Case Files Surgery

Essay text:

Often present with iron def anemia, fatigue, hemoccult-positive stool - Overt lower GI tract bleed = most common causes in children and adolescents are Meckel diverticulum, inflammatory bowel dz, and polyps. In older adults, most commonly diverticulosis, angiodysplasia, and neoplasm. - Tagged RBC scan = RBC labeled with technetium-99; sensitive in identifying active bleeding - Mesenteric angiography = greater specificity at localizing site that RBC scan - Rigid proctosigmoidoscopy = to see the the most distal 25cm of the GI tract - colonoscopy has the highest specificity in identifying the source of lower Gi bleed - Angiodysplasia = aka vascular ectasia; a common degenerative vascular lesion characterized by small, dilated, thin-walled veins in the mucosa of the GI tract; most commonly in the cecum and asc colon in pts >50yo; 1 in 4 have aortic stenosis; usu present with low-grade, self-limiting bleeding, although some present with massive bleeding - if pt had previous abdominal vascular reconstruction, the possibility of an aortoenteric fistula must be strongly considered and ruled out - melena is usu assoc with upper GI tract or small bowel bleeding, but can occur with bleeding from the asc colon - passage of maroon colored stool usu excludes rectal or anal involvement BREAST CANCER RISK AND SURVEILLANCE: - benign fibrocystic changes can lead to difficulty in detecting breast carcinoma by PE and mammography; breast u/s may be helpful - benign histology not assoc with incr risk of breast cancer = adenosis, apocrine metaplasia, cysts, ductal ectasia, fibroadenoma, fibrosis, mild hyperplasia, mastitis, squamous metaplasia - Risk increase 1...