1 What is melanoma? The term melanoma implies a malignant tumor that arises from melanocytes. The most malignant of all skin cancers, melanoma usually forms from a preexisting nevus or mole but may develop de novo. It accounts for <1% of all skin cancers, but the vast majority of skin cancer deaths. 2 What is the incidence of melanoma? It is the sixth most common cancer…
1 What is a neoplasm? A neoplasm, or tumor, is any new mass of cells, where they grow under conditions that normally should not give rise to new cell growth. Benign neoplasms grow, but they do not spread; they disrupt adjacent tissues through mass effect. A malignant neoplasm, or cancer, is composed of cells that invade adjacent tissues and spread. Cancer can spread through lymphatics or…
1 How is breast cancer diagnosed? A breast cancer diagnosis requires tissue confirmation by needle sampling or less commonly by surgical biopsy. Historically, excisional biopsy was the gold standard, but needle sampling has become the preferred initial diagnostic method most often using core needle biopsy. Needle sampling is desirable because it does not create skin incisions that adversely affect surgical planning in the event a therapeutic…
1 What are evidenced-based components of breast screening? Screening mammography has the most evidence to support it as a breast cancer screening tool. A screening study has value when: a. The incidence of the disease is high. b. The risks from the screening study are low. c. There are disease-specific treatments that can be administered when the disease is caught early that will improve the patient…
1 What is the arterial and venous anatomy of the adrenal gland? There are two adrenal glands, each located in the retroperitoneum superior to the kidneys. The blood supply consists of three arteries: The superior adrenal artery that is a branch of the inferior phrenic artery, the middle adrenal artery that is a branch of the abdominal aorta, and the inferior adrenal artery that is a…
1 What are the surgically correctable causes of hypertension? Renovascular hypertension, pheochromocytoma, Cushing’s syndrome, primary hyperaldosteronism (Conn’s syndrome), coarctation of the aorta, and unilateral renal parenchymal disease. Surgical hypertension accounts for 5%–10% of all hypertensive patients. 2 Which form of surgical hypertension is most common? Renovascular hypertension is the most common cause of surgical hypertension (approximately 3% of patients with hypertension), followed by primary hyperaldosteronism (1.5%),…
1 What is the prevalence of thyroid nodules and cancer? The prevalence of thyroid nodules increases throughout life and is dependent on the method of detection—by palpation 5%, by ultrasound (US) 35%, and by autopsy 50%. Thyroid nodules are four times more common in females than in males. After exposure to radiation, nodules develop at approximately 2% annually, reaching a peak at 25 years. Up to…
1 How common is hyperthyroidism? Of the 1.2% prevalence of hyperthyroidism in the United States, 0.5% is overt, while 0.7% is subclinical. The incidence of overt disease is approximately 0.4 per 1000 women, and 0.1 per 1000 men, but varies significantly by age. 2 What are the signs and symptoms of hyperthyroidism? General: Heat intolerance, perspiration, flushing, tremor, sleep disturbance, or hair loss Psychologic: Nervousness, emotional…
1 How common is hyperparathyroidism (HPT)? The prevalence of hyperparathyroidism is 1:1000. There are approximately 100,000 new cases of HPT annually in the United States. Seventy-four percent of all cases are in women, and the risk increases with age. Primary HPT occurs in 1 in 500 women and in 1 in 2000 men older than age 40. 2 What are the symptoms of HPT? Painful bones,…
1 My patient weighs 250 lb (114 kg). Is he or she morbidly obese? Maybe. The most widely used definition of morbid obesity uses the concept of body mass index (BMI), which is weight (kg) divided by height squared (m). This is simply a description of how heavy a patient is for his or her height. A BMI of 40 is considered morbidly obese. A patient…
1 Groin hernia refers to which three hernias? Direct and indirect inguinal hernias and femoral hernias. 2 Francois Poupart, a French surgeon and anatomist (1616–1708), described a ligament that bears his name. What is the anatomic name of the Poupart ligament? Inguinal ligament, which is a key element in most groin hernia repairs. 3 Franz K. Hesselbach, a German surgeon and anatomist (1759–1816), described a triangle…
1 What aspect of the initial patient encounter is most important in the diagnosis of anorectal disease? A careful history of anal complaints can point to the correct diagnosis even before completion of a physical exam. It is important to ask about the timeline of symptoms, characteristic of the discomfort, associated masses, bowel characteristics, sexual history, treatments attempted in the past, history of colonoscopy, and anal…
1 What are the top three causes of cancer deaths in the United States? Lung, breast or prostate, and colon cancer. 2 List a few of the presenting symptoms of patients with colorectal cancer Intermittent rectal bleeding, vague abdominal pain, fatigue secondary to anemia, change in bowel habits, constipation, tenesmus, weight loss, and perineal pain. 3 What options are available to evaluate a patient who has…
1 What are polyps? A gastrointestinal (GI) polyp is an abnormal growth of tissue projecting from the mucosal layer anywhere along the GI tract. Almost half of patients with GI polyps do not complain of bowel symptoms. Bowel habit alteration is more common than abdominal pain. The majority of colorectal polyps found at screening colonoscopy are ≤5 mm. Two-thirds of polyps occur in the rectosigmoid and…
1 Describe the initial treatment of a patient who presents with massive lower gastrointestinal (GI) bleeding Assessment of ABCs (airway, breathing, circulation). Vital signs including orthostatics should be assessed to determine the severity of blood loss. Treatment begins with resuscitation. Place two large-bore intravenous (IV) catheters (18-guage or greater) in the upper extremities. Obtain hemoglobin and hematocrit levels, blood type, and cross-match. Frequent monitoring of vital…
1 What is upper gastrointestinal bleeding (UGIB)? Bleeding from a gastrointestinal (GI) source proximal to the ligament of Treitz (i.e., from the esophagus, stomach, or duodenum). 2 What is the ligament of Treitz? It is a thin, suspensory muscle that extends from the left crus of the diaphragm to the junction of the duodenum and jejunum. It is named for the Austrian physician Wenzel Treitz. 3…
1 What clinical entities encompass the diagnosis of inflammatory bowel disease (IBD)? Crohn’s disease (CD) and ulcerative colitis (UC). A third entity called indeterminate colitis describes the situation when the clinical or pathologic features do not entirely fit the criteria for either CD or UC. 2 Although the two diseases often overlap, they usually can be distinguished by clinical criteria. What are the major clinical differences?…
1 What are the mechanical causes of large bowel obstruction (LBO)? The most common mechanical causes are carcinoma (50%), volvulus (15%), adhesions (15%), and diverticular disease (10%). Extrinsic compression from metastatic carcinoma or noncolonic neoplasms is another cause of obstruction. Less frequent causes include hernia with colonic incarceration, intussusception, benign tumor, fecal impaction, inflammatory bowel disease, ischemic colitis, adhesions, bezoars, and retroperitoneal fibrosis. 2 How is…
1 What is a colonic diverticulum? A protrusion of mucosa and submucosa through the muscular layers of the bowel wall. It has no muscular covering. Because these diverticula do not involve all layers of the bowel wall, they are really “false” diverticula. Diverticulum formation may be related either to weakness of the bowel wall at the sites of vessel perforation or to increased intraluminal pressure caused…
1 What is the arterial supply to the gut? The foregut (stomach and duodenum) receives its blood supply from the celiac artery, the midgut (jejunum to the proximal descending colon) from the superior mesenteric artery (SMA), and the hindgut (the remainder of the intraperitoneal gut) from the inferior mesenteric artery (IMA). 2 Name the potential collateral pathways between the celiac axis and SMA, SMA and IMA,…