2.3. Dexamethasone

2.3. Hyperparathyroidism

2.3.1. Primary

2.3.1.1. Adenoma

2.3.1.2. Hyperplasia

2.3.2. Secondary

2.3.3. Tertiary

3. Genitourinary

3.1. Kidney

3.2. Ureter

3.2.1. Injury

3.2.1.1. Proximal

3.2.1.1.1. Ureteroureterostomy

3.2.1.1.2. Ureteropelicostomy

3.2.1.1.3. Ureterocalicostomy

3.2.1.2. Distal

3.2.1.2.1. Ureter does not reach

3.3. Bladder

3.4. Gonads

3.4.1. Testes

3.4.2. Ovaries

3.5. Pudenda

3.5.1. Penis

3.5.2. Vagina

4. Breast

4.1. Mass

4.1.1. Fibroadenoma

4.1.1.1. Core Bx

4.1.1.1.1. Excise if

4.1.2. Cyst

4.1.2.1. Simple

4.1.2.1.1. Aspiration

4.1.2.2. Complex

4.1.2.2.1. US guided Biopsy

4.2. Pain

4.3. Nipple discharge

4.3.1. PE focus on culprit quadrant

4.3.2. Calculate GAIL Risk

4.3.3. Imaging

4.3.4. Fluid type

4.3.4.1. Serous/bloody

4.3.4.1.1. If duct ID'd

4.3.4.1.2. If not

4.3.4.2. Milky

4.3.4.2.1. Prolactin level

4.3.4.3. Do not send it for Histology

4.3.4.4. No galactogram

4.3.5. Concerning

4.3.5.1. Spontaneous

4.3.5.2. Unilateral

4.3.5.3. Recurrent

4.4. Screening

4.4.1. Self exam @20 Qm

4.4.1.1. Clinical exam @3y

4.4.1.2. Start @40

4.4.1.2.1. MMG & CE yearly

4.4.2. MRI if

4.4.2.1. BRCA +

4.4.2.2. Li-Fraumeni

4.4.2.3. Radiation to chest

4.4.2.4. Calculated lifetime risk >25%

4.5. Infection

4.5.1. PO ABx

4.5.2. I&D if abscess

4.5.2.1. Excise/Bx if recurrent

4.5.3. Lactation

5. Thoracic

5.1. Esophagus

5.1.1. Motility Disorders

5.1.1.1. Esophagram

5.1.1.2. PH Probe

5.1.1.3. EGD

5.1.1.4. Manometry

5.1.1.5. TREATMENT

5.1.1.5.1. DES

5.1.1.5.2. Nutcracker Eo

5.1.2. Diverticuli

5.1.2.1. Zenker's

5.1.2.1.1. Endoscopic

5.1.2.1.2. Open Resection

5.1.2.1.3. EGD

5.1.2.2. Parabronchial Diverticulum

5.1.2.2.1. Traction

5.1.2.2.2. TB or Lung CA

5.1.3. Achalasia

5.1.3.1. Characteristics

5.1.3.1.1. Medical

5.1.3.1.2. Endoscopic

5.1.3.1.3. Surgical

5.1.4. Stricture

5.1.4.1. R/o CA

5.1.4.1.1. Bx

5.1.4.1.2. EUS

5.1.4.2. R/o Achalasia

5.1.4.2.1. Manometry

5.1.4.3. Balloon dilation

5.1.4.3.1. Nissen for GERD control

5.1.5. Barrett's

5.1.5.1. Nondisplastic

5.1.5.1.1. GERD control

5.1.5.2. LGD

5.1.5.2.1. ReBx in 3 mos

5.1.5.2.2. Treat GERD

5.1.5.3. HGD

5.1.5.3.1. Surveillance Q 3 mos

5.1.5.3.2. CA W/U

5.1.5.4. Indeterminate GD

5.1.5.4.1. Place on high dose PPI

5.1.5.5. Length

5.1.5.5.1. >3cm

5.1.5.5.2. <3cm

5.1.6. Reflux

5.1.6.1. Try Non-Surgical

5.1.6.1.1. Per-op W/U

5.1.6.1.2. Trans-Thoracic

5.1.6.1.3. Trans-abdominal

5.1.6.1.4. Short-Esophagus

5.1.7. Perforation

5.1.7.1. General Approach

5.1.7.1.1. Find it

5.1.7.1.2. Thin barium swallow

5.1.7.2. Highly unstable pt

5.1.7.2.1. Cervical esophagostomy

5.1.7.2.2. T tube drainage

5.1.8. Malignancy

5.1.9. Caustic Inj

5.1.9.1. R/o perf

5.1.9.1.1. + Perf

5.1.9.2. EGD

5.1.9.2.1. 1st degree

5.1.9.2.2. 2-3rd degree

5.2. Aorta

5.3. Cardiac

5.4. Lung

5.5. Mediastinal

6. Vascular

6.1. Peripheral arterial

6.1.1. Claudication

6.1.1.1. Exercise regimen

6.1.1.2. Quit smoking

6.1.1.2.1. Do not operate if still smoking

6.1.1.2.2. Life-limiting ischemia

6.1.2. Critical limb ischemia

6.1.2.1. Ulcer/ open wound

6.1.2.2. Rest pain

6.1.2.3. Neuropathy

6.1.3. Popliteal aneurysm

6.1.3.1. Check for other aneurysms

6.1.3.2. Asymptomatic

6.1.3.2.1. Thrombosed

6.1.3.2.2. Non-thrombosed

6.1.3.3. Symptomatic

6.1.3.3.1. Elective bypass

6.1.3.4. Limb-threatening

6.1.3.4.1. Emergent bypass

6.1.3.4.2. Fogarty thrombectomy

6.2. Peripheral venous

6.3. Carotid

6.3.1. H&P

6.3.1.1. Sx

6.3.1.1.1. Intervene if > 60%

6.3.1.1.2. Plaque ulcer

6.3.1.2. A/Sx

6.3.1.2.1. Intervene if > 70%

6.4. Abdominal aorta

6.4.1. AAA

6.4.1.1. H&P

6.4.1.1.1. C-Scope

6.4.1.1.2. Check for pop aneurysm

6.4.1.2. CT Angio

6.4.1.2.1. Offer EVAR

6.4.1.2.2. Open repair

6.4.1.3. Ruptured

6.4.1.3.1. CTA

6.4.1.3.2. Prep & Drape before induction

6.4.1.3.3. Get supra celiac control

6.4.1.4. Incidental

6.4.1.5. Post-op

6.4.1.5.1. Colonic ischemia

6.5. Acute Mesenteric Ischemia

6.5.1. CT Scan w IV

6.5.1.1. Embolic Dz

6.5.1.1.1. Suspected source

6.5.1.1.2. Evidence of end-organ injury

6.5.1.2. Thrombotic Dz

6.5.1.2.1. Source

6.5.1.2.2. Bypass to supraceliac aorta preferred

6.5.1.2.3. Bypass to inferior aorta may kink

6.6. Aorto-enteric Fistula

6.6.1. HD stable

6.6.2. Unstable

6.6.2.1. Lap

6.6.2.1.1. Prox-Dist Control

6.6.3. Any GIBleed after Aortic bypass

6.6.3.1. AEF UPO

6.7. Infected Graft

6.7.1. Extra-anatomic bypass

6.7.1.1. Then Resection

6.8. Chronic Mesenteric Ischemia

6.8.1. CT Angio

6.8.1.1. Bypass

6.8.1.1.1. Supraceliac

6.8.1.1.2. Retrograde

6.8.1.2. Endovascular stenting

7. Trauma

7.1. Liver

7.1.1. Blunt

7.1.1.1. Grade I-II

7.1.1.1.1. Serial H/H

7.1.1.2. Grade III-IV

7.1.1.2.1. ICU Admit

7.1.1.3. +Blush on CT

7.1.1.3.1. Angio-Embolization

7.2. Rectum

7.2.1. Procto

7.2.2. Laparotomy

7.2.2.1. Extraperitoneal Inj

7.2.2.1.1. Primary Repair if Feasible

7.2.2.1.2. Loop Colostomy

7.2.2.1.3. Presacral Drainage

7.2.2.2. Intraperitoneal Inj

7.2.2.2.1. Repair

7.2.2.2.2. Resection& Anastomosis

7.2.2.3. GU Involved

7.2.2.3.1. Repair both

7.2.2.3.2. Divert Both

7.2.2.3.3. Interpose tissue

7.2.2.4. Anal Sphincter Involved

7.2.2.4.1. Sphincteroplasty after healing

7.3. Thoracic

7.3.1. Transmediastinal GSW

7.3.1.1. HD unstable

7.3.1.1.1. To OR

7.3.1.1.2. No pericardiocentesis

7.3.1.2. Post-Repair

7.3.1.2.1. Esophagram

7.3.2. Subclavian inj

7.3.2.1. Unclear

7.3.2.1.1. Median sternotomy

7.3.2.2. Left

7.3.2.2.1. Unstable

7.3.2.2.2. Stable

7.3.3. Tracheal Injury

7.3.3.1. Cervical

7.3.3.1.1. Collar incision

7.3.3.2. Thoracic

7.3.3.2.1. R Thoracotomy

7.4. Pelvic Fx

7.4.1. Stable

7.4.2. Unstable

7.4.2.1. Absent Intraabdominal Issues

7.4.2.1.1. Pre-Peritoneal Pelvic Packing

7.4.2.1.2. Angio if available

7.4.2.2. FAST+ or possible peritonitis

7.4.2.2.1. Ex-Lap

7.5. Diaphragmatic Inj

7.5.1. Primary repair

7.5.1.1. Non-absorb sutures

7.5.1.2. #o

7.5.1.3. Interrupted horizontal mattress

7.5.2. Large defect

7.5.2.1. Goretex Graft

7.5.2.2. Porcine Graft

7.5.2.2.1. If contaminated

8. Hernias

8.1. Inguinal

8.2. Ventral

8.3. Diaphragmatic

8.4. Laparoscopy

8.4.1. Inguinal

8.4.2. Ventral

8.4.3. Diaphragmatic

9. Hepatobiliary

9.1. Gallbladder

9.1.1. Gallstone ileus

9.1.1.1. Small laparotomy

9.1.1.1.1. Milk bowel for stone

9.1.1.1.2. Run entire bowel

9.1.1.1.3. Enterotomy to extract

9.1.1.1.4. Don't touch the GB

9.1.2. Acalculous Cholecystitis

9.1.2.1. Stable

9.1.2.1.1. Lap Chole

9.1.2.2. Unstable

9.1.2.2.1. CT or US-guided Perc Cholecystotstomy

9.1.2.2.2. IR unavailable

9.1.3. Cholecystitis ina Cirrhotic

9.1.3.1. Partial cholecystectomy

9.2. Biliary tract

9.2.1. Cholangitis

9.2.1.1. Stabilize

9.2.1.1.1. IV Cipro/Flagyl

9.2.1.2. ERCP or PTC

9.2.1.3. CBDE

9.2.1.3.1. Extract stone

9.2.1.3.2. T-Tube if pt unstable

9.2.1.4. Duodenotomy

9.2.1.4.1. Sphincterotomy

9.2.2. Primary sclerosing cholangitis

9.2.2.1. Ursodeoxycholic acid

9.2.2.1.1. Sx relief

9.2.2.1.2. Surgery

9.2.2.1.3. Transplant

9.2.3. Post-Lap Chole Jaundice

9.2.3.1. Labs

9.2.3.2. Occlusion

9.2.3.2.1. ERCP

9.2.3.2.2. PTC

9.2.3.2.3. RUQ Exploration

9.2.3.3. Stenosis

9.2.3.3.1. ERCP

9.2.3.3.2. Balloon dilation

9.2.3.4. Late presentation

9.2.3.4.1. Retained/Primary stones

9.2.4. Obstruction

9.2.4.1. Malignant

9.2.4.1.1. Unresectable Dz

9.2.4.1.2. Cannot dissect out CBD

9.2.4.2. Stone Dz

9.2.4.2.1. Choledochotomy

9.2.4.2.2. Transduodenal Sphincteroplasty

9.2.4.2.3. Unextractable stone

9.2.4.3. Post-Op Stricture

9.2.4.3.1. Choledochoplasty

9.3. Liver

9.3.1. Abscess

9.3.1.1. IV ABx

9.3.1.1.1. Colonic Source

9.3.1.1.2. H/o Cholangitis

9.3.1.2. Perc Drain

9.3.1.2.1. Not if Multiple

9.3.1.3. If peritoneal source

9.3.1.3.1. Lap for source

9.3.2. Amebic Abscess

9.3.2.1. IV Flagyl

9.3.2.1.1. No Drain/No OP

9.3.3. Variceal bleeding

9.3.3.1. Tx

9.3.3.1.1. IV octreotide

9.3.3.1.2. Vasopressin

9.3.3.1.3. EGD Banding

9.3.3.1.4. 10% failure

9.3.4. Ascites

9.3.4.1. Max med Tx

9.3.4.1.1. Lasix 160mg/day

9.3.4.1.2. Spironolactone 400mg/day

9.3.5. Cysts

9.3.5.1. Simple

9.3.5.1.1. Watch

9.3.5.2. Imaging

9.3.5.2.1. Ecchinococal

9.3.5.2.2. Congenital

9.3.5.2.3. Cystadenoma

9.3.5.3. Symptomatic

9.3.5.3.1. Perc drain

9.3.5.4. Eccinococcal

9.3.5.4.1. Albendazole

9.3.5.4.2. Open cystectomy

9.3.5.4.3. PAIR

9.3.6. Scoring Systems

9.3.6.1. Child's-Pugh

9.3.6.1.1. Components

9.3.6.1.2. Mortality

9.3.6.2. MELD

9.3.6.2.1. Components

9.3.6.2.2. 3 Mo. Mortality

9.4. Pancreas

9.4.1. Pancreatitis

9.4.1.1. Mild

9.4.1.2. Severe

9.4.1.2.1. ICU Admission

9.4.1.2.2. Blood Cx

9.4.1.2.3. Serial CT, Hb/Hct

9.4.1.2.4. Necrosis on CT

9.4.1.3. Infected

9.4.1.3.1. IV Primaxin

9.4.1.4. Hemorrhagic

9.4.1.4.1. Angio-Embo

9.4.1.5. Sequelae

9.4.1.5.1. Pseudocyst

9.4.1.5.2. Necrosis

10. Small Bowel & Colon

10.1. Oncology

10.2. Infectious

10.2.1. C. Diff Colitis

10.2.1.1. Toxic Megacolon

10.2.1.1.1. ICU Admit

10.2.1.1.2. D/C offending agent

10.2.1.1.3. IV Flagyl, PO Vanc

10.2.1.1.4. MTx Failure

10.2.1.1.5. HD Instability

10.2.1.2. Diarrhea

10.2.1.2.1. PO or IV Flagyl

10.2.1.2.2. PO Vanc

10.2.1.2.3. PR Vanc

10.2.1.2.4. PO Rifaximin

10.2.1.2.5. Fecal transplant

10.3. Diverticulitis

10.3.1. Uncomplicated

10.3.1.1. Cipro flagyl

10.3.1.1.1. Add Amp

10.3.1.2. NPO IVF

10.3.1.2.1. Until better cliniclly

10.3.2. Complicated

10.3.2.1. Abscess

10.3.2.1.1. Hinchey I

10.3.2.1.2. Hinchey II

10.3.2.1.3. Hinchey III

10.3.2.1.4. Hinchey IV

10.3.2.2. Perforation

10.3.2.2.1. Hartmann

10.3.2.2.2. Resection impossible

10.3.2.3. Fistula

10.3.2.3.1. Hartmann

10.3.2.4. Stricture

10.3.2.4.1. Do not plasty

10.3.2.4.2. New node

10.4. Diverticula

10.4.1. Duodenal

10.4.1.1. Resect if Sx

10.4.1.1.1. Stent duct if necessary to avoid it

10.4.1.1.2. Transduodenal is better

10.4.2. Meckel's

10.4.2.1. Resect only if Sx

10.4.2.1.1. Appendectomy

10.5. Bleeding

10.5.1. Approach

10.5.1.1. NGT Aspiration

10.5.1.2. Foley, IVs, Type and Cross

10.5.1.2.1. IVF Challenge 2L

10.5.1.2.2. Transfuse 2U PRBCs

10.5.1.3. DRE, Proctoscopy

10.5.1.4. Work-up

10.5.1.4.1. Nuclear Scintigraphy

10.5.1.4.2. Colonoscopy

10.5.1.4.3. Angiography

10.5.2. Diverticular

10.5.2.1. Numbers

10.5.2.1.1. 25% lifetime risk

10.5.2.2. Work-Up

10.5.2.2.1. Colonoscopy

10.5.2.2.2. Nuclear scintigraphy

10.5.2.2.3. Angio

10.5.2.3. Surgery

10.5.2.3.1. Unstable

10.5.2.3.2. Tx >6u/24h

10.5.2.3.3. Intra-op Localization

10.5.2.3.4. Unable to localize

10.5.3. Angiodysplasia

10.5.3.1. Localized Dz

10.5.3.1.1. Resect

10.5.3.2. Diffuse

10.5.3.2.1. Tamoxifen

10.5.4. Occult bleeding

10.5.4.1. Small bowel sources

10.5.4.1.1. Angioectasia

10.5.4.2. Workup

10.5.4.2.1. Capsule endoscopy

10.5.4.2.2. Angiography

10.5.4.2.3. EGD and push enteroscopy

10.5.4.2.4. CT enteroscopy

10.5.4.2.5. Deep enteroscopy

10.5.4.3. Provocative endoscopy

10.5.4.3.1. Doesn't work!!

10.5.4.3.2. Admin anticoag??

10.6. Inflammatory Bowel Disease

10.6.1. Crohn's

10.6.1.1. Medical Tx

10.6.1.1.1. Steroids

10.6.1.1.2. 5-ASA

10.6.1.1.3. Immunomodulators

10.6.1.2. Colonoscopy

10.6.1.2.1. Bear-Claw Ulcers

10.6.1.3. Abscess

10.6.1.3.1. Perc Drain

10.6.1.3.2. NPO, TPN

10.6.1.4. IHOP

10.6.1.4.1. Operate

10.6.1.5. Appendicitis

10.6.1.5.1. Incidental Crohn's

10.6.1.6. Stricture

10.6.1.6.1. Short <10cm

10.6.1.6.2. Long 10-20

10.6.2. Ulcerative colitis

10.6.2.1. Extra intestinal Dz

10.6.2.1.1. Pyoderma gangrenosum

10.6.2.1.2. Ocular dz

10.6.2.1.3. Primary sclerosing cholangitis

10.6.2.1.4. ankylosing spondylitis

10.6.2.2. Toxic Megacolon

10.6.2.2.1. Bowel Rest

10.6.2.2.2. Ab XR Q 12h

10.6.2.2.3. ICU Admission

10.6.2.2.4. IV ABx

10.6.2.2.5. IV Steroids

10.6.2.2.6. Peritonitis

10.6.2.2.7. Failure MTx in 24h

10.6.2.3. Fulminant Colitis

10.6.2.3.1. S/Sx

10.6.2.3.2. IV Steroids

10.6.2.4. Cancer Risk

10.6.2.4.1. 20% @ 20 years of dz

10.6.2.4.2. 10% @10y

10.6.2.4.3. + 1% per year after

10.6.2.4.4. Total colectomy

10.6.3. Indeterminate (10%)

10.7. Rectum

10.7.1. Cancer

10.7.2. Ulcer

10.7.2.1. Characteristics

10.7.2.1.1. Non-surgical Tx

10.7.3. Prolapse

10.7.3.1. Evaluation

10.7.3.1.1. Mucosal

10.7.3.1.2. Partial

10.7.3.1.3. Procidentia

10.7.4. Fissure

10.7.4.1. Acute

10.7.4.1.1. Fiber, Sitz

10.7.4.2. Chronic

10.7.4.2.1. Fiber, Sitz + Topical Tx

10.7.5. Radiation Proctitis

10.7.5.1. Sucralfate enemas

10.7.5.1.1. Loop diversion if failure

10.7.5.2. Formalin enemas

10.7.5.3. Argon beam fulguration

10.7.6. Fistula in Ano

10.7.6.1. Fibrin plug

10.7.6.2. Sphincters

10.8. Colon

10.8.1. Volvulus

10.8.1.1. Cecal

10.8.1.2. Sigmoid

10.8.1.3. Transverse

10.8.1.4. Necrotic

10.8.1.4.1. Clamp mesentery prior to detorsion

10.8.2. Pearls

10.8.2.1. Distal obstruction

10.8.2.1.1. Proximal colonic compromise

11. Abdominal

11.1. Pain

11.1.1. OIder pt with arthritis

11.1.1.1. Perf'd Gastric ulcer

11.1.2. Transplant pt

11.1.2.1. Epigastric pain + steroids

11.1.2.1.1. Gastric ulcer

11.2. Obstruction

11.2.1. GI Tumor

11.2.1.1. Rectal Ca

11.2.1.1.1. Prox divert

11.2.1.2. Colon

11.2.2. Ogilvie's

11.2.2.1. Abd XR

11.2.2.1.1. Cecum >10cm

11.2.2.1.2. Cecum >14cm

11.2.2.2. NPO, IVF

11.2.2.3. Q12h Abd XR

11.2.2.4. Serial exams

11.2.2.5. MTx Fail in 24h

11.2.2.5.1. ICU Bed

11.2.2.6. Sx of Perf

11.2.2.6.1. Subtotal Colectomy & Ileostomy

11.2.3. Pediatric

11.2.3.1. Pyloric Stenosis

11.2.3.2. Duodenal atresia

11.2.3.2.1. Duodeno-jejunostomy

11.2.3.3. Jejunal atresia

11.2.3.3.1. Segmental Rsxn

11.2.3.4. Intussusception

11.2.3.4.1. BE

11.2.3.4.2. Laparotomy

11.2.3.5. Hirschprung's

11.2.3.5.1. Decompress with soft rectal tube

11.2.3.5.2. Unstable

12. Stomach & Duodenum

12.1. Para esophageal Hernias

12.1.1. Symptoms

12.1.2. W/U

12.1.2.1. Esophagram

12.1.2.2. EGD

12.1.2.2.1. Assess ulceration

12.1.2.3. Manometry

12.1.3. Treatment

12.1.3.1. Type I

12.1.3.1.1. A/Sx

12.1.3.1.2. Symptomatic

12.1.3.2. Type II & III

12.2. PUD

12.2.1. Gastric Ulcer Dz

12.2.1.1. Types

12.2.1.1.1. Type I (60%)

12.2.1.1.2. Type II (15%)

12.2.1.1.3. Type III (20%)

12.2.1.1.4. Type IV (<10%)

12.2.1.1.5. Type V

12.2.1.1.6. Stress Gastritis

12.2.1.2. Treatment

12.2.1.2.1. Medical Mgmt x 6 mos

12.2.1.2.2. Check for ZES

12.2.1.2.3. Surgery

12.2.2. Duodenal Ulcer Dz

12.2.3. H.Pylori

12.2.3.1. Testing

12.2.3.1.1. Serum ABs

12.2.3.1.2. UBT

12.2.3.1.3. Stool Ag

12.2.3.1.4. Suspected PUD

12.2.3.2. Treatment

12.2.3.2.1. Triple-Tx

12.2.3.2.2. + PPI

12.2.4. IHOP = Surgery

12.2.4.1. Intractable

12.2.4.2. Hemorrhage

12.2.4.2.1. Duodenum

12.2.4.2.2. Gastric

12.2.4.3. Obstruction

12.2.4.3.1. EGD

12.2.4.4. Perforation

12.2.4.5. Difficult stump

12.2.4.5.1. Nissen-Cooper repair

12.3. Gastric CA

12.4. Periampullary Tumor

12.5. Duodenal Diverticula

12.6. UGIB

12.6.1. Gastric

12.6.1.1. EGD

12.6.1.1.1. Pulsatile or Visible vessel

12.6.1.1.2. Nonpulsatile or clot

12.6.1.1.3. Endocscopic Tx

12.6.1.1.4. PPI

12.6.1.1.5. Surgery

12.6.2. Duodenal

12.6.2.1. EGD

12.6.2.2. Duodenotomy

12.6.2.2.1. Direct suture ligation

12.6.2.2.2. Definitive Tx

12.6.3. Obtain Hx

12.6.3.1. H/o sx

12.6.3.2. Use of NSAIDs

12.6.3.3. Use of steroids

12.6.3.4. Liver Dz

12.6.4. Angioembolization

12.6.5. Esophageal

12.6.5.1. Mallory-Weiss

12.6.5.1.1. 90% Self-limiting

12.6.5.1.2. Bleeding on EGD

12.6.5.2. Varices

12.6.6. Varices

12.6.6.1. Esophageal

12.6.6.1.1. Band ligation

12.6.6.2. Gastric

12.6.6.2.1. Cyanoacrylate Inj

12.6.6.3. IV

12.6.6.3.1. Octreotide

12.6.6.3.2. Beta-blockade

12.7. Gastric Outlet Obstruction

12.7.1. PUD stricture

12.7.1.1. Antrectomy

12.7.1.2. B II

12.7.2. Can r/o CA

12.7.2.1. G-J & HSV

12.8. Dumping Syndrome

12.8.1. Post-Gastrectomy

12.8.1.1. Early

12.8.1.1.1. Diet mod trial

12.8.1.2. Late

12.8.1.2.1. Diet modification

12.9. Pyloric Stenosis

12.9.1. 1-2 mos old

12.9.2. Low K

12.9.3. Paradoxical aciduria

12.9.4. Palpable "Olive"

12.9.5. Treat

12.9.5.1. Hydrate IV

12.9.5.2. Ramstedt

12.9.5.2.1. Divide muscle to submucosa

12.9.5.2.2. NGT test for leaks

12.9.5.2.3. Start feeds 4hrs post-op

12.10. Difficult duodenal stump

12.10.1. Nissen-Cooper

12.10.1.1. Suture duodenum to posterior ulcer bed

12.10.1.2. Tube duodenostomy

12.10.1.3. Wide drainage

12.10.1.4. Post-op

12.10.1.4.1. 3 weeks