Surgery Notları

1. LIQUID, ELECTROLYTE BALANCE AND ACID - BASE DISORDERS

• Daily fluid requirement  first 10KG 100ml/kg, 2nd 10 kg 50 ml/kg then 20ml/kg
• Plasma osmolarity = 2xNa + glucose/18 + bun/2.8
• The most important source of invisible fluid lossesRemoval of water vapor from the skin
• If a patient weighing 70 Kg cannot take oral food, the daily fluid requirement is  2500.
• The most common fluid balance disorder in surgical patients Volume loss in extracellular fluid
• Not a serious extracellular loss after surgery  Fluid sequestration from the wound (those that do: fog losses,
bleeding, soft tissue trauma, infections, peritonitis, intestinal obstruction, burns)
• The finding to be seen in hypovolemia due to an average volume loss Collapse in the veins
• The organ with the highest amount of bicarbonate ions in its secretion Pancreas
• Type of secretion with low chlorine content Colon secretion
• The most appropriate fluid to be given to the patient in order to avoid acidosis in the first 24 hours
postoperatively Ringer's lactate
• Crystalloid solution, which can cause hyperchloremic metabolic acidosis when given at high rates0.9% NaCl
solution
• Body fluid with the most similar electrolyte content to Ringer's lactate solution Small intestine contents and bile
• The contents of Ringer's lactate solution Sodium, Chloride, Calcium, Potassium
• The most reliable way to monitor whether the treatment is adequate in a patient receiving intravenous fluid
therapy Hourly urine tracking
• Dextran, which causes a decrease in blood viscosity from solutions used as volume expanders in hemorrhagic
shock.
• Most common electrolyte disorder after major surgery Hyponatremia
• Situation in which hyponatremia is observed despite increased plasma osmolality Hyperglycemia
• Responsible for postoperative dilutional hyponatremia ADH
• The most likely cause of low sodium level in a postoperative patient with normal renal function Inappropriate
antidiuretic hormone secretion
• Inappropriate ADH release that causes  chronic (dilutional) hyponatremia.
• The situation explaining this picture in a patient with a postoperative Na level of 108 mEq/L, a urine Na
concentration of 68 mEq/L, and a urine osmolarity of 501 mOsm/L Increased secretion of ADH to maintain
extracellular volume
• In syndrome of inappropriate antidiuretic hormone secretion Despite normal water and salt intake, urinary
sodium concentration  & Hyponatremia is seen. In treatment, water intake is limited.
• Condition leading to hyponatremia with normal extracellular fluid volume  Inappropriate ADH syndrome
• Symptoms of hyponatremia are mainly related to the central nervous system. Symptoms of cerebral edema
appear with a rapid ↓in plasma sodium concentration  Hypertension, bradycardia, convulsion, diarrhea, oliguria
• The most probable electrolyte disorder in a patient whose general condition deteriorated after the operation and
who had increased intracranial pressure findings, oliguria, excessive sweating and watery diarrhea in the physical
examination Hyponatremia.
• Findings observed during hyponatremia Headache, confusion, changes in deep tendon reflexes, increased tear
and saliva secretion, and oliguria
• The amount of 0.9% NaCl solution required to the serum sodium level to 140 in a patient weighing 70 kilograms
with a serum sodium level of 115 mg/dl 2300 mL
 Total sodium deficit in a 70-kg, 40-year-old male patient with a serum sodium level of 122 mEq/L 840 mEq/L
• Regarding the relationship between plasma glucose level and plasma sodium level in a patient whose plasma
glucose level is measured as 300 mg/dL For every 100 mg/dL plasma glucose increase above normal, plasma
sodium decreases by 1.6 mEq/L.
• Conditions that cause hypernatremia Excessive sweating, using Sodium bicarbonate in resuscitation,
Hypoosmotic gastrointestinal fluid losses
• Regarding hypernatremia and its treatment It is usually seen with fluid deficit, sodium level should not be
decreased rapidly in chronic hypernatremia, oral therapy can be applied, 5% dextrose can be used in treatment,
fluid deficit should be treated first in hypovolemic patients.
• The condition that causes persistent hypokalemia in a patient hospitalized in the surgical intensive care unit in the
posttraumatic period due to its deficiency Hypomagnesemia
• in treatment of acute hypokalemia Mg is given with intravenous K for the maintenance of intracellular K level
• Metabolic conditions seen in hypokalemia Plasma pH above 7.40,  in plasma bicarbonate, variable urinary
K excretion,  in urinary acid excretion,  in pCO2 level in the compensated period
• Electrocardiographic finding suggestive of hypokalemia Prominent U wave
 Weight loss for one month and vomiting in the last ten days, decompressed stomach for three days by inserting a
nasogastric tube after clepotage in the epigastrium in his physical examination, tumoral mass obstructing the
gastric outlet and dilated stomach in gastroscopy, and hypoactive bowel sounds. the most probable electrolyte
imbalance in a patient with muscle weakness, respiratory depression on the third day, and T inversion, QRS
prolongation and U waves on ECG Hypokalemia
• Clepotage = churning (‫ )متماوجة‬sounds typically heard in pyloric stenosis and intestinal obstruction.
• The maximum amount of K+ that can be given as IV in 1 hour without ECG monitoring  10 mEq/hour
• Regarding the treatment of hypokalemia in cases where gastrectomy was performed due to gastric carcinoma and
the serum potassium value is 2.2 mEq/L on the postoperative first day  Central venous catheter route should be
preferred, cardiac functions should be observed, attention should be paid to the absence of oliguric, potassium
level should be checked 2 hours after the end of the infusion.
• The first thing to do in a patient who had an emergency surgery due to a gunshot injury and whose ECG showed
sharpening of T and QRS enlargement 11 days after surgical correction Checking serum electrolytes
• Conditions leading to this electrolyte disturbance in a patient with a sharpened T wave and a widened QRS
complex in his electrocardiography Blood transfusion, crush injury, rhabdomyolysis, metabolic acidosis, and
gastrointestinal bleeding
 Respiratory distress, weakness, nausea and vomiting, it was learned that he had been on peritoneal dialysis for 6
years and could not apply dialysis treatment for the last 5 days due to acute abdomen symptoms. In laboratory
examinations, potassium 7 mEg/L, creatinine 5 mg/dL and BUN 75 mg/dL. T tapering, P flattening and PR
elongation in ECG. in the treatment of a detected patient, the electrolyte that is corrupted, the level that does not
normalize Calcium gluconate
• Organs involved in the regulation of calcium metabolism in physiological conditions Bone, liver, kidney and small
intestine
• Used intravenously in the treatment of symptomatic acute hypocalcemia  Calcium chloride.
• The most common cause of hypercalcemia in hospitalized patients  Malignant Diseases
• Factors leading to magnesium deficiency Starvation, severe alkalosis, acute pancreatitis, primary aldosteronism
and chronic alcoholism
• The most common cause of hypermagnesemia Chronic renal failure
• Playing most important role in buffering hydrogen ions in the body in case of acidosis Bicarbonate-carbonic acid
• Most common cause of metabolic acidosis with a high anion gap  lactic acidosis
• The cause of metabolic acidosis with an increased anion gap  Ketoacidosis
• Metabolic disorder that may develop hyperkalemia Metabolic acidosis
• If we treat the patient with metabolic acidosis with high doses of alkali, the cause of the contraction in the hands
 Decrease in ionized Ca
• In a patient whose serum Na level was 139 mEq/L, Cl level was 85 mEq/L, K' was 2.9 mEq/L, HCO3 level was 38
mEq/L, and pH value was 7.51, urine Na level was 10 mEq/L. Most likely cause in a patient with L, K level 60 mEq/L
urine density 1017  Vomiting
• The most probable diagnosis in a patient with pyloric stenosis who underwent nasogastric drainage, laboratory
results with K level of 3 mEq/L, PCO2 level 44 mmHg, HCO3 level 37mEq/L and pH 7.50 Metabolic alkalosis
• The formation mechanism of hypochloremic hypopotassic metabolic alkalosis due to pyloric stenosis--> Increased
potassium excretion in response to hydrogen ion reabsorption from the kidneys
• Causes of respiratory acidosis Chronic emphysema
• First approach to the patient with hypoxia and hypercapnia Tracheobronchial aspiration
• Conditions with acute respiratory alkalosis Pain, fever, hypoxia and anxiety
• In respiratory alkalosis its excretion increases from the kidneys  Potassium
• Acid-base disorder in a patient with normal HCO3 level, high PaCO2 level and low pH value Respiratory acidosis
• Acid-base disorder compatible with blood gas values with a pH value of 7.20, PCO2 level of 80 mmHg, and HCO3
level of 22 mEq/L  Decompensated respiratory acidosis
• Acid-base disorder in a 70-year-old patient who underwent cholecystectomy, developed fever of up to 39°C at the
end of 24 hours and had difficulty in breathing, and arterial blood gases were found to have pO2 60 mmHg, pCO2
52 mmHg, HCO3 28 mEq/L  Respiratory acidosis
• Treatment to be applied to a patient at the age of 70 who underwent cholecystectomy, who developed fever up to
39°C and respiratory distress after 24 hours, and whose arterial blood gases were found to be pO2 60 mmHg, pCO2
52 mmHg, HCO3 28 mEq/L Tracheobronchial aspiration
• A 70-year-old patient who underwent cholecystectomy, developed fever up to 39°C at the end of 24 hours and had
respiratory distress, and in the arterial blood gases taken during this time, pO2 was 60 mmHg, pCO2 52 mmHg,
HCO3 28 mEq/L, as a result of repeated arterial hypertension. in blood gas measurements; If the pO2 level is 50
mmHg, the pCO2 level is 55 mmHg, and the HCO3 level is 38 mEq/L, the next most appropriate treatment is 
Mechanical ventilation
• Acid-base disorder in a patient with pH value of 7.36, pCO2 level of 20 mmHg and HCO3 level of 9 mEq/lt
Compensated Metabolic Acidosis
• Patients with chronic kidney failure and upper gastrointestinal bleeding, pH 7.2, pCO2 25 mmHg, CO2: 10 mEq/L,
measured CO2 capacity 14 mEq/L, current bicarbonate 13 mEq/L, standard bicarbonate 16 mEq/L, base The most
likely acid-base disorder in a patient with minus -15, anion gap of 28 mEq/L Primary metabolic acidosis -
compensated respiratory alkalosis
• Acid-base disorder in a patient hospitalized due to a traffic accident, whose blood pH was 7.23 pCO2 40 mmHg,
bicarbonate was 10mEq/dl Uncompensated metabolic acidosis
• With diaphragmatic laceration due to blunt abdominal trauma, arterial blood gas analysis pCO2 70 mmHg, CO2
content 32 mEq/L, CO2 capacity 27 mEq/L, standard bicarbonate 25 mEq/L, current bicarbonate 30 mEq/L, base
excess +2.5 mEq Disorder of acid-base balance in a patient with /L, pH 7.2 Respiratory acidosis in metabolic
balance
• The most probable acid-base disorder in a patient with a pH value of 7.30, HCO3 mEq /L 12 mEq, PCO2 56.5 mmHg,
total PCO2 14.2 mmHg Metabolic acidosis + respiratory acidosis
 • Conditions that cause prerenal azotemia Sepsis, hemorrhagic shock, hypoxia and burns
• Postoperative causes of prerenal failureBleeding, heart failure, diarrhea and sepsis
• The most useful parameter in differentiating prerenal from renal azotemia  Fractionated Na excretion (%)
• Indications for hemodialysis in a patient who developed renal failure in the postoperative period Serum K > 5.5
mEq/L, BUN > 90 mg/dL, persistent acidosis and excessive fluid load
2. NUTRITION
• Diseases requiring nutritional support 
o Patients with serum albumin <3 g/dL in the absence of any inflammatory process,
o patients with significant weight loss (> 10%),
o patients with dysfunctional gastrointestinal tract,
o burns
o catabolic problem such as sepsis or pancreatitis.
• Situation where perioperative nutritional support is required--> The patient with a body BMI < 18.5 kg/m2
• The trauma type with the highest resting energy consumption on the fifth day of trauma Major burn
• Advantages of enteral nutrition  Less risk of developing intestinal mucosal atrophy, being cheaper, less
development of infectious complications
• The most appropriate method for feeding a patient who is followed up for nasopharyngeal cancer invading the
proximal part of the esophagus, cannot take liquid or solid food by mouth, and cannot undergo upper
gastrointestinal system endoscopy due to tumor  Surgical gastrostomy
• The most appropriate way for nutritional support in a patient who has been in a coma for a long time after a traffic
accident  Feeding via jejunostomy
• The reason for increasing the ratio of branched-chain amino acids by reducing aromatic amino acids in order to
reduce the risk of hepatic encephalopathy in patients with liver disease receiving parenteral nutrition  Reducing
the number of pseudoneurotransmitters in the circulation
• Indications for parenteral nutrition 
o Short bowel syndrome
o critical diseases in which enteral nutrition cannot be given for more than seven days
o high-output enterocutaneous fistulas and malabsorption syndrome
• Conditions that are contraindicated to enteral nutrition of the surgical patient 
o Paralytic ileus
o mechanical intestinal obstruction
o diffuse peritonitis
o diffuse GIT ischemia
• TPN applied
o standard amino acid solution containing 1.7 g protein per kilogram in 24 hours,
o glucose enough to give 150 kcal energy to 1 g nitrogen
o 50 mEq sodium 40 mEq potassium 90 mEq phosphorus, 30 mEq magnesium and calcium in 24 hours
o and who did not take any oral, The most likely metabolic disorder in a patient with hair loss, dry skin, and
decreased intraocular pressure on the 10th day of treatment  Essential fatty acid deficiency
• The most likely cause of this condition in a patient with parenteral hyperalimentation, hepatomegaly and elevated
liver enzymes  Excess glucose administration
• Complications of long-term parenteral nutrition  Hyperglycemia, respiratory failure, azotemia, gallstone
formation and hepatic steatosis, hyperglycemia and hypoglycemia
• The most serious complication seen in children treated with total parenteral nutrition  Catheter sepsis
 • Intervention-related complications of total parenteral nutrition  Catheter malposition, venous thrombosis,
subclavian artery injury and pneumothorax
• Regarding refeeding syndrome  It occurs as a result of metabolism using carbohydrates instead of fat. It is
prevented by slowly increasing the amount of calories given. It is observed in total parenteral nutrition and enteral
nutrition. It is seen in those with severe malnutrition and weight loss. Patients present with hypophosphatemia,
hypomagnesemia, and hypokalemia.
• Related to glutamine metabolism and functions in healthy individuals  It is not an essential amino acid. It is a
glutathione precursor. It is an important energy source for lymphocytes and macrophages. Protects enterocyte
function. About 75% of the glutamine stores in the body are found in skeletal muscle.
• It reduces TNFalpha, IL-1 release and prostaglandin E2 production from Kupffer cells in enteral nutrition solutions
 Omega 3 Fatty Acids
• Daily monitoring required in a patient whose general condition is stable and who is given enteral nutrition therapy
 daily intake and output and defecation
3. SYSTEMIC RESPONSE TO TRAUMA and METABOLIC SUPPORT
• Released from the posterior pituitary in response to injury  Vasopressin
• Hormone that decreases in response to trauma after major surgery  Thyroxine
• Effects of cortisol in trauma 
o Increased release of amino acids from muscles,
o delayed wound healing,
o increased fat in the blood
• Hormone that reduces muscle protein synthesis due to trauma or infections  Glucocorticoids
• In hemorrhagic shock, the hormone that first rises in reaction to shock in the pituitary-adrenal axis  CRH
• The first thing to consider if amenorrhea develops in a patient who has undergone major surgery, despite the
absence of any gynecological pathology  Increased prolactin secretion
• Factors that increase the release of antidiuretic hormone  Angiotensin II, pain, adrenaline and hyperglycemia
• Changes in the body in the early period after major surgery 
o Increase in heart rate
o increase in ventricular stroke volume
o increase in cortisol release
o increase in catecholamine release
o development of resistance to insulin action
• The effect of catecholamines in trauma 
o Decreases insulin
o Increases glucagon
o Hyperglycemia
o Tachycardia
• Those that play a role in the apoptotic process developing in the cell  Caspase activation, DNA
• Those involved in the counter-regulatory response in intra-abdominal infection  TNF-binding factor, IL-1
receptor antagonist, IL-4, IL-10
• Anti-inflammatory mediator released during shock  IL-4
• Anti-inflammatory cytokine that inhibits IL-6, a potent fibroblast stimulant in wound healing  IL-4
• Earliest inflammatory cytokines to be released into blood in response to tissue injury or infection  TNF-alpha
 • Related to TNF-alfa released in the body after trauma  It is released within 30 minutes after stimulation. It is
secreted by monocytes, macrophages and lymphocytes. It has procoagulant activity. It causes cachexia. It causes
peripheral vasodilation.
• Cell that secretes both TNF alpha and IL-6  macrophage
• Macrophage-derived cytokines  IL-1 and TNF
• Cytokine associated with transient immunosuppression after major injuries and massive blood transfusion  IL-2
• Conditions that play a role in neutrophil activation in the early post-traumatic period  Ischemia, reperfusion,
oxygen radicals and cytokines
• Molecule that activates eosinophils after the inflammatory response to trauma  Platelet activating factor
• The structure that provides smooth muscle relaxation by increasing the level of nitric oxide  cGMP
• What is seen after trauma 
o Increased ACTH-induced glucocorticoid secretion,
o increased amino acid mobilization from muscles in proportion to the severity of trauma,
o increased urinary nitrogen excretion as a result of conversion of body proteins to glucose,
o increased amount of free fatty acids in the serum,
o decreased sodium excretion of mineralocorticoids and renin
• Changes seen in the early period in extensive burns 
o Increase in triglyceride,
o increase in resting energy use,
o increase in gluconeogenesis,
o increase in protein breakdown
o increase in insulin

4. SHOCK
• Seen in hemorrhagic shock (lost 30-40% of blood volume)  HR> 120/m, Systolic BP low, low Pulse pressure,
Significant tachypnea
• Finding in a patient who lost 10% of the total blood volume  urine output >30 mL/hour
• Renal lesion in severe shock  Acute tubular necrosis
• Changes observed with hemorrhagic shock caused by abdominal trauma 
o Increased vascular resistance,
o tachypnea,
o low base excess,
o low cardiac output
o hyperglycemia
• Conditions involved in the pathophysiology of shock 
o Parenchymal cell damage,
o decreased tissue perfusion,
o cellular hypoxia,
o endothelial cell activation
o decreased venous return
• Regarding lactate metabolism in a patient diagnosed with shock 
o Pyruvate is converted to lactate by lactate dehydrogenase.
o Lactate accumulation indirectly indicates the depth of hypoxia.
o The accumulated lactate is metabolized by the liver and kidney.
o The lactate level cannot be corrected by giving oxygen to the patient.
o The lactate level indicates the depth of shock.
• A condition that shifts the hemoglobin 02 dissociation curve to the left  Acute alkalosis
• The most basic element of shock therapy  Appropriate fluid replacement
• The most appropriate method to correct metabolic acidosis in acute hemorrhagic shock  Ringer's lactate and
blood transfusion
• Ringer's lactate  preferred for the first resuscitation of a patient in hypovolemic shock
• A patient who had no additional medical problems, had a right hemicolectomy due to a tumor, was taken to the
recovery room after the operation, and was found to have a blood pressure of 85/50 mmHg and a pulse rate of
130/min in the follow-up, with a urine output of 5 ml in the last hour. The first thing to do for the treatment of the
patient  The patient should be given 500-1000 ml of saline intravenously quickly.
• Best criterion indicating that the fluid given during treatment of shock is sufficient  Increase in urine flow
• Parameters indicating that resuscitation is successful at cellular level  PaO2, serum lactate, base deficit & gastric
tonometry
• Gastric tonometry  measurement of the carbon CO2 inside stomach to assess the level of its blood flow
• The most specific parameter that reflects the metabolic status at the cellular level  Serum lactate level
• Organ without arteriolar vasoconstriction in mild or moderate shock  Brain
• Diagnostic criteria for systemic inflammatory response syndrome:
o Fever above 38 degrees
o fever below 36 degrees
o PaCO2 <32 and
o presence of band over 10% in peripheral smear
• Patients hospitalized in the surgical intensive care unit with the diagnosis of acute biliary pancreatitis, with a body
temp. 36.7°C, pulse 120/m, RR 30/m, BP 100/60 mmHg, oxygen saturation 98%, and a normal PA chest X-ray. The
most probable diagnosis for a patient with a WBCs of 13,000/mm3, a normal urine analysis, and no other source of
infection  Systemic inflammatory response syndrome
• Cough, weakness and fever that had been going on for a week, in examination, body temp 39.2°C, HR 114/minute,
BP 80/60 mmHg and RR 32/minute, and rails were detected on lung auscultation  Septic shock
• Possible causes of septic shock  Extensive tissue necrosis seen in colon perforation, leakage of gastrointestinal
anastomosis, urinary and intravenous catheters, and electrical burns
• In order to diagnose severe sepsis, the patient must have in addition to sepsis  Oliguria
• Required for the diagnosis of septic shock in a patient with severe sepsis  Unresponsive to IV fluid resuscitation
• First response in septic shock  Peripheral vasodilation
• Changes seen in septic shock  TNF increases. IL-1 level increases. Hyperdynamic state is seen in hypovolemia.
Bacterial translocation occurs in the gut due to increased cytokine response.
• TNF effects in septic shock 
o Increased secretion of IL-1,
o increased capillary permeability,
o inducing fever,
o increased expression of adhesion molecules and
o increased neutrophil, eosinophil, monocyte activation
• Occur in the early period in septic shock and cause microcirculatory disorder  Increase in vascular permeability
• Shock type with high central venous pressure and cardiac index and low arteriovenous oxygen difference 
Hyperdynamic septic shock
• Regarding the hyperdynamic phase of septic shock  Systemic vascular resistance has decreased. Peripheral
vasodilation develops. Hyperglycemia and insulin resistance develop. Often cardiac output is increased. The
contraction of vascular smooth muscles is impaired.
• Change of myocardial functions in hyperdynamic septic shock picture  Myocardial depression is observed.
• Characteristics of septic shock in a normovolemic patient 
o Increased cardiac output,
o pink and dry extremities,
o low blood pressure,
o decreased arteriovenous oxygen difference,
o low systemic vascular resistance
• The most probable diagnosis is in a patient who had a traffic accident, whose general condition was stable during
the first 3 days of his admission to the intensive care unit, cardiac output increased after the fourth day, decreased
systemic vascular resistance, decreased urinary output, and extremity was found to be hot, dry and pink on
examination  Septic shock, hyperdynamic stage
• Finding specific to hypodynamic phase of Gram-ve septic shock  Increased peripheral vascular resistance
• Most common source of gram-ve septic shock in patients with normal immune system  Genitourinary system
• The earliest findings in a patient with septic shock  Hypoxia, hyperventilation, respiratory alkalosis
• Drugs that can be used in endotoxic shock  Beta blockers, alpha stimulants, steroids and broad antibiotics
• In the treatment of severe sepsis and septic shock 
o Insulin therapy for the regulation of blood sugar,
o initiation of intensive fluid therapy if the mean arterial pressure is < 65 mmHg,
o if mean arterial pressure does not increase with fluid therapy, switching to vasopressor therapy,
o if the result is not obtained despite vasopressor therapy use steroids
• Weakness, cough, respiratory distress and fever that did not improve despite antibiotic and symptomatic treatment
for two weeks, T 38.5°C, HR 122/m, BP 85/55 mmHg, RR 22/minute. and on auscultation, diffuse crepitant rales in
both lungs, and SpO2: 84%. For a patient whose hypotension persists despite fluid administration in the first 6
hours and SpO2 level rises to 92%, the next step is the most appropriate approach  Norepinephrine infusion
• BP: 70/40 mmHg, 20 mL/kg crystalloid fluid replacement was started by inserting a central venous catheter, but
MAP: 55 mmHg could not be increased even though the central vein pressure reached 10 mmHg. It is most
appropriate to do next step in the treatment of a patient with a value of 33%  Starting noradrenaline infusion
• To reduce mortality in a patient with septic shock 
o Start fluid resuscitation immediately,
o starting antibiotic treatment within the first hour,
o perform source control as quickly as possible,
o administering low-dose steroids in cases whose hypotension persists despite treatment.
• Range in which blood glucose level should be kept to reduce the risk of complications in ICU 80- 110 mg/dL
• Recommended basic therapy for a patient in septic shock  Fluid resuscitation, vasopressors, inotropic therapy,
and steroid therapy
• The most appropriate fluid to be given to a patient with septic shock  Ringer's lactate
• Dopamine  which is used both in shock and increases renal blood flow.
• A substance that acts by increasing the activity of enzymes in the cell membrane in the correction of lactic
acidemia in a patient diagnosed with septic shock  Epinephrine
• Decreased circulating level in severe sepsis  Protein C
• The most likely finding in neurogenic shock  Decreased peripheral vascular resistance
 • Findings expected to develop in the cardiovascular system in a patient with acute spinal cord injury  Hypotension,
bradycardia, heart rhythm disturbances, decrease in cardiac output and decrease in peripheral vascular resistance
• Differential symptom of cardiogenic shock from hypovolemic shock  Neck venous distention
• Regarding the body's hemodynamic response to shock types 
o Hypovolemic shock  cardiac index decreases, systemic vascular resistance increases, CVP decreases.
o Neurogenic shock  cardiac index decreases, systemic vascular resistance decreases, CVP decreases.
o Cardiogenic shock  cardiac index decreases, systemic vascular resistance increases, CVP increase.
o Septic shock  cardiac index increases, systemic vascular resistance decreases, CVP increases or
decreases.
• Pathologies leading to multi-organ failure  Peritonitis, trauma, pancreatitis and burn
• Organ system showing the earliest signs of failure in multiple organ dysfunction syndrome in severely hospitalized
patients  Respiratory system
• Criteria of acute respiratory distress syndrome 
o Infiltration on chest X-ray,
o CO retention,
o pulmonary artery wedge pressure below 18 mmHg,
o absence of signs of right heart failure
• Diagnostic criteria of acute respiratory distress syndrome 
• Related to PaO2, PaCO2 and alveolar-arterial oxygen gradient (AaDO2) levels that will diagnose postoperative acute
respiratory failure  PaO2 Low, PcO2 High, AaDO2 High
5. SURGICAL INFECTIONS
• In implants and grafts surgeries, latest time for surgical site infection to occur  1 year
• Risk factors for development of surgical site infection:
o Length of operation time
o Staphylococcus carriage on the skin or mucous membranes
o Hypocholesterolemia
o Hypoxemia
o operated are is shaved within 48 hours of surgery
o Drainage from the incision
• Conditions that increase the likelihood of post-operative infection:
o Obesity
o age over 65
o Malnutrition
o diabetes mellitus
o steroid therapy
o recent surgery
o blood transfusion before the surgery
• Example of a clean-contaminated wound  Cholecystectomy
• Reasons for surgery requiring antibiotic prophylaxis:
o Gallstones
o Pancreatic cancer
o Colon cancer
o Lung cancer
• Surgery category of appendectomy for non-perforated acute appendicitis  Clean-contaminated
• The type of surgery in which surgical site infection is most common  Colon resection
• Dirty wounds in terms of risk of developing surgical site infection:
 o Intraabdominal abscess
o necrotizing soft tissue infection
o periappendicular abscess
o perforated colon diverticulitis
• Correct antibiotic prophylaxis principles in surgery 
o Antibiotic prophylaxis is applied in clean surgeries where grafts or prostheses are used.
o Antibiotic prophylaxis is done within an hour before surgery.
o The antibiotic can be repeated as a second or third dose after surgery.
o The most appropriate and narrowest-spectrum antibiotic possible is preferred.
o with long procedures, the dose of some antibiotics with a short half-life is repeated.
• Best antibiotic for bacterial endocarditis-prophylaxis in SIS and genitourinary surgery  Ampicillin & Gentamicin
• Optimal treatment for gluteal abscess after injection  Incision and drainage
• First thing to do in gas gangrene  Wide debridement
• Seen in necrotizing soft tissue infections  Cutaneous anesthesia systemic Inflammation, ecchymosis and bullae
• The first-choice antibiotic in the treatment of gas gangrene  Penicillin G
• The most appropriate treatment for tetanus is given to a patient who comes as a result of a traffic accident 
Tetanus diphtheria toxoid + tetanus immunoglobulin, vaccine, serum antitoxin and antibiotics are given.
6. WOUND HEALING
• First response in tissue injury  Vasoconstriction
• TNF alpha  secreted from neutrophils in wound healing in the inflammatory phase
• The time period when the proliferation phase is seen in wound healing  between 4-12 days
• The most important component that ensures the strength of the wound during healing  Collagen
• What day does the maximum tensile strength occur in wound healing? It can never reach its full strength.
• The most important cell in the contraction phase of wound healing  Fibroblast
• Cell that synthesizes tropocollagen  Fibroblast
• Have a role in the repair phase of wound healing  Fibroblast, macrophage, endothelial cells, epithelium
• Major glucosaminoglycans involved in wound healing are  dermatan and chondroitin sulfate.
• Those that increase collagen synthesis  IGF-1, TGF-beta, PDGF and Ascorbic acid
• Cytokine whose overproduction causes hypertrophic scar & keloid  Transforming growth factor-beta (TGF-beta)
• Those who have a negative effect on wound healing  Malnutrition, Immunosuppression, Infection, Age, Iron
deficiency, hypoxia, local tension and glucocorticoids.
• Vitamin that plays the most important role in wound healing  Ascorbic acid
• Those whose deficiency inhibits wound healing  Vitamin A, Vitamin C, Zinc and Iron
• Regarding the effects of vitamin A on wound healing 
o Increases collagen synthesis
o It increases the inflammatory response
o It corrects impaired wound healing due to diabetes
o It corrects impaired wound healing due to radiation
o Ineffective against the inhibitory effects of corticosteroids on wound healing
• Events in which chronic glucocorticoid use has a negative effect on the wound healing process:
o Epithelialization
o Fibroblast proliferation
o Wound contraction
 o Collagen synthesis (Glucocorticoids do not adversely affect wound oxygenation)
• Regarding chronic wounds 
o Severe inflammation is a contributing factor to chronic wound development.
o Wounds that do not heal within three months are considered chronic.
o Repetitive traumas play a role in the etiology.
o Decreased tissue perfusion is common.
o The histopathological type of cancers that develop on the chronic wound floor is squamous cell carcinoma.
7. HEMOSTASIS and TRANSFUSION
• Compensatory mechanisms are more effective in  venous bleeding.
• The most common hemostasis disorder in surgical patients  thrombocytopenia
• Laboratory test for dose adjustment in heparin anticoagulation  Activated partial thromboplastin time (aPTT)
• To prevent bleeding due to warfarin use before emergency surgery  Fresh frozen plasma
• Used to monitor the effect of low molecular weight heparin  Anti-factor Xa level
• Drugs that must be discontinued at least 5 days before the operation  Antiplatelets drugs
• Mediator that acts by converting plasminogen to plasmin in cancer invasion  Urokinase
• Coagulation factor with the shortest half-life  factor 7
• Findings expected to be seen in blood that is kept at 37°C for 5-6 hours 
o Increase in PCO2
o Increase in lactate
o Decrease in glucose
o Decrease in factor 5
o Decrease in pH
• Most suitable for coagulation factor replacement in massively transfused patient  Fresh frozen plasma
• The hemoglobin threshold required for blood transfusion without cardiac or respiratory problems  7 g/dL
• Causes of coagulopathy in hemorrhagic shock  Hypothermia, acidosis, coagulation factors consumption and
dilution
• "Lethal triad" defined for patients in shock  Acidosis, hypothermia, coagulopathy
• Regarding acute trauma coagulopathy 
o Thrombin-thrombomodulin complexes exert their anticoagulant effects through protein C activation.
o Mortality is higher in patients with acute trauma coagulopathy.
o There is increased fibrinolysis.
o The most important triggering factors are shock and tissue damage.
• Complications that may be related to blood transfusion  Urticaria, hemolysis, sepsis, thrombosis, febrile reaction
• Early signs of hemolytic reaction  Dyspnea, hemoglobinuria, back pain and hypotension
• The most typical finding of intravenous hemolysis after blood transfusion  Hemoglobinuria
• Immune reaction due to the complications of erythrocyte suspension transfusion 
o Acute hemolytic reaction
o Nonhemolytic fever
o Acute lung injury
o Anaphylactic shock
• Twenty-eight years old, 38 weeks pregnant, receiving general anesthesia for planned cesarean section, admitted to
the service after surgery without any problems for mother and baby, transfusion decision was made because
hemoglobin level was <7 g/dL, 1 unit of erythrocyte in appropriate group and Rh. 2 hours after the suspension was
finished, 10 L/min oxygen (FiO2 = 50%) support was started with an open face mask for sudden onset of dyspnea,
 tachycardia, fever, tachypnea, hypoxemia (SpO2<90%) and chest X-ray was taken, and a "ground glass"-like X-ray
was taken. The most probable preliminary diagnosis in a patient with homogeneous infiltration and PO2:82 mmHg
in arterial blood gas  Transfusion-related acute lung injury
• Related to delayed hemolytic reactions after transfusion
o Occur 2-10 days after transfusion
o Anemia may develop in patients
o The patient has indirect hyperbilirubinemia
o They are IgG-mediated reactions
o The direct Coombs test is positive
o A decrease in serum haptoglobulin level is observed.
• Complications of massive blood transfusion 
o Hyperkalemia
o Hypothermia
o Left shift of the oxyhemoglobin dissociation curve
o Heart failure
• The most common cause of coagulopathy after massive transfusion  Thrombocytopenia
• Decreased blood coagulation factor in patients who received massive blood transfusion  Factor 5
• Reasons for recommending discontinuation of the "ginseng" used by the patient one week before the operation
in a patient whose operation is planned  Hypoglycemia and bleeding risk
8. TRAUMA AND TRAUMA PATIENT APPROACH
• The first thing to do in a patient who is brought to the emergency room due to a traffic accident and whose physical
examination is unconscious, shallow breathing, fractures in the lower extremities, hypotension and significant
tachycardia  Opening an airway with endotracheal intubation
• Blood pressure 85/40 mmHg, brought to the emergency room due to a motorcycle accident. The first intervention
to be performed on a patient with a heart rate of 120/minute, unconscious and shallow breathing, and a Glasgow
coma score of 5  Intubating the patient
• The most likely diagnosis for a 22-year-old patient who fell off a bicycle, was brought to the emergency room, had
normal blood pressure, had tachycardia and air hunger, and had crepitation under the skin on the left side of his
neck  Pneumothorax
• The most probable diagnosis for a 30-year-old patient who was brought to the emergency room after a traffic
accident, with severe respiratory distress, fullness in the neck veins, and hypotension, was not heard on the right
side of the chest  Tension pneumothorax
• Type of injury caused by open pneumothorax  An open wound in the thoracic wall connected with pleural space
• To be performed in acute cardiac tamponade caused by a penetrating trauma  Pericardiocentesis
• Brought to the emergency room due to an out-of-vehicle traffic accident, blood pressure: 80/55 mmHg, pulse
132/minute, respiratory rate 42/minute, oxygen saturation 82%, responding only to painful stimuli, ecchymosis in
the abdominal wall and pelvis, ecchymosis in the left leg In a patient who has an open fracture, subcutaneous
emphysema on the neck, no breathing sounds in the right hemithorax, left dorsalis pedis and tibialis posterior
pulses are not palpable, the first thing to be done at this stage is  Inserting a chest tube into the right hemithorax
• For a patient who had an in-vehicle traffic accident, had normal blood pressure, had tachycardia and dyspnea on
physical examination in the emergency room, had a wider mediastinum than normal in the posteroanterior chest X-
ray, and had an irregular contour of the aortic arch, the first thing to consider is the diagnosis and the confirmation
of this diagnosis.  Rupture of the descending thoracic aorta and Computed tomography angiography
• Diagnosis in case of increased BP, decreased HR and RR after a trauma  Increased intracranial pressure
• The least damaged organ in blunt abdominal trauma  Pancreas
• Situation with Kehr sign  Intraabdominal bleeding
• He had a traffic accident, stated that there was pain hitting his left shoulder, widespread ecchymoses were
observed in the left proximal left thigh and left lumbar region, systolic blood pressure was 100 mmHg in physical
examination, pulse was 100/min, sensitivity was detected in epigastrium and left hypochondrium, hematocrit was
40% in laboratory examination, The most probable diagnosis in a patient with a leukocyte count of 15000 / mm3,
with 9th and 10th rib fractures on the left and medial thrust in the gastric gas chamber on direct abdominal X-ray
 Rupture of the spleen
• Diagnostic method to be used in the definitive diagnosis to determine intraperitoneal hemorrhages in blunt
abdominal trauma  Peritoneal lavage
• Indications for diagnostic peritoneal lavage to detect suspected intraabdominal bleeding
o Unexplained hypotension,
o negative paracentesis,
o Hematuria after abdominal trauma, ribs, lumbar vertebrae and pelvis fractures
• Results considered positive in the diagnostic peritoneal lavage fluid examination performed in patients with
abdominal trauma  RBCs >100,000 /mm3, presence of bile, food particles, or intestinal contents
• Useful tests in guiding the diagnosis and treatment in a patient with blunt abdominal trauma, positive diagnostic
peritoneal lavage and no shock picture 
o Oral and intravenous contrast-enhanced computed tomography,
o Diagnostic laparoscopy
o Intravenous pyelography and arteriography
• Examination of unconscious male patient who had an automobile accident and in the emergency room, BP 90 mm
Hg systolic, HR 112/min, abdominal tenderness and suspicious rigidity were detected. After the necessary first aid,
the first thing to do for this patient for diagnosis  Focused on trauma ultrasonography
• Most sensitive test to be performed first in the detection of bleeding in blunt abdominal trauma  abdominal US
• The preferred imaging method for suspected Symphysis pubis fracture due to a non-vehicle traffic accident, with BP
90/60 mmHg, a pulse of 120/minute, and a Hb of 9 mg/dL  For trauma abdominal focused ultrasonography
• Most appropriate method for investigating whether there is an intra-abdominal injury in a patient who had blunt
abdominal trauma as a result of falling from a height and whose blood pressure, arterial pressure, pulse and urine
output were stable after the first intervention  Computed Tomography
• Findings that can be decided for non-surgical follow-up in a patient who was brought to the emergency room after
an in-vehicle traffic accident, with rapid ultrasonographic evaluation and 2nd degree spleen injury in computed
tomography  less than 2 units of blood transfusion requirement
• Absolute laparotomy indication for a patient with isolated blunt abdominal trauma  Failure to achieve
hemodynamic stability
• related to spleen injuries 
o The success of non-operative follow-up in elderly patients is lower than in younger patients.
o Injuries to the diaphragm and pancreas may accompany penetrating spleen injuries.
o Patients in non-operative follow-up should be followed for 24-72 hours in the intensive care unit.
o Non-operative follow-up should not be preferred in hemodynamically unstable patients.
o Computed abdominal tomography should not be performed in hemodynamically unstable patients.
• The most appropriate approach in the next step is for a patient who applied to the emergency department due to
isolated blunt abdominal trauma, whose vital signs were found to be stable in the evaluation, and whose physical
examination did not reveal any finding other than minimal tenderness in the abdomen, and 3rd degree spleen
laceration was determined in the abdominal computed tomography  Close clinical follow-up
• The degree of injury to the liver of these lesions in a patient who was brought to the emergency department due to
a traffic accident, whose hemodynamics was stable, who underwent intravenous contrast-enhanced abdominal
tomography, and who found a non-expanding subcapsular hematoma involving 15% of the surface of the liver and
a 5 cm long and 2 cm deep laceration  Stage 2
• For a patient brought to the emergency room due to blunt abdominal trauma and accompanying head trauma, an
emergency operation decision was made upon detection of hypotension, tachycardia and peritoneal irritation
findings, a diagnostic laparotomy was performed, intra-abdominal bleeding was detected, and the bleeding was
found to be caused by vascular injury in the splenic hilum during exploration. appropriate treatment 
Splenectomy
• the most frequently injured organ in significant abdominal trauma  small intestines
• The most appropriate approach for a patient who was brought to the emergency room with a gunshot injury, with
a bullet entry hole under the umbilicus, and a hemodynamically stable patient with no exit hole  Emergency
laparotomy
• The most useful examination for the diagnosis of a person who has been injured by a knife in the posterior and
flank region of the abdomen but has no signs of shock  CT with contrast
• Absolute laparotomy indications in a patient with abdominal trauma 
o Hypovolemic shock due to bleeding into the abdomen
o Gunshot injury involving the abdomen
o Mixed bacterial flora in diagnostic peritoneal lavage
o Signs of peritoneal irritation as a result of stab wounds
• The most common cause of retroperitoneal hematomas in patients exposed to blunt trauma  Pelvic fractures
• In the classification used in retroperitoneal hematoma, the cause of Zone II hematoma  Renal injury
• related to traumatic injuries of the diaphragm 
o The majority of blunt injuries are on the left side.
o Additional organ damage and mortality are higher when blunt injuries are due to high-energy trauma.
o Diagnosis of diaphragmatic injuries after blunt trauma is difficult.
o Absence of abdominal organs in the thorax on chest X-ray does not exclude diaphragmatic injury.
o Diaphragmatic injuries can be diagnosed and treated with video-assisted thoracoscopy or laparoscopy.
• If there is retroperitoneal air in the standing direct abdominal X-ray with abdominal trauma and the abdomen is
tender in the examination, the most likely diagnosis is  rupture of the 2nd piece of the duodenum.
• A patient who was brought to the emergency room due to a traffic accident, whose history was learned that he was
sitting in the front seat and was wearing a seat belt, was conscious in the physical examination, had pain in the
epigastric region, was hemodynamically stable, had no other visible injuries, and had air in the retroperitoneum on
the standing direct abdominal X-ray. The most appropriate procedure to confirm the diagnosis in the patient  CT
abdomen with contrast
• Type of intra-abdominal injury that is not considered conservative if detected  Duodenal rupture
• The most common cause of death in pancreatic trauma  Vascular injury
• In a hemothorax due to thoracic trauma, the most appropriate procedure is to be performed in a patient in whom
1200 ml of blood is drained by drainage and a total of 1000 ml of bleeding is detected three hours after blood
replacement is performed  surgery
• If there is a trill on palpation and a continuous murmur on auscultation in the mass formed as a result of trauma,
the most likely diagnosis is  Arteriovenous fistula
• Glasgow Coma Score in a patient who was brought to the hospital with serious injuries after a non-vehicle traffic
accident, had no eye opening in his neurological evaluation, had a meaningless response to verbal stimuli, and had
motor response as an extensor response.
• Conditions that cause a marked increase in respiratory rate in a trauma patient  Pneumothorax, hypovolemia,
inhalation injury and rib fracture
• Patients with an indication for resuscitative thoracotomy in the emergency department 
o Patients who are known to have penetrating trauma to their body and who have undergone
cardiopulmonary resuscitation for less than 15 minutes before the hospital,
 o Patients who are known to have had blunt trauma and who have undergone cardiopulmonary resuscitation
for less than 10 minutes before the hospital,
o Neck or Patients with known penetrating trauma to the extremity and undergoing cardiopulmonary
resuscitation for less than 5 minutes before the hospital,
o Patients with air embolism as a cause of post-traumatic persistent severe hypotension (SBP <60 mm Hg)
• Situations where surgical intervention is a priority in a patient with thoracic trauma 
o Esophageal perforation,
o diaphragm rupture and intra-abdominal organ herniation,
o massive intrathoracic hemorrhage and deceleration aortic tear
9. BURN
• The first thing to be applied to a patient with a second degree burn on the upper body, head and neck, 15% of the
total body surface with hot liquid--> To ensure that the respiratory tract is open.
• The first thing to do in an 8-year-old child who was rescued by firefighters and brought to the emergency room in a
building fire, with second and third degree burns covering 40% of the body surface, should be done first 
Opening the airway due to respiratory system inhalation injury
• What should not be done in the first 24-hour follow-up of a patient who has deep 2nd and 3rd degree burns
covering 40% of the body area as a result of pouring hot water on him, who is hospitalized in the burn unit 
Starting broad-spectrum antibiotics
• The cause of death, which should be considered when the dead bruises appear on a corpse in a light to pinkish
color from normal  carbon monoxide poisoning
• The first thing to do in chemical burns other than lime burns. Washing the burned area with plenty of water.
• Situations where transfer of the patient to a burn center is required due to burn injuries 
o Second degree burns of more than 10% of the total body surface,
o perineal burn,
o inhalation damaged burn,
o electrical burn
o chemical burn
• The reason why colloid-containing fluid is not given in the first 24 hours in the burnt patient  It causes edema by
increasing the extracellular volume.
• A drug that causes acidosis when used in extensive burns in the body  Mafenid acetate
• Those used in the regulation of hyper-metabolic response in burn patients 
o Propranolol
o Oxandrolone
o recombinant human growth hormone
o insulin-like growth factor binding protein
• A complication of burn  curling ulcer (acute gastric erosion)
• A late complication of burn  Marjolin ulcer (cutaneous malignancy that arises in the setting of previously injured
skin, longstanding scars, and chronic wounds.)
• The most common distant septic complication in burns  Bronchopneumonia
• The most common cause of death after the 5th day in burns  Sepsis
• Microorganism causing blue-green discharge in burns  P. aeruginosa
10. BREAST DISEASES and SURGERY
• Vascular structures that contribute to the blood supply of the breast 
o Lateral thoracic artery,
o posterior intercostal artery,
o internal mammarian artery
 o Thoracoacromial artery
• Definition of Poland syndrome  Hypoplasia in ipsilateral breast, pectoral muscle and thorax
• Most effective method for population-based screening to detect breast cancer at an early stage  Mammography
• Radiological findings requiring breast biopsy 
o Star-shaped opaque mass,
o 5 or more microcalcifications in the form of clusters,
o mass appearance with poorly defined borders and
o prominent mass appearance with well-defined borders
• Calcification that can be seen on mammography, which is more likely to be malignant  Pleomorphic calcification
• Regarding the pathology of the lesion in a patient who had a mass in the left breast and the lesion was determined
to be BI-RADS 4 in mammography  The lesion is suspicious and a biopsy must be performed.
• For a 42-year-old female patient with no family history of breast cancer and no breast-related complaints, the next
stage is the most appropriate for a patient with no abnormality in breast examination, mammographic examination,
reported as BIRADS 3 because of asymmetrical density in the left breast, and no pathological findings on
ultrasonography. Approach  Repeat mammography for left breast 6 months later
• The first examination to be performed in a 65‫ إ‬patient with clinically suspicious mass in breast  Mammography
• A 40-year-old female patient, who applied to the hospital for routine breast examination, had a history of being
married for 16 years, had no children, started menstruating at the age of 10, had regular periods, had a 2x1 cm
mass in the upper outer quadrant of the right breast in her physical examination, suspicious findings on
mammography. The most appropriate approach for this patient  Examination with ultrasonography and biopsy
• The most appropriate approach in the next step in a patient who presented with a hard mass in the left breast and
nipple discharge, which she noticed six months ago, who had limited mass movements on examination, and who
had a lesion with microcalcifications, irregular borders and 2.5 cm in diameter on mammography  Providing
tissue diagnosis with core biopsy
• The most appropriate approach in a patient with no complaints, lesions with spicular extensions containing
microcalcifications causing lobular asymmetry on mammography, and no palpable mass on physical examination.
 Excision by marking the area with mammography
• Characteristics of pathological nipple discharge 
o unilateral
o yellow-green in color
o associated with a mass
o bloody
• Proliferative breast diseases  Radial scar, epithelial hyperplasia, sclerosing adenosis and intraductal papilloma
• Benign proliferative breast disease  Sclerosing adenosis
• Disease with a high risk of developing breast carcinoma  epithelial hyperplasia
• The most common benign tumor of the breast in women of reproductive age  Fibroadenoma
• A hard, mobile breast mass (1-1.5 cm) that can be seen in all ages especially in young girls  Fibroadenoma
• The most common breast lesion in young women  Fibroadenoma
• 20Y patient with a 2 cm firm, well-circumscribed mobile mass in the right breast  Fibroadenoma
• 20Y patient with hard, well-circumscribed mobile 2 cm mass in the Rt breast Ultrasonography at regular intervals
• Stromal disease in the breast  Fibroadenoma
• 25Y patient with a single, solid, 5 cm diameter painless and mobile mass in the breast  Surgical excisional biopsy
• The most common benign breast disease in women between the ages of 35 and 50  Fibrocystic changes
• 35Y with a 3 cm cystic soft-consistent and painless mass in her right breast with no solid component in the
ultrasonography  Evacuation of the cyst with a needle
• The most appropriate method in breast cyst detected by ultrasonography  Aspiration and follow-up
• 4x5 cm cystic mass on breast examination  Aspiration and follow-up
• Hard mass in the lower inner quadrant of the left breast, has a history of trauma, on physical examination, a 2 cm,
firm, irregularly circumscribed and fixed mass is palpated, no feature is detected in the axilla, and an image with
spicular extensions and microcalcification is defined on mammography. The first thing to consider in the
differential diagnosis of breast cancer in a patient  Fat necrosis
• If pain, swelling and skin retraction are observed in breast after trauma, the most likely diagnosis is  Fat necrosis
• Lesion likely to cause nipple discharge 
o Ductal ectasia,
o intraductal papilloma,
o breast carcinoma and
o cystic disease of the breast
• Regarding Mondor's disease 
o On physical examination, thrombosed vein may be felt as a hard structure along its trace.
o There is no cancer risk.
o It is thrombophlebitis of the anterior chest wall and superficial veins of the breast.
o Patients apply to the physician with acute breast pain.
o Initial treatment is medical.
• Redness and pain around the nipple, who is not still breastfeeding, local temperature increase and tenderness
detected in the examination, who described a similar picture twice before, who smoked for a long time, and who
had ductal ectasia in the breast ultrasonography, should be the first thing to do.  Periductal mastitis 
Antibiotic therapy + drainage
• The most likely cause of bloody nipple discharge in a young female patient  Intraductal papilloma
• 45Y with spontaneous bloody discharge from the nipple and no mass on palpation Intraductal papilloma.
• 25Y with serous bloody discharge from the nipple, she gave birth 3 years ago and her menstrual periods were
normal, no mass was detected in the breast on physical examination, but bloody discharge was observed from a
single point from the nipple by pressing. most likely diagnosis  Intraductal papilloma
• A breast lesion that develops in epithelial-lined structures, usually close to the areola, and does not have a risk of
malignancy  Intraductal papilloma
• Breast tumor that usually does not require axillary lymph node dissection  Cysto sarcoma phyllides
• In the patient who applied with the complaint of fever, it was learned that she gave birth 2 months ago and
breastfed her baby, the body temperature was 38.8°C, the right breast was red and tender, a firm, nodular and
fluctuating mass was detected, the left breast was found to be normal. What should be recommended to a patient
who states that there is no such mass, but that he has not done a breast examination, along with the use of
antibiotics  Observation and breastfeeding his baby with both breasts
• Most likely microorganism to grow in a culture made from drainage fluid, a six-month-old baby who is breast-
feeding, presenting with complaints of redness, pain and swelling in the right breast, an abscess that completely
covers the upper outer quadrant of the right breast in the physical examination  Staphylococcus aureus
• The most likely cause of discharge in a patient who presented with a history of spontaneous and unilateral nipple
discharge, on physical examination, brown discharge from the nipple when the left breast was compressed from
the periphery to the nipple in the 2 o'clock direction, no mass was palpable, and no pathological finding was found
on ultrasonography of the breast  Intraductal papilloma
• Conditions with an increased risk of developing breast cancer 
o Lobular carcinoma in situ
o Atypical ductal hyperplasia
 o Atypical lobular hyperplasia
o Severe (Florid) hyperplasia
• The lesion with the highest risk of developing breast cancer  Lobular carcinoma in situ
• Pathology requiring close follow-up in a patient who underwent breast biopsy due to the lesion on mammography
 Atypical ductal hyperplasia
• Important risk factors in the development of breast cancer 
o Gender
o Age
o family history of breast cancer
o atypical ductal hyperplasia
• Factors that increase the risk of developing breast cancer 
o Using high-fat foods for a long time,
o Early menarche,
o Late menopause
o having cancer in the other breast
o 2 or more biopsies for benign reasons after the age of 50,
o History of breast cancer in one of the first-degree relatives,
o Nulliparity
o Advanced age and
o Alcohol use
• Those with the highest risk of developing breast cancer  Breast cancer in mother and sister
• A sixty-year-old female patient who applied with the complaint of a mass in the left breast, never gave birth,
entered menopause at the age of 35, underwent surgery for right breast cancer 15 years ago, breast cancer in one
of her 3 sisters, and was found to have breast cancer as a result of a biopsy from the mass in the left breast. Factors
that increase the risk of breast cancer in her history  Never giving birth, being 60 years old, having cancer in the
other breast and having breast cancer in one of her sisters
• Some cancers that are common in societies with high oil consumption  Breast carcinoma, colon carcinoma
• The most determining factor in the malignancy of fibrocystic disease in the breast  Epithelial hyperplasia
• The gene most frequently mutated in women diagnosed with hereditary breast cancer  BRCA1
• Mutations associated with breast cancer  BRCA1, ATM, PTEN and CHEK2
• Characteristic of BRCA-2 (+) breast cancers  Higher hormone receptor positivity rate
• Relating to lobular carcinoma in situ 
o It is likely to be seen bilaterally
o Axillary metastases are unlikely
o It is usually not asymptomatic on mammography
o It is not seen in men, but is common in premenopausal women.
• Related to ductal carcinoma in situ 
o Clumping calcification is the most common radiological finding.
o Increased tissue density can be seen on mammography.
o Surgical margins should be negative in breast-conserving approaches.
o There is usually no indication for axillary dissection.
o The most common type in multicentric cases is the comedo type.
• Breast disease manifested by erythema and eczematous lesions on the nipple and areola  Paget's disease
• Cells with a clear halo in the epithelium are detected in a biopsy performed in a patient with erosion of the nipple
 Paget's disease
• Elderly patient with an eczematoid lesion on the nipple and areola  Paget's disease of the breast
• Most definitive diagnosis of an elderly patient with an eczematoid lesion on the nipple & areola  Nipple biopsy
• Possible diagnosis in a patient with an eczema-like ulcerated lesion in the areola and large and pale staining cells
with oval nuclei and large nucleoli on biopsy  Paget's disease
• Disease associated with Paget's disease of the breast  Intraductal carcinoma
• The most common of breast cancers  Invasive ductal carcinoma schizoid type
• The most common histopathologically seen breast carcinoma  Infiltrative ductal carcinoma
• The type with the worst prognosis among breast carcinoma types  Infiltrative ductal carcinoma
• Slow growing type of breast cancer seen in older women  Mucinous carcinoma
• The one with the best prognosis among malignant breast cancers  Papillary carcinoma
• Type of breast cancer with better prognosis than others  Tubular carcinoma
• with the best prognosis among malignant breast cancers  Tubular carcinoma
• Breast cancer that tends to be bilateral  Lobular carcinoma
• Multicentric and bilateral breast cancer  Invasive lobular carcinoma
• Breast cancer is the most common quadrant  Upper outer quadrant
• The reason for the orange peel formation seen in the breast tissue in breast carcinoma  Lymphatic permeation
• An example of permeation spread in breast cancer  Satellite skin nodules
• The bone where breast cancer most frequently metastasizes  Vertebra
• The most appropriate method for the diagnosis of a patient who had back pain who had undergone surgical
treatment for breast cancer two years ago  Bone scintigraphy
• In painful metastases detected on the back, the first thing to do in the treatment is  Local radiotherapy
• Regarding inflammatory breast cancer 
o Neoadjuvant chemotherapy containing anthracyclines cause marked regression in majority of patients.
o Most patients have palpable axillary lymphadenopathy at diagnosis.
o Inflammatory breast cancer can be confused clinically with bacterial infections of the breast.
o Permeation of dermal lymphatics by tumor cells is observed in skin biopsy samples.
o It is common to detect distant metastases in patients at the diagnosis stage.
• Cancer staged as T2 Nll M0 in breast cancer  2-5 cm tumor, an unfixed lymph node, no metastasis
• Diameter of 35 mm breast mass and 2 mm micrometastases in the axillary lymph node, TNM stage  Stage IIB
• The most appropriate treatment method for a patient with a 1.5 cm mass in the upper outer quadrant of the left
breast, tru-cut biopsy result of which was reported as invasive ductal carcinoma, and no axilla metastasis was
detected clinically  Partial mastectomy + sentinel lymph node biopsy + radiotherapy
• more appropriate approach in treatment of 20th week first pregnancy lady, presenting with a mass in the right
breast, and the pathological diagnosis of a 2 cm mass is invasive ductal carcinoma  Modified radical mastectomy
• The anatomical structures included in the modified radical mastectomy material performed for breast tumor 
o Nipple and areola complex,
o breast skin,
o glandular tissue of the breast
o axillary lymph nodes
• Condition caused by injury of long thoracic nerve during axillary dissection  wing scapula
• Organ, which is an indication that additional treatment can be applied in estrogen receptor positivity in
immunohistochemical examination in cancer  Breast
 • The most important criterion in predicting the response to hormonal therapy in breast cancer  Hormone
receptor status in tumor cells
• The most common agent to be used in hormonal therapy with premenopausal breast cancer  Tamoxifen
• situations where tamoxifen use is appropriate to reduce the risk of invasive breast cancer 
o Ductal carcinoma in situ,
o atypical ductal hyperplasia,
o lobular carcinoma in situ,
o 5-year cancer risk > 5% in a premenopausal woman > 35 years of age, according to the Gail model
• Treatment in a patient with a breast cancer diagnosis who underwent lumpectomy and axillary dissection, a 2.5
cm mass, 4 LN (+) and estrogen receptor negative  Radiotherapy and Chemotherapy
• Advanced stage findings of breast cancer 
o Presence of satellite nodule in breast skin,
o Extensive edema in breast skin,
o Presence of supraclavicular & infraclavicular lymph node,
o Mass fixed on chest wall
• Locally advanced cancers according to TNM classification in breast cancer 
o T0 N2 M0, o T3 N1 M0,
o T1 N2 M0, o T3 N2 M0,
o T2 N2 M0, o T4 N02 M0
• The most appropriate treatment for recurrent breast cancer that is estrogen receptor negative  Chemotherapy
• Metastasis, which benefits most from hormonal therapy in a patient with breast cancer and distant organ
metastasis, and a positive estrogen receptor as a result of biopsies  Bone
• The most important indicator that breast cancer may recur  The number of metastatic lymph nodes in the axilla
• Causes gynecomastia without causing excess estrogen  Klinefelter syndrome
• Risk factors for the development of breast cancer in men 
o Estrogen intake,
o Klinefelter syndrome,
o Sertoli-Leydig cell testicular tumor and
o BRCA-2 gene mutation
• Breast cancer that is least likely to occur in men  Lobular carcinoma
• Regarding the treatment of ductal carcinoma in situ in the breast 
o If microinvasion is detected as a result of pathological examination in a patient undergoing breast conserving
surgery, sentinel lymph node biopsy is performed.
o Routine axillary dissection is not required in patients undergoing mastectomy.
o Negative surgical margin should be provided at the excision.
o Adjuvant tamoxifen can be used in estrogen receptor positive patients.
o Appropriate surgical treatment is applied according to the extent of the disease and breast size.
11. THYROID DISEASES and SURGERY
• The test that is sufficient for evaluation of thyroid functions in a patient who is thought to be euthyroid  TSH
• No TSH response to TRH; The most probable diagnosis in a breast cancer patient with low T3 and T4 values and
normal free T4  Sick euthyroid syndrome
• a mass in the midline of the neck that moves upwards with tongue movements  Thyroglossal duct cyst
• Surgical indications of simple goiter 
o Substernal enlargement, o cosmetic reasons,
o compression, o suspicion of cancer
• Pathology causing simple diffuse enlargement of the thyroid  Graves
• Clinical and laboratory features of Graves' disease 
o Presence of eye findings,
o suppressed TSH level,
o diffuse enlargement of thyroid gland,
o high thyroid stimulating hormone receptor antibodies
• Conditions that may require surgical indication in hyperthyroidism 
o Low RAI uptake and large goiter,
o ophthalmopathy,
o pregnancy,
o hyperthyroidism secondary to amiodarone use
• Used first in treatment of young patient with diffuse hyperthyroidism that is not too large  Antithyroid drugs
• Related to toxic multinodular goiter 
o It is more common in older people.
o Most patients have a history of non-toxic multinodular goiter.
o Symptoms usually come on slowly.
o In some patients, the diagnosis is made while investigating atrial fibrillation and congestive heart failure.
o There are no extrathyroidal findings.
• Treatment in a patient who is 2 months pregnant, with neck swelling, irritability, weight loss and palpitation, and
who has a multinodular goiter with a high T3 & T4  Thyroidectomy by bringing her to euthyroid state
• Patient with palpitations, excessive sweating, a single 2 cm nodule in the thyroid on physical examination, and high
thyroid hormone levels in laboratory tests  Thyroidectomy after euthyroidism with antithyroid drugs
• Tertiary hypothyroidism is caused by pathological condition  hypothalamic insufficiency
• Painful thyroid enlargement and giant cells in the thyroid biopsy following acute upper respiratory viral disease 
De Quervain's Thyroiditis
• The most probable diagnosis in a patient with high free T3 and T4 levels, low TSH level and low radioactive
substance uptake in thyroid scintigraphy  Subacute thyroiditis
• Diffuse thyroid enlargement and suspicious nodule in the right lobe, high TSH, thyroglobulin and TSH-receptor
antibody levels, and Hürthle cells in the fine needle aspiration biopsy  Hashimoto's thyroiditis
• The disease in which a surgical treatment in the form of wedge resection is applied for the thyroid isthmus 
Riedel's thyroiditis
• 45Y patient with shortness of breath and difficulty in swallowing, whose thyroid gland was palpated as very hard
and fixed in physical examination, had high TSH, slightly low T3 and T4 values in laboratory findings, heterogeneous
thyroid gland in ultrasonography and no pathological cervical lymphadenopathy  Riedel's thyroiditis
• Surgery is indicated due to the risk of malignancy  Solitary hypoactive nodule
• Initial evaluation of a palpable solitary thyroid nodule 
o Anamnesis and physical examination,
o serum TSH measurement,
o fine needle aspiration biopsy
o thyroid ultrasonography
• Most important risk factor for the development of papillary thyroid cancer  Exposure to radiation in children
• Nodule in the right thyroid lobe in his routine examination, a history of radiation for adenoid hypertrophy, thyroid
hormone levels within normal limits, hypoactive nodule in thyroid scintigraphy (with 1131), and a solid nodule in
US and lymphadenopathies  Thyroidectomy & modified radical neck dissection to the involved side
• The most likely diagnosis in a patient diagnosed with cribriform-morular variant papillary carcinoma after
thyroidectomy  Familial adenomatous polyposis syndrome
• He applied with a recent swelling in his neck, his serum T3, T4 and TSH levels were normal, his family history was
found to be thyroid cancer, a solid nodule with a calcified focus of approximately 2.2 cm in the right thyroid lobe
on neck ultrasonography and a follicular lesion in fine needle aspiration biopsy. The most appropriate approach for
a patient diagnosed with  Thyroid lobectomy
• Excessive sweating, palpitation and 10 kg weight loss in 2 months, BP 130/85 mmHg, HR 130/minute, the thyroid
gland was diffusely large in neck examination and a nodule of 2 cm in the left lobe was detected. The first
technique to be done in terms of guiding the treatment  Thyroid function tests and TSH
• Excessive sweating, palpitation and 10 kg weight loss in 2 months, BP 130/85 mmHg, HR 130/minute, thyroid gland
was diffusely large in neck examination and a nodule of 2 cm in the left lobe was detected. If the palpable nodule is
found to be a solitary hypoactive nodule, most appropriate approach is  Fine needle aspiration
• The first method to be done in a patient who presented with a complaint of swelling in the neck, a nodule of 3 cm
in diameter in the left thyroid lobe and high thyroid function tests  I131 scintigraphy
• If a solitary non-functioning nodule is detected in the left lobe in the scintigraphy, the first examination to be done
 Fine-needle aspiration biopsy
• The most useful test in determining the path to be followed in the treatment of a patient with a solitary thyroid
nodule  Fine needle aspiration cytology
• The most useful test in the differential diagnosis of a benign-malignant nodule in the thyroid  Fine needle
aspiration biopsy
• What to do first if thyroid function tests are normal in a patient with a thyroid nodule  Fine needle aspiration
cytology
• Appropriate approach in a patient with a 2.5 cm nodule developed on the basis of Hashimoto's thyroiditis  Fine
needle aspiration of the nodule
• Ordering the incidence of thyroid cancer types from highest to lowest 
o Papillary carcinoma
o Follicular carcinoma
o Medullary carcinoma
o Hürthle cell carcinoma
o Anaplastic carcinoma
• Cancer that most frequently metastasizes to the thyroid  Bronchogenic carcinoma
• Oncogenes that play a role in the development of thyroid cancers  RET, Ras, c-MYC and MET
• Regarding papillary thyroid cancers 
o It is the most common type of thyroid cancer
o with the best prognosis.
o Psammoma bodies are typical for this type of cancer.
o After surgical treatment, TSH suppression is required by administering thyroid hormone.
o It most commonly spreads by lymphogenous route.
o Tumors < 1 cm in diameter are called occult.
o most likely to occur due to radiation
o Usually, multifocal
• Thyroid carcinoma with the best prognosis  Papillary carcinoma
• Mass in the neck region for 2 months, a single nodule with a diameter of 2 cm in the right lobe of the thyroid gland
and 2 enlarged cervical lymph nodes on the same side in the physical examination, and malignant cells were
observed in the fine needle aspiration cytology  Papillary thyroid cancer
• Organ cancers in which lymph node metastasis affects the prognosis the least  Papillary thyroid cancer
• Those with an increased risk of differentiated carcinomas of the thyroid
o Mass size
 o Extension outside the lymph node
o Local spread
o Age
• Low risk prognostic factor in well-differentiated thyroid cancers  female gender
• 4 cm solitary nodule in Lt. thyroid lobe & papillary thyroid cancer in fine needle aspiration  Total thyroidectomy
• Nodular goiter at the age of 40, who underwent total lobectomy and istmectomy on the side with nodules, and
papillary thyroid cancer was found in a 2.5 cm focus in the pathology report  Complementary thyroidectomy
• Related to follicular thyroid cancer 
o It is often solitary.
o Associated with iodine deficiency
o low probability of lymph node metastasis
o mostly seen in women > 50 years
o not clearly diagnosed by fine-needle aspiration biopsy
• Pathology showing good prognosis in follicular thyroid cancers  Encapsulated and minimal vascular invasion
• Neck mass with hard 3 cm nodule in left lobe of thyroid gland in the physical examination, and Hurthle cell
carcinoma in the biopsy result  Total thyroidectomy + central dissection
• Treatments to be applied when local bone metastasis is detected after adequate surgery in a patient with
differentiated thyroid carcinoma  Radioactive iodine and TSH suppression
• Used in the follow-up of differentiated thyroid carcinoma  Thyroglobulin
• Thyroid cancers where it is used to monitor serum thyroglobulin level:
o Papillary cancer
o Follicular cancer
o Hürthle cell cancer
o Papillary cancer follicular variant
• Thyroid cancer with Multiple Endocrine Neoplasia (MEN)  Medullary cancer
• Regarding medullary thyroid carcinoma 
o High thyroglobulin level in the blood is diagnostic.
o There is a mutation in the RET protooncogene.
o 25% of which are part of the multiple endocrine neoplasia syndrome.
o can be seen within Type 2A or Type 2B of Multiple endocrine neoplasms.
o Bilateral total thyroidectomy and central lymph node dissection are the most appropriate treatment.
o Radioactive iodine therapy is not helpful in the post operative period.
o In familial type, the disease is often multicentric.
o They originate from thyroid parafollicular or C-cells,
o They develop secondary to the RET proto-oncogene mutation.
o Cushing's syndrome develops in approximately 2-4% of patients.
o It originates from parafollicular C cells.
o High serum calcitonin level is an important finding for diagnosis.
o It constitutes 4-5% of all thyroid cancers.
o Surgical intervention should be at least bilateral total thyroidectomy + central lymph node dissection
• Neck swelling, a 3 cm nodular lesion in the thyroid and cervical lymphadonepathy is palpated in the physical
examination, the T3, T4 and TSH levels are normal in the laboratory examination, and the calcitonin level is high 
Medullary carcinoma
• Related to sporadic medullary thyroid cancer 
o It is more common than the familial type.
o Serum carcinoembryonic antigen levels may be elevated.
 o It is observed at a later age than the familial type.
o The prognosis is better in familial medullary thyroid cancers without MEN than in sporadic medullary
thyroid cancers.
• In a patient diagnosed with medullary thyroid carcinoma, multiple endocrine neoplasia (MEN) should be
evaluated  Serum calcium and urinary catecholamine level
• Complications of thyroidectomy in the first 24 hours after surgery  Wound hematoma, asphyxia, vocal cord
paralysis and tracheomalacia
• The most likely disorder in a child after subtotal thyroidectomy  Hypocalcemia
• A patient who developed convulsions and tetany after thyroidectomy  Hypoparathyroidism
• In a patient who presents with the complaints of numbness and tingling around the mouth, hands and feet, it is
learned that he had thyroidectomy surgery 3 days before, he is nervous and agitated, and there is no abnormal
swelling or redness at the operation site  Serum calcium level
• Those who increase the risk of nerve laryngeus inferior injury in thyroid surgery 
o Surgery due to cancer,
o no recurrence of the nerve,
o accompanying chronic thyroiditis
o recurrent goiter surgery
• Early symptoms in case of unilateral injury of the recurrent laryngeal nerve after thyroidectomy  Fixation of the
vocal cord near the midline, choking sensation during fluid intake, hoarseness and deepening of the voice
• The most likely structure to be damaged when connecting the superior thyroid artery and vein in thyroidectomy
 Superior laryngeal nerve
• Intervention for a patient who has undergone bilateral subtotal thyroidectomy, has agitation and respiratory
distress at the 6th postoperative hour, and has signs of hypotension and tachycardia  Urgently evacuating the
accumulated hematoma
• The reason for this picture in a patient who underwent bilateral subtotal thyroidectomy for nodular goiter and
developed severe respiratory distress and cyanosis 2-3 hours after the operation  Bleeding and hematoma
• The most likely cause of bleeding in a patient with normal preoperative bleeding and coagulation tests and no
history of bleeding diathesis, who developed bleeding at the wound site in the early period after elective
thyroidectomy  Inadequate surgical hemostasis.
• Anatomical structure injured in a patient who underwent total thyroidectomy and left modified radical neck
dissection due to 28 mm in diameter medullary thyroid carcinoma in the left thyroid lobe, inability to lift the left
shoulder and weakness in left shoulder movements in the postoperative period  Complications of spinal
accessory nerve
• Thyroidectomy complications:
o Postoperative bleeding,
o transient hypocalcemia,
o surgical site infection and
o dysphonia
12. PARATHYROID GLAND DISEASES and SURGERY
• causes hypercalcemia more frequently  Metastatic tumor
• The earliest and most common pathology in multiple endocrine neoplasia type 1 disease  Primary
hyperparathyroidism
• The most common cause of primary hyperparathyroidism  Parathyroid adenoma
• Single parathyroid adenoma is more likely than hyperplasia  Sporadic primary hyperparathyroidism
 • Finding that did not improve after parathyroidectomy in a patient with primary hyperparathyroidism 
Hypertension
• The test to be done in a patient with peptic ulcer and kidney stone  Checking Ca and PTH levels
• Condition with hypercalciuria  Hyperparathyroidism
• Things that are essential in the diagnosis of primary hyperparathyroidism 
o Serum calcium level,
o 24-hour urinary calcium excretion,
o serum phosphorus level
o serum parathormone level
• Those who support the diagnosis of primary hyperparathyroidism 
o Increase in serum calcium level,
o increase in serum parathormone level,
o decrease in serum phosphate level,
o increase in serum chlorine level
o increase in serum chlorine/phosphate ratio
• Absolute indications for surgical treatment in asymptomatic primary hyperparathyroidism 
o The patient is younger than 50 years of age,
o the bone mineral density decreases by more than 2 standard deviations in both areas,
o T score of bone density less than -2.5 in lumbar region, hip and distal radius
o the serum calcium concentration is 1 mg/dL above the upper limit,
o the patient cannot be followed-up medically,
o primary hyperparathyroidism development of serious complications
• The safest, sensitive and specific localization study before surgery in patients diagnosed with primary
hyperparathyroidism  Sestamibi scintigraphy-SPECT
• Persistent hyperparathyroidism! Definition  Failure to improve hypercalcemia after parathyroidectomy
• Ectopic parathyroid glands most likely localization  Paraesophageal groove
• Conditions seen in a patient diagnosed with primary hyperparathyroidism  Bone pain, nephrolithiasis, peptic
ulcer and depression
• Most likely diagnosis for a patient who has undergone hemodialysis for 12 years due to chronic renal failure, who
has developed parathormone and calcium elevations in the last few years, and whose parathormone and calcium
elevations continue despite 2 years have passed since the kidney transplant  Tertiary hyperparathyroidism
• Hyperthyroidism treatment with the highest risk of developing hypoparathyroidism  Total thyroidectomy
• The most common cause of hypoparathyroidism  Previous thyroidectomy
• Parameter compatible with pseudohypoparathyroidism  Low calcium, high phosphate and parathormone
13. ADRENAL GLAND DISEASES AND SURGERY
• The most common cause of Cushing's syndrome  ACTH-secreting pituitary adenoma
• Characteristics of adrenocortical cancer 
o Half of them are non-functional,
o the functional ones most often secrete cortisol,
o they are usually over 6 cm,
o contain areas of necrosis and hemorrhage,
o invasion and metastasis can be observed
• The most important factor in the indication for surgery in a patient with a nonfunctional pheochromocytoma larger
than 6 cm of adrenal origin  High rate of malignancy
 • The most probable diagnosis is for a patient who had a major injury, whose vital signs did not improve despite all
attempts, whose general condition was poor, no bleeding, fever, hypotension, nausea and vomiting, and
hypoglycemia, hyponatremia and hyperkalemia in blood biochemistry.  Acute adrenal insufficiency
• Findings that can be seen if the increased glucocorticoid requirement is not met during the treatment of a patient
who uses glucocorticoids for a long time and is hospitalized in the intensive care unit as a result of severe trauma-->
Hypoglycemia, azotemia, hypotension, hyponatremia and hyperkalemia
• The most probable diagnosis in a patient whose only complaint is hypertension and laboratory findings of
hypernatremia, hypokalemia and low renin  Primary hyperaldosteronism
• What needs to be done in a patient with no complaints and a mass of 1.5 cm in diameter with smooth suprarenal
nerves in the tomography  Follow-up with CT at certain intervals
• Patient who does not have a known disease, who has a 2 cm solid mass located in the left adrenal gland on CT of
the abdomen taken for another reason, and whose hormonal evaluation is normal  reevaluation
• Preferred approaches in the follow-up and treatment of incidental adrenal masses 
o between 3-5 cm, adrenalectomy if there is suspicion of malignancy on CT
o non-functional tumors smaller than 3 cm, follow-up with CT
o hormonal evaluation regardless of size,
o hormonal evaluation of more than 5 cm.
o adrenalectomy for large tumors
• Tests used in the diagnosis of adrenal incidentalomas 
o Low dose (1 mg) dexamethasone suppression test,
o 24-hour urine cortisol level determination,
o 24-hour urine metanephrine level determination,
o plasma renin level determination
o plasma aldosterone level determination
• Genetic syndromes associated with pheochromocytoma  Von Hippel-Lindau and Neurofibromatosis
• Most probable diagnosis for a patient who presents with headache, palpitation and facial flushing and has high
metanephrine levels in his 24-hour urine  Pheochromocytoma
• A disease with a diagnostic value for catecholamine levels measured in 24-hour urine  Pheochromocytoma
14. TRANSPLANTATION
• Allograft  Graft taken from genetically different but same species
• The organ with the most common graft-versus-host reaction after transplantation  Bone marrow
• The earliest infection in organ transplantation  Herpes virus
• If there is no contrary will or declaration for the transfer from the dead in our country, the donor's permission is
not required  Cornea
• A patient who had a kidney transplant from a cadaver, who presented with fever and achy joint complaints one
week after the transplantation, an increase in the creatinine level, and membrane damage and apoptosis in the
graft cells were detected in the kidney biopsy  Acute rejection
• Those applied for immunosuppression in transplantation surgery 
o Tacrolimus,
o Corticosteroids,
o Cyclosporine A
o Antilymphocytic globulin
• Drugs that act through biological immunosuppression 
o Alentuzumab,
o Belatacept,
o Muromonab-CD3
 o Rituximab
• The most important indication of pancreas transplantation  type 1 diabetes
• Most common cause of liver transplantation in children  Biliary atresia
• The most common disease in which liver transplantation is performed in adults  Viral hepatitis
• Laboratory tests included in the "King's College" prognostic scoring system used in the treatment planning of a
patient followed up with acute liver failure 
o INR,
o arterial pH value,
o serum creatinine value
o serum bilirubin value
• Conditions preventing liver transplantation for the patient 
o Active alcohol use,
o metastatic hepatocellular carcinoma,
o liver metastasis of colon cancer
o advanced pulmonary hypertension
• He was followed up for cirrhosis due to hepatitis C for ten years, 4 cm hepatocellular carcinoma in his liver and 2
cm metastasis in his lung, band ligation was performed for esophageal variceal bleeding 2 months before his
history, he had peritonitis 1 month ago, he had frequent encephalopathy. Contraindication for liver
transplantation in a patient who was admitted to the hospital and learned that trans jugular intrahepatic
portosystemic shunt (TIPS) was performed for treatment-resistant ascites  Lung metastasis
• Regarding the side effects of immunosuppressive therapy used in a liver transplanted patient 
Immunosuppression increases graft survival. In the early period, the risk of developing surgical infection increases.
Herpes virus group viruses are the most common cause of viral infections that can develop after transplantation.
Viral infections are more common in the late post-transplantation period. Immunosuppression increases the risk of
developing malignancy.
• Case in which kidney transplantation is strictly contraindicated with terminal renal failure  Malignancy
• Condition that is a relative contraindication for renal transplantation  Short life expectancy of the recipient
• Complication seen in the early period after kidney transplantation and usually resulting in the loss of the
transplanted kidney  Renal vein thrombosis
• a patient with HCV positive and orthotopic liver transplantation, deterioration in liver function tests at
postoperative 1st week, vacuolization of hepatocytes around central vein in liver biopsy  preservation damage
15. ACUTE ABDOMEN (Book 2)
• Abdominal pain, sudden onset diseases 
o Hollow organ perforation
o Urolithiasis
o Mesenteric embolism
o Ectopic pregnancy rupture
• The most common cause of acute abdomen in pregnancy  Acute appendicitis
• The finding that makes the diagnosis of acute appendicitis more prominent  The onset of pain before vomiting
• sudden onset of severe abdominal pain, diffuse guarding in all quadrants, WBCs 18 500/mm3, serum amylase 55
IU/L, free fluid was found in the abdomen in the whole abdomen CT  The most likely diagnosis is duodenal ulcer
perforation in a patient whose fluid has an amylase value of 415 IU/L, and gram staining of this fluid shows both
gram (+) and gram (-) bacteria.
• in a patient with acute left lower quadrant pain, physical examination revealed tenderness and a palpable mass in
the left lower quadrant of the abdomen, Temp: 38.5 °C, WBCs: 12,000/mm3 in blood tests.  patient with
suspected colonic diverticulitis  Contraindicated test Barium contrast colon radiography
 • Regarding the pain seen in the acute abdomen picture 
o The intensity and severity are generally related to the degree of underlying organ damage.
o The endpoint of parietal peritoneal stimuli in cortex is brodman 3,1,2.
o Pain from ileum pathologies is felt in the periumbilical region.
o Appendicitis pain begins directly in the periumbilical region.
o Cholecystitis pain radiates to the right shoulder.
• Sudden onset of abdominal pain and free air under the diaphragm in the chest X-ray  The patient has hollow
organ perforation and surgical intervention should be planned.
16. DISEASES OF ESOPHAGUS and SURGERY
• Burning, pain and feeling of fullness behind the sternum after meals  Gastroesophageal reflux
• The most sensitive and specific test for gastroesophageal reflux  24-hour pH monitoring (Intraluminal impedance
measurement is used to differentiate acid/non-acid reflux)
• Complications due to gastroesophageal reflux  Esophagitis, Barret metaplasia, Barrett's esophagus, Stricture,
Aspiration, Esophageal malignancy, Asthma
• The most likely etiologic cause in a patient with adenocarcinoma in the middle third part  Barrett's esophagus
• Regarding Barret's esophagus 
o The stratified squamous cells in the esophagus are replaced by intestinal columnar cells.
o Chronic gastroesophageal reflux is the most important cause.
o It develops in 10% of reflux patients.
o Gastric acid content and bile are effective in its development.
• Conditions that can be corrected with Nissen fundoplication surgery  Failure of medical management of
Complications of GERD (eg, Barrett esophagus or peptic stricture)
• Regarding gastroesophageal reflux 
o Its symptoms can be confused with heart disease.
o It is a risk factor for neoplastic changes in the esophagus.
o Inadequate treatment can lead to pulmonary fibrosis.
o There is a relationship with hiatal hernia
• Diagnosis in a patient with regurgitation, retrosternal burning, dysphagia, and air-fluid level behind the heart
shadow on chest X-ray  Sliding hiatal hernia
• Complications of paraesophageal hiatus hernia  Bleeding, incarceration, obstruction, strangulation, gastric
volvulus
• In diaphragmatic hernia, which is the most common bleeding complication  Paraesophageal hernia
• Complication that is less likely to be seen in paraesophageal hiatal hernias  Stricture
• Diaphragmatic hernia type characterized by occasional bleeding, acute gastric dilatation or volvulus 
Paraesophageal hernia
• Retrosternal burning, regurgitation, and bird's beak appearance on barium X-ray who cannot swallow solid and
liquid foods  achalasia
• The first thing to do in the treatment of achalasia patient  balloon dilatation
• Bird's beak appearance with dilated esophagus in barium esophagography  Achalasia
• Diseases diagnosed by manometric studies of the esophagus 
o Achalasia,
o diffuse and segmental esophageal spasm,
o nutcracker esophagus,
o hypertensive LES,
o nonspecific motility disorders
• Esophageal manometry study findings in achalasia 
o Aperistalsis in the esophageal body,
o Increase in lower esophageal sphincter pressure,
o Intraesophageal pressure higher than gastric pressure,
o Incomplete lower esophageal sphincter relaxation
• Esophageal manometry plays a decisive role in selection of appropriate surgical treatment for  Achalasia
• Achalasia treatment 
o Medical treatment such as balloon dilatation,
o Bougie dilatation,
o Calcium channel blockers,
o Botulinum toxin injection,
o Esophagomyotomy
• Cause of Zenker's diverticulum  Upper esophageal sphincter dysfunction
• Zenker's diverticulum is frequently encountered in the GIT  In the pharyngoesophageal region
• The most common benign tumor of the esophagus  Leiomyoma
• 5cm diameter mobile mass at 25 cm, covered with smooth mucosa in esophagoscopy  leiomyoma
• The most appropriate treatment for this mass  Right thoracotomy and enucleation of the mass.
• Factors having a role in the etiology of esophageal cancer  Alcohol, Smoking, Vitamin A deficiency, Barrett's
esophagus
• The most useful method for preoperative local staging of esophageal cancer  Endoscopic ultrasonography
• Methods used in pretreatment staging of esophageal cancer 
o Endoscopic ultrasonography,
o Computed thorax tomography,
o Contrast computed abdominal tomography,
o Positron emission computed tomography
• The most common accompanying condition in a patient with atrophic oral mucosa, dysphagia due to web at the
upper esophageal junction, and easily broken spoon nails  Iron deficiency
• The most probable diagnosis in a patient with subcutaneous emphysema on the neck of the patient after a traffic
accident  Esophageal perforation
• 1st test for diagnosis in a patient with neck subcutaneous emphysema after a traffic accident  Lung X-ray
• Regarding esophageal perforation 
o Subcutaneous emphysema may develop in the patient.
o Many patients have neck pain.
o The patient is followed up with antibiotic therapy.
o Oral intake of the patient is stopped.
o It is usually iatrogenic.
• The most appropriate approach in a patient with stable vitals in a patient presenting with hematemesis due to
hyperemesis gravidarum  Applying nasogastric decompression and following up with antiemetic
• The most likely diagnosis in a patient with sudden onset of chest pain, left pleural effusion, and subcutaneous
emphysema after nausea and vomiting  Esophageal rupture (Boerhaave Syndrome)
• Esophageal lower end and upper stomach are ruptured due to sudden increase in esophageal internal pressure as
a result of vomiting and burping  Mallory-Weiss syndrome
• The area of injury in the upper gastrointestinal tract in Mallory-Weiss syndrome  Cardia lesser curvature side
• Retching after alcohol use followed by bloody vomiting  Mallory-Weiss Syndrome
• The first diagnostic procedure in previous patient  Endoscopy
 • The best time for esophagoscopy after drinking alkali that causes esophageal burn  Immediately after
• Things to do in the early treatment of esophageal caustic burns 
o Neutralizing agents can be used,
o i.v. fluid therapy,
o broad-spectrum antibiotics,
o Endoscopy within 12-24 hours at the latest (very valuable in diagnosis).
• Procedures that should be performed in a patient with erythema, ulcerations and an area of obstruction on
endoscopy after corrosive substance ingestion, and air in the esophageal wall on tomography 
Esophagogastrectomy, esophagostomy and feeding jejunostomy
17. STOMACH DISEASES AND SURGERY
• First branch of celiac trunk  Left gastric artery
• Relating to the right gastroepiploic artery in a healthy person 
o It joins the left gastroepiploic artery.
o It is the continuation of the gastroduodenal artery.
o Its source is the same as the superior pancreaticoduodenal artery.
o When it is ligated, ischemia does not develop in the stomach.
o Its main source is the celiac trunk.
 Regarding gastric emptying  Leptin inhibits gastric emptying.
 Conditions leading to hypergastrinemia and ulcer formation 
o Antral G-cell hyperplasia,
o Zolinger-Ellison syndrome,
o Gastric outlet syndrome,
o Short bowel syndrome (non-ulcer developing  Atrophic gastritis)
• Disease that does not increase gastric basal acid secretion and progresses with hypochlorhydria  atrophic
gastritis
• Contraindication to upper gastrointestinal endoscopy if it has recently occurred  Myocardial infarction
• Situations that require upper GIT urgent endoscopy  Weight loss, Anemia, Dysphagia, Recurrent vomiting
• Diseases that can be caused by H. pylori  Gastric cancer, Chronic gastric & duodenal ulcer, Gastric lymphoma
• Regarding the development of duodenal ulcer associated with Helicobacter pylori 
o Acid secretion increases,
o gastric metaplasia develops in the duodenum,
o Somatostatin/gastrin regulation is disturbed,
o Duodenal inflammation develops.
• Organs where peptic ulcer is likely to be seen  Duodenum, Stomach, Ileum, Gastrojejunostomy junction
• The most common complication of peptic ulcer disease  Bleeding
• Artery causing massive bleeding in duodenal ulcers  A. Gastroduodenale
• The most common place of perforation in peptic ulcer  Anterior surface of duodenum
• Disease causing loss of liver dullness by percussion  Ulcer perforation in stomach and duodenum
• 1st radiological examination to be performed in a patient with gastric perforation  P-A chest X-ray
• Severe abdominal pain that started suddenly in epigastric region and felt in the entire abdomen, and in whom
physical examination revealed tenderness and diffuse abdominal guarding  Peptic ulcer perforation
• Sudden onset of severe abdominal pain, with a large rectangular gas in the middle of the abdomen on the
standing direct abdominal X-ray  perforation of the bursa omentalis of the stomach
• In a patient with peptic ulcer perforation with normal lab values, further investigations were performed and
could not be referred  Nasogastric decompression, intravenous fluid and antibiotic administration
• Sudden onset abdominal pain, diffuse guarding on examination, WBCs 19.200/mm3, amylase: 48 IU/L, diffuse
fluid on US  Peptic ulcer perforation
• Evidence of duodenal ulcer penetrating the pancreas  Onset of back pain
• Signs and symptoms of pyloric stenosis 
o Hypochloremic alkalosis,
o Weight loss without diarrhea,
o Postprandial colic abdominal pain,
o Mass palpation in the right umbilicus
• What is the metabolic picture of a patient with pyloric stenosis who has frequent vomiting  Hypokalaemic
hypochloremic alkalosis
• The most important factor in gastric ulcer physiopathology  Mucosal circulation disorder
• which plays the most important role in the pathogenesis of acute erosive gastritis in a patient with severe
burns?  Mucosal ischemia
• Factors that increase the risk of bleeding in stress gastritis 
o Mechanical ventilation support longer than 48 hours,
o Coagulopathy,
o Metabolic acidosis,
o Hypothermia,
• Causes of gastrointestinal bleeding caused by acute stress ulcer 
o Acute lung injury,
o Coagulopathy,
o Acute renal failure,
o Acute liver failure,
o Patients with burns of more than 30% of body surface area
• Total gastrectomy is the latest and most appropriate surgery in the treatment of  Zollinger-Ellison syndrome
• Factors affecting the prognosis in peptic ulcer perforation 
o Presence of hypotension at presentation,
o Location of perforation,
o Time between the onset of symptoms and admission to hospital,
o Age of the patient
• Stage according to Forrest classification of a patient who was evaluated for upper gastrointestinal system
bleeding, in whom there was no active bleeding in his gastroscopy, but an ulcer in the postpyloric region and a
non-bleeding vessel on its background  IIa
Forrest classification for upper GIT hemorrage
Acute hemorrhage
 Forrest I a (Spurting hemorrhage)
 Forrest I b (Oozing hemorrhage)
Signs of recent hemorrhage
 Forrest II a (Non bleeding Visible vessel)
 Forrest II b (Adherent clot)
 Forrest II c (Flat pigmented haematin (coffee ground base) on ulcer base)
Lesions without active bleeding
 Forrest III (Lesions without signs of recent hemorrhage or fibrin-covered clean ulcer base)[2]
• The most common precancerous lesion of the stomach  Atrophic gastritis
• Diffuse spreading carcinoma involving the entire wall of the stomach  Linitis plastica
• Factors involved in the etiology of gastric cancer 
o Distal gastric resection for pernicious anemia,
o Helicobacter pylori infection,
o blood group,
o duodenal ulcer
• Polyp with the least probability of being a precursor in gastric cancer  Hyperplastic polyp
• Gastric epithelial polyp types with the highest risk of transformation into malignancy  Adenomatous
• The most common cancer in the stomach  Adenocarcinoma
• Risk factors for adenocarcinoma of the stomach 
o Helicobacter pylori infection,
o excessive salt consumption,
o pernicious anemia,
o smoking,
o blood group A
• Factor reducing the risk of gastric cancer 
o Acetylsalicylic acid,
o high amount of fresh fruits and vegetables in the diet,
o vitamin C
• The superiority of endoscopy over barium radiographs in the evaluation of the upper gastrointestinal tract-->
Differentiation of malignant and benign gastric ulcer
• The most common finding of stomach cancer  Weight loss
• Characteristics of intestinal type gastric carcinoma compared to diffuse type 
o seen in younger people,
o epidemic,
o associated with Helicobacter pylori,
o has a better prognosis,
o more common
• Localizations where lymphatic drainage of the stomach is provided 
o Surrounding the splenic artery,
o splenic hilum,
o truncus celiacus,
o arteria hepatica communis (retrohepatic region without these)
• Early gastric cancer  Tumor in mucosa and submucosa (TlNx), regardless of metastasis to lymph nodes or
not.
• Relating to early gastric cancer 
o It does not pass the muscularis propria.
o Recurrence is low after surgery.
o It can metastasize to lymph nodes.
o It may grow exophytic into the lumen.
o They are usually well-differentiated
cancers.
• Early stomach cancers  Tis, T1N0, TINI, T1N2
• Inoperability criteria for gastric cancer 
o Virchow lymph node,
o mass on rectal touch,
o multiple metastases in liver,
o ascites in abdomen
• Advanced gastric cancer findings 
o Supraclavicular lymph node metastasis,
o palpable umbilical nodule,
o presence of ascites that can be detected in physical examination,
o liver metastasis
• Stage of gastric carcinoma that has invaded the muscularis propria, has not reached the serosa, and has
metastases in 12 lymph nodes  T3N3
• Surgery of a patient who was operated on for a malignant mass of approximately 3 cm located on the lesser
curvature of the stomach  Subtotal gastrectomy + Billroth II reconstruction
• Metastatic gastric cancer findings 
o Virchow nodule,
o Blumer's shelf,
o Sister Mary Joseph nodule,
o Krukenberg tumor
• Stomach tumor originating from interstitial Cajal cells that regulate intestinal motility  Gastrointestinal
stromal tumor
• Malignant gastrointestinal stromal tumors are the most common place  Stomach
• C-kit inhibitor drug used in the targeted treatment of metastatic GIT stromal tumors  Imatinib
• Regarding GIT stromal tumors 
o It is most commonly detected in the stomach,
o the malignant potential increases as the tumor size increases,
o the c-kit proto-oncogene is detected in most of the patients,
o it can cause GIT bleeding
• Stomach tumor that is likely to disappear completely with the eradication of H. pylori  MALToma
• The most common organ of gastrointestinal lymphoma in developed countries  Stomach
• Surgical interventions that cause postgastrectomy syndrome 
o Removal of the reservoir function of the stomach,
o removal of the pyloric sphincter mechanism,
o cutting of the vagal nerves
• Early postoperative complications of peptic ulcer surgical treatment 
o Duodenal stump leakage,
o gastric aphonia,
o bleeding,
o organic obstruction
• Postgastrectomy syndromes 
o Dumping syndrome,
o afferent ans syndrome,
o alkaline reflux gastritis,
o Roux stasis syndrome
o Vasoactive amine causing diarrhea in dumping syndrome  Serotonin
• Surgery without dumping syndrome  Proximal gastric vagotomy
• Late dumping syndrome formation mechanism  Reactive hypoglycemia
• The most common cause of gastrojejunocolic and gastrocolic fistula  Marginal ulcer
• Conditions that led to this situation in a patient who underwent distal subtotal gastric resection and Billroth 2
anastomosis for gastric cancer, and admitted to the emergency department with the complaint of inability to
 remove gas and stool 12 months after the operation--> Intra-abdominal adhesion, bezoars, efferent ans
syndrome, tumor recurrence
• Gastric surgery, in which late-stage iron deficiency anemia is the most common  Billroth II
• The most probable cause of anemia in a patient with gastric resection despite taking vitamin B12 once a
month  Decreased iron absorption
• Iron deficiency is expected to develop after operations in which
o The duodenum is bypassed (Billroth II gastrectomy)
o or removed (Whipple procedure).
• The most common cause of anemia developing after partial gastrectomy  Iron
• The least common complication after truncal vagatomy and antrectomy  Vitamin B12 deficiency
• The most probable diagnosis for a patient who underwent distal subtotal gastrectomy and gastrojejunostomy
for gastric cancer, developed severe right upper quadrant pain on the second day of the operation, a dilated
intestinal loop was detected in the medial pancreatic head in abdominal ultrasonography, and was completely
relieved after a sudden onset of severe bilious vomiting  Afferent loop occlusion
18. MORBID OBESITY AND SURGERY
• Associated problems that can be corrected with bariatric surgery  Diabetes mellitus, sleep apnea, hypertension,
hyperlipidemia
• The surgery with the highest malabsorptive effect in bariatric surgery  Biliopancreatic diversion (BPD)
• BMI of a patient who was diagnosed with Type II diabetes mellitus and hypertension, whose height was 160 cm and
whose weight was 100 kg  39
• Necessary criteria for making a decision for bariatric surgery in a morbidly obese patient 
o good mental health,
o Body mass index >40 kg/m2,
o body mass index 35-40 kg/m2 and obesity-related co-morbidity,
o the patient's operation Being knowledgeable and willing about the changes that will occur in the post-term
• The surgical procedure that defines the Scopinaro surgery  Biliopancreatic diversion
• Absolute contraindication for morbid bariatric surgery  Prader - Willi syndrome

19. SMALL BOWEL DISEASES AND SURGERY

• Findings compatible with the macroscopic appearance of Crohn's colitis 
o Wall thickening,
o mesenteric thickening,
o segmental involvement,
o mesenteric lymphadenopathy
• The first pathological finding of Crohn's disease observed in the small intestine  Aphthous ulcers in the mucosa
• Disease with segmental involvement and noncaseating granulomatous lesion involving all layers  Crohn's
• Radiologic findings of Crohn's disease 
o Long segmental stenosis in the terminal ileum,
o fistulization with adjacent organs,
o segmental and asymmetric bowel involvement,
o mucosal linear ulcers and cobblestone findings
• Findings in Crohn's disease  Recurrent abdominal pain, diarrhea, fever, arthritis
• The most common symptom of regional enteritis  Abdominal pain
• In a 35-year-old patient, if there is right lower quadrant pain, diarrhea, weakness, and fistulas opening to the skin,
the probable diagnosis is  Crohn's disease.
• In a patient with occasional crampy abdominal pain, stenosis in three separate segments and enteroenteral fistula
in the small intestine passage radiograph  Crohn's disease
• Extraintestinal manifestations of Crohn's disease 
o Erythema nodosum,
o conjunctivitis,
o ankylosing spondylitis,
o amyloidosis
• The most common complication of Crohn's disease  Obstruction
• The most common complication requiring surgical intervention in Crohn's  Obstruction + stricture
• Absolute operation indications in Crohn's disease 
o Gastrointestinal fistula,
o intestinal obstruction,
o free perforation,
o intra-abdominal abscess
• The most likely diagnosis for a patient who presented with the complaint of sudden onset of massive lower
gastrointestinal bleeding, whose history was learned to have recurrent episodes of mouth aphthae and genital
ulceration in the last 10 years, and who had hemorrhage in the terminal ileum on angiography  Entero-Behçet's
disease
• The most probable diagnosis for a patient who presented to the emergency department with acute abdomen
symptoms, had tenderness and defense in all abdominal regions, especially in the right lower abdomen, free air in
the standing abdominal X-ray, and learned that diarrhea started after a trip he made 3 weeks ago  Typhoid
enteritis perforation
• The most common site of tuberculous enteritis  Distal ileum and cecum
• The most common pathogen causing severe enterocolitis in patients diagnosed with AIDS  Cytomegalovirus
• Disease in which barium radiography is useful in diagnosis and treatment  Intussusception
• Situation where purgatives are not recommended  Inability to hear bowel sounds
• Symptoms and signs seen in blind loop syndrome  Diarrhea, weight loss, anemia, neurological disorder
• The most common true diverticulum  Meckel's diverticulum
• The most common congenital anomaly in GIT  Meckel's diverticulum
• The most common symptom of Meckel's diverticulum in children  Rectal bleeding
• The most common complication of Meckel's diverticulum in adults  Obstruction
• Pneumatosis intestinalis and the appearance of gas in the portal vein tracing are the radiological findings of which
disease  Necrotizing enterocolitis
• Occasional episodes of rash, diarrhea, mass in the liver and pathology in the right heart valve, and a high level of 5-
hydroxyindolacetic acid in the urine  Carcinoid syndrome
• Regarding carcinoid tumors 
o They are most commonly seen in the GIT.
o Long-term survival can be achieved with surgical & medical treatment in patients with distant metastases,
o symptoms associated with carcinoid syndrome can be alleviated with somatostatin analogues,
o metastases are more likely in lesions larger than 2 cm.
• Findings in a patient with malignant carcinoid syndrome  Telangiectasias in the skin, bronchoconstriction,
diarrhea and malabsorption
 • The most appropriate test to be performed in a patient with pellagra-like findings, facial flushing, episodes of
hypotension, and increased bowel sounds  5 HIAA in urine
• The most common benign tumor of the small intestine that causes clinical symptoms  Stromal tumors
• The place where adenocarcinomas are seen the least in the gastrointestinal tract  Small intestine
• Regarding small bowel cancers 
o It is rarely seen among gastrointestinal tumors,
o the most common types are adenocarcinoma and carcinoid tumors,
o seen in advanced ages.
• The most common localization of primary adenocarcinoma of the small intestine without any other disease of the
gastrointestinal tract  Duodenum and proximal jejunum
• sudden onset of radiating pain in the entire abdomen and inability to pass gas and stool, a history of intermittent
abdominal pain and distention attacks, a normal temperature, pulse and leukocyte count, and marked
asymmetrical distension and diffuse tenderness in the abdomen, the most ineffective imaging diagnosis 
Abdominal ultrasonography
• Complications that may occur after resection of the terminal ileum 
o Kidney stone formation,
o steatorrhea,
o vitamin B12 deficiency,
o malabsorption of bile salts (unseen Iron deficiency anemia)
• Kidney pathology seen after wide ileum resection  Ca-oxalate stones
• The most common type of kidney stones seen after ileal resection  Oxalate
• Risk factors for short bowel syndrome developing after massive small bowel resection 
o Absence of ileocecal valve
o remaining small intestine shorter than 200 cm
o presence of additional colon resection
o presence of Crohn's disease in the remaining intestine
o ileum resection
20. DISEASES OF THE COLON AND RECTUM, AND SURGERY
• Branches of the inferior mesenteric artery  Left colic artery, Sigmoidal artery, Superior rectal artery
• elderly patient with abdominal pain, fever and tenderness in the left lower quadrant  Computed tomography
• Not recommended in diagnosis of patient with GIT bleeding due to colon diverticulum  barium study
• Contraindicated method for diagnosis in an elderly patient with 39 degrees fever, left lower quadrant tenderness
and guarding  Barium colon radiography
• Elderly patient who presented to the emergency room with abdominal pain, fever of 39 degrees, tenderness and
guarding in the left lower quadrant, and mechanical intestinal obstruction was also found in the examinations 
Diverticulitis
• In an elderly patient with tenderness and guarding in the left lower quadrant, and mechanical intestinal obstruction
in the examinations performed, the most appropriate test to be performed 6 weeks after the acute phase has
passed  Colonoscopy
• The most likely diagnosis is in a patient with occasional mild abdominal pain in the left lower quadrant and
constipation  diverticulosis
• An 82-year-old patient was admitted to the emergency department due to pain in the left lower quadrant of the
abdomen, with a history of increasing abdominal pain for 2 days, a fever of 38.9°C on physical examination, no
pathological findings other than tenderness and guarding in the left lower quadrant, WBCs 13.000/mm3. Diseases
in differential diagnosis of a patient are  Diverticulitis, Colon tumor, Sigmoid volvulus, Ischemic colitis
• The most appropriate radiological method to confirm the diagnosis in previous patient  Computed tomography
• The most probable diagnosis in a 65-year-old patient with constipation, abdominal pain, fever, left lower quadrant
tenderness, and leukocyte 12.5OO/mm3  Sigmoid diverticulitis
• Colon disease, which should be considered first in an elderly patient who has abdominal pain, fever and tenderness
in the left lower quadrant on physical examination, and who has previously had similar complaints  Diverticulitis
• Relating to colon diverticulum 
o usually seen where the muscle layer in the colon wall is weak.
o Before diverticula formation, hypertrophy may be seen in the muscle layer.
o They are located on the mesenteric side of the antimesenteric tapeworm.
o In some cases, the arteriole may be displaced towards the dome of the diverticulum.
o It usually occurs in the sigmoid colon.
• The test that is contraindicated in a patient who presented to the emergency department with acute left lower
quadrant pain, physical examination revealed tenderness and palpable mass in the left lower quadrant of the
abdomen, body temperature was measured at 38.5°C, and leukocyte count was 12.000/mm3 in blood tests. 
Barium colonography
• The most common cause of colovesical fistula  Diverticulitis
• The most probable diagnosis in a patient with stool in his urine and colovesical fistula detected in colonoscopy 
Diverticulitis
• Frequent urinary tract infection, particulate urine and air with urine for the last 6 months, and was admitted to
the hospital 6 months ago due to severe pain and fever on the left side of the abdomen and was administered
antibiotic therapy  Colovesical fistula
• Complications of diverticular disease of the colon  Abscess, Fistula, Diffuse peritonitis, Obstruction
• Regarding colon diverticulum 
o Most patients who develop diverticulitis survive diverticulitis attack without developing diffuse peritonitis.
o The majority of diverticula in the descending colon and sigmoid colon are false diverticula.
o Medical treatment should be considered primarily in patients with diverticulitis.
o Colovesical fistula due to diverticulitis is common among diverticulitis-related fistulas.
o Contraindicated examination in case of diverticulitis is barium colon radiography.
• Situations suggestive of complicated diverticulitis 
o Formation of intraperitoneal abscess,
o Free perforation,
o Formation of fistula between the colon and adjacent organs,
o Obstruction
• is the most frequently affected part of the large intestine in idiopathic ulcerative colitis  Rectum
• Typical findings observed in ulcerative colitis 
o Uveitis,
o Arthritis,
o Pyoderma gangrenosum,
o Erythema nodosum
o Rectal bleeding,
o Diarrhea,
o Weight loss,
o Anemia
• Abdominal pain, rectal bleeding and difficulty in holding stool, in colonoscopy, the entire colonic mucosa from the
rectum mucosa to the terminal ileum was found to be hyperemic and fragile, patchy ulcers were detected in
places, and limited inflammation and crypt abscesses in the mucosa-submucosa were observed in the biopsy. The
most likely diagnosis for a patient  Ulcerative colitis
• Treatments recommended for a patient with active ulcerative colitis, whose diarrhea has stopped for the last 12
hours, and who is brought in a table with distension, with transverse colon overfilling with gas and 9 cm in diameter
in the direct abdominal X-ray 
o Stopping oral food and switching to nasogastric decompression,
o Giving steroids ,
o Broad spectrum antibiotics and
o IV fluids, Bed rest
• Drugs recommended to be used in the treatment of ulcerative colitis  Amino salicylic acid, Corticosteroids,
Azothioprine, Immunosuppressives
• Indications for emergency surgery in ulcerative colitis 
o Non-stop bleeding,
o Toxic megacolon unresponsive to treatment,
o Free perforation,
o Obstruction unresponsive to treatment
• Indications for surgical treatment in ulcerative colitis 
o Failure to respond to long-term medical treatment,
o Development of dysplasia,
o Toxic megacolon,
o Massive bleeding
o Growth and developmental retardation in children
• The most appropriate approach for a patient who has been followed up with the diagnosis of ulcerative colitis for
30 years and whose colonoscopic biopsy has found carcinoma in situ  Total proctocolectomy
• Solitary rectal ulcer as a complication  Pain, Rectal bleeding, Internal intussusception, Mucus stool
• 3x1 cm ulcer in the anterior rectum with defecation difficulty and rectal bleeding  Solitary rectal ulcer
• Indicating that colonic ischemia is chronic  Symptomatic colonic stenosis
• Amoeba, which causes tumor-like formation, albeit rare, in the intestinal wall (A mass in the colon following bloody
diarrhea will bring to mind ameboma)
• The most probable diagnosis in a 70-year-old patient with inability to pass gas, distention, fever and leukocytosis,
and an inverted U appearance on the ABKG  Sigmoid volvulus
• Organs that may develop volvulus 
o Sigmoid colon,
o Right colon and
o cecum,
o Small intestine,
o Stomach
• The most probable diagnosis in a 65-year-old patient who presented to the emergency room with abdominal
distension, vomiting and abdominal pain, distension and tenderness on physical examination, and an inverted U-
shaped (omega sign, coffee bean-shaped) large bowel loop covering the left side on standing direct abdominal X-
ray  Sigmoid volvulus
• The first thing to be done in such patient  sigmoidoscopy
• First step in the treatment of sigmoid volvulus  Decompression with a rigid sigmoidoscope
• Conditions that may become cancerous 
o Ulcerative Colitis
o Gardner's syndrome
o familial polyposis
o villous adenoma in the colon
• Colon segment where adenomatous polyps of the colon are most frequently located  Rectosigmoid
• The most common region of colon cancer  Rectosigmoid region
• The strongest evidence supporting that a colonic polyp with a stalk is malignant  Invasion of the muscularis
mucosa
• with the highest malignant potential in colorectal polyps  Villous adenoma
• with lowest risk of malignancy from colonic lesions  Hyperplastic polyp
• The lowest risk of developing colon cancer  Hamartomatous polyp
• The method that should be preferred for the treatment of a patient with a 2 cm stalked polyp in the transverse
colon during colonoscopy performed for abdominal pain, removed by polypectomy and no malignancy detected in
the pathological examination reported as adenomatous polyp  The procedure is sufficient and is followed up.
• Conditions that increase the risk of local recurrence and metastasis in a colon polyp that was removed by
maintaining its integrity by polypectomy and reported as malignant by pathological examination 
o Presence of lymphovascular invasion,
o histopathologically poor differentiation,
o polyp larger than 2 cm,
o invasive carcinoma in the sessile polyp
• The most appropriate approach for a patient who develops perforation of the sigmoid colon during colonoscopic
polypectomy and has no signs of peritonitis  Initiation of broad-spectrum antibiotics and nasogastric
decompression to the patient
• The type of polyp in Peutz-Jeghers syndrome  Hamartomatous
• A patient with colic-like abdominal pain from time to time, intussusception secondary to polyps in the small
intestine X-ray, and polyp in the rectum in the rectoscopic examination, physical examination revealed
pigmentation on the face, a tumor in the genital area, and tenderness in the abdomen. The most likely diagnosis
for the patient is  Peutz-Jeghers syndrome
• Characteristics of Peutz-Jeghers syndrome 
o Mucocutaneous pigmentation,
o multiple polyps,
o colic pain,
o intussusception
• Matches 
o Peutz Jeghers - mucosal hyperpigmentation,
o Sardner syndrome - osteoma,
o Turcot syndrome - CNS tumors,
o Behçet - Oral and genital ulcers
• Those found in Sardner syndrome 
o Polyposis coli,
o Osteoma,
o Desmoid tumors,
o Epidermoid cyst
• Amsterdam criteria for the diagnosis of hereditary nonpolyposis colorectal cancer syndrome 
o At least 3 relatives of the patient have colon cancer,
o At least one of them is a first degree relative,
o Existence of the disease for two generations,
o Presence of the disease in at least one of the relatives before the age of 50
• Related to hereditary nonpolyposis colorectal cancer (Lynch syndrome) 
o Cancer usually occurs at younger ages.
o The incidence of synchronous and metachronous cancer is higher than normal.
o It constitutes 5-10% of colorectal cancers.
 o The rate of endometrium's carcinoma is high.
o Most cancers are located in the proximal colon.
• Organ with high risk of secondary cancer in a patient with familial colorectal carcinoma  Endometrium
• Related to hereditary colorectal cancers (familial adenomatous polyposis syndrome) 
o Familial adenomatous polyposis syndrome shows autosomal dominant inheritance.
o Duodenal adenomas are common in familial adenomatous polyposis syndrome.
o Hereditary nonpolyposis colorectal cancer is more common in familial adenomatous polyposis syndrome.
o Endometrial cancer is the most common accompanying extracolonic malignancy.
o MYH mutation is seen in attenuated familial adenomatous polyposis syndrome.
• Tumor suppressor gene that plays role in transformation of normal epithelium to dysplastic epithelium  APC
• Risk factor for colorectal cancer  APC gene mutation
• High risk factors that play a role in the development of colon cancer 
o Being over 50 years old,
o Having a family history of colorectal cancer or polyps,
o Presence of ulcerative colitis for more than 10 years,
o Presence of familial adenomatous polyposis
• The most appropriate approach for a patient in whom a pedunculated polyp was detected in the 45th cm of the
colon in the colonoscopic examination and was totally excised, and adenocarcinoma in the polyp was reported in
the pathological examination and the stem region was tumor-free  Follow-up
• The most appropriate screening of individuals without risk factors for colon cancer  annual occult blood
determination in stool after 50 years of age.
• The most reliable screening tool for the diagnosis of colorectal cancer  Colonoscopy
• Colonoscopy is contraindicated clinical situation  Fulminant colitis
• Examinations that should be done first in the diagnosis of colon cancers  Colonoscopy, Rectosigmoidoscopy,
Computed tomography, Barium colon radiography
• which should be performed first to confirm the diagnosis in a patient with iron deficiency anemia, who applied
with the complaints of 5 kg weight loss and abdominal pain in the last six months, and who was found to be
positive for occult blood in the stool  Colonoscopy
• The most common symptom in rectal cancer  Hematochezia
• Section of the colon that is completely infiltrated and perforated due to the presence of lumen-occluded
rectosigmoid region cancer--> Cecum
• If there is complete obstruction with tumor formation in the sigmoid colon, the most common part of perforation
 Cecum
• Cause of cecum perforation due to rectosigmoid obstruction  Wide cecum
• If there is obstruction in the sigmoid in a patient with normal ileocecal valve, perforation is the most common
part in the future  Cecum
• Part of large intestine where malignant tumors with early obstructive symptoms develop more  Sigmoid colon
• The most common part of the obstruction caused by colorectal carcinomas  Sigmoid colon
• The disease that should be considered first in a 70-year-old patient with recurrent lower gastrointestinal bleeding
and tenesmus  Rectum cancer
• The disease that most frequently causes anemia by occult bleeding  Right colon cancer
• The most common section of iron deficiency anemia in the presence of colon cancer  ascending colon
 • The most probable diagnosis for an elderly patient who presents with complaints of weakness and fatigue, no
pathological findings in physical examination, low serum iron, high transferrin level in laboratory examinations, and
positive occult blood in the stool  Right colon tumor
• presented with iron deficiency anemia, 5 kg weight loss in the last six months, and abdominal pain  Occult blood
in the stool
• weakness, weight loss, palpitation and constipation lasting for 6 months, no pathology other than pallor of the
conjunctiva was detected in his physical examination, and hypochromic-microcytic anemia was found in laboratory
examinations  Right colon tumor - colonoscopy
• In the Dukes classification, only the closest lymph nodes are involved in colon cancer  Stage C
https://en.wikipedia.org/wiki/Colon_cancer_staging
• Stage of a colon carcinoma with complete wall invasion, paracolic lymph node involvement and no distant
metastasis, according to TNM classification  Stage 3
• Stage of colorectal cancer that invades adjacent organs, does not involve lymph node involvement and does not
have distant metastases  T4 N0 M0
• TNM of the patient in whom the sigmoid tumor invades the muscularis propria and 2 lymph nodes are positive and
there is no evidence of metastasis  T2 N1 M0
• The organ in which colorectal tumor metastases are most common after regional lymph nodes  Liver
• In the follow-up of a patient undergoing colon cancer surgery, an examination that must be performed every 3
months for the first 2 years  Carcinoembryogenic antigen determination
• The structure that causes ejaculation disorder in men if it is damaged during rectal surgery  Hypogastric nerve
• Reasons that require ostomy opening with a "loop" in a patient who presented with the complaint of rectal
bleeding, in the colonoscopic evaluation, a tumoral mass that started 5 cm away from the anal entrance was
detected, and a protective "loop" ostomy was opened by performing lower anterior resection surgery 
Immunosuppression, Radiotherapy, Intraoperative hypotensive course of the patient, Nutritional disorder
• Regarding the tests used in the pre-surgical evaluation of rectal cancer 
o Fluorodeoxyglucose positron emission tomography (FDG-PET) is used in staging of rectal cancer.
o Colonoscopy is performed to investigate presence of synchronous tumor in a rectal cancer patient
o Rectal endosonography gives information about the T and N stage of the tumor.
o Pelvic MRI provides information about the T and N stages of the mass in the rectum.
o The thorax should be evaluated by CT for distant metastases.
21. APPENDIX VERMIFORMIS DISEASES AND SURGERY
• Acute appendicitis is an inflammatory event and starts slowly and progresses slowly
• The most important event that plays a role in the etiology of acute appendicitis  Obstruction
• During the development of acute appendicitis, the most obstructing appendix lumen  Fecalitis
• The most important factor in the etiology of acute appendicitis  Luminal obstruction
• The most common parasite causing appendicitis is  Ascaris lumbricoides
• The causative agent of intra-abdominal abscess in perforated appendicitis  Bacteroides fragilis
• A finding that makes the diagnosis of acute appendicitis more prominent  The onset of pain before vomiting
• The most likely diagnosis in a patient who comes to the emergency room with complaints of abdominal pain,
nausea, vomiting and fever that starts in the navel and then localizes to the right lower quadrant  Appendicitis
• The first diagnostic method to be applied to the previous patient  Physical examination
• Disease in which the obturator test is positive  Acute appendicitis
• Diseases in the differential diagnosis of acute appendicitis 
 o Acute mesenteric adenitis,
o acute pelvic inflammatory disease,
o ovarian cyst torsion,
o acute gastroenteritis
• Most appropriate diagnostic method in the differential diagnosis of acute appendicitis  Abdominal CT
• Bilateral lower quadrant pain and tenderness with guarding in the right lower quadrant, had pain in the right lower
quadrant when pressure was applied to the left lower quadrant, and had a leukocyte count of 18,000/mm3 on
laboratory examination.  Perforated appendicitis
• There is no indication for emergency appendectomy in the treatment  Plastrone appendicitis
• Plastrone appendicitis  an abscess formation that occurs when the appendix is surrounded by the omentum
following perforation of acute appendicitis.
• Phlebitis of the portal veins (pilefflebitis) is a rare complication of  Necrotizing acute appendicitis
• If the patient diagnosed with acute appendicitis has fever with chills, intermittent abdominal pain and
hyperbilirubinemia, the most likely diagnosis is  Pilephlebitis
• Complications of appendicitis 
o Perforation,
o Pilephlebitis
o periappendicular abscess,
o generalized peritonitis,
o plastron formation
• The most common cause of acute abdomen in pregnancy  Acute appendicitis
• He was admitted with complaints of loss of appetite, fever and pain in the lower right part of his abdomen lasting
for 24 hours, his physical examination revealed signs of peritoneal irritation in the right lower quadrant of the
abdomen, he was operated with the preliminary diagnosis of acute appendicitis, the appendix appeared normal
during the operation, but the cecum and terminal ileum were inflamed, slightly edematous and reddish. The most
appropriate approach for a patient who has been found to have Typhlitis (inflammation of the cecum)  Closing
the abdominal folds and ending the surgery without any further intervention.
• Areas where carcinoid tumor is frequently localized in the gastrointestinal tract 
o Appendices,
o ileum,
o rectum (or Colon)
• Patient who was operated with a preliminary diagnosis of appendicitis and a 1 cm mass was found at the tip of the
appendix during the operation  carcinoid tumor
• More common appendiceal malignancy  Appendiceal carcinoid
• The most appropriate treatment option in a patient with a pre-diagnosis of appendicitis who underwent surgery
and a 1 cm mass at the tip of the appendix was detected  Appendectomy is sufficient.
• In the pathological examination of the patient who underwent appendectomy with the diagnosis of acute
appendicitis, the most appropriate treatment method in a patient who presented as a 1 cm carcinoid tumor located
at the end that did not exceed the appendiceal wall  Appendectomy is sufficient.
• The most probable source of a pathology, which is considered to be consistent with pseudomyxoma peritonei, is
the findings during the surgery for an abdominal mass  Appendix
22. DISEASES OF THE PERIANAL REGION AND SURGERY
• Causes of fecal incontinence 
o Anorectal surgical interventions,
o pudendal nerve injury,
o pelvis fractures,
 o trauma during labor
• Related to the etiology of rectal prolapse 
o Chronic constipation,
o Congenital causes,
o loose connective tissue,
o long sigmoid colon,
o hemorrhoidectomy operations,
o nulliparity
• Related to hemorrhoidal disease 
o Grade I and Grade II internal hemorrhoidal disease are often painless.
o hemorrhoids; contains submucosal arterioles, venules, and smooth muscle fibers.
o Fibrosis may develop after sclerotherapy.
o Urinary retention may develop after hemorrhoidectomy.
o Infrared photocoagulation is one of the methods used in treatment.
• First degree hemorrhoid treatment 
o Infrared photocoagulation,
o Medical treatment,
o Band ligation,
o Sclerotherapy
• The method by which acute anal fissure is diagnosed  Visual examination
• Possible diagnosis in a patient with painful defecation followed by dripping bleeding  Anal fissure
• The most likely diagnosis in a patient who was found to have severe and sharp pain, such as a knife stabbing in the
anus during defecation, and bright red bleeding that spreads to the stool in the form of lines  Anal fissure
• Regarding anal fissure 
o In 90% of patients, the fissure is in the posterior midline.
o In chronic fissure, internal sphincter fibers are seen at the base of the lesion.
o It is caused by high resting pressure in the anal canal and insufficiency of blood circulation in the area.
o Its atypical location should suggest anal tuberculosis.
o It most often develops as a result of constipation.
• Disease in which lateral internal sphincterotomy is applied  Anal fissure
• Regarding the anal fissure 
o It is often located at 6 o'clock in the lithotomy position.
o Chronic fissure has 3 components: papilla, fissure and sentinel pili.
o In treatment, a hot sitz bath, pulpy food intake and defecation habits should be regulated.
o Lateral internal sphincterotomy is recommended for surgical treatment.
• Diseases causing anorectal abscess and fistula  TB, ulcerative colitis, granulomatous colitis, actinomycosis
• The main cause of anal abscesses and fistulas  Anal gland and crypt inflammations
• The most common type of anal fistula  Intersphincteric
• The most common cause of perianal fistula  Perianal abscess
• If perianal discharge starts one month later in a patient who uses antibiotics together with perianal abscess
drainage, the first thing to consider is the disease  Perianal fistula
• Which is more common among malignant tumors developing in the anal canal  Squamous cell carcinoma
• The approach that should be preferred first in the treatment of a patient who underwent biopsy for a wide-based
tumor located in the anal canal, involving the sphincter, and whose biopsy result was reported to be squamous cell
carcinoma  Combined chemoradiotherapy
• Anus margin lesions associated with human papilloma virus 
 o Squamous cell carcinoma,
o Bowen's disease,
o Verrucous carcinoma,
o Buschke-Lövvenstein tumor
• Anal canal epidermoid carcinoma below dentate line most frequently metastasizes to  Inguinal lymph nodes
23. INTESTINAL OBSTRUCTIONS and SURGERY
• The most common cause of small bowel obstructions  Adhesion
• The prominent symptom in proximal small bowel obstructions  Vomiting
• Causes of chronic intestinal pseudoobstruction 
o Visceral myopathy,
o Amyloidosis,
o Collagen vascular diseases,
o Radiation enteritis
• Relating to Ogilvie syndrome 
o Acetylcholinesterase inhibitors can be used in treatment.
o There is no mechanical obstruction in the colon.
o It is usually seen in elderly patients.
o Medical treatment should be considered first in treatment.
o Colon dilatation is most common in the right and transverse colon.
24. GASTROINTESTINAL SYSTEM BLEEDING AND SURGERY
• Minimum bleeding for the formation of melena  50 mL
• The first diagnostic procedure in a patient presenting with hematochezia  Nasogastric aspiration
• The method of choice for detecting the localization of upper gastrointestinal bleeding  Endoscopy
• The most appropriate follow-up approach for a patient, who has a stable hemodynamics and who has no other
known disease and who has vomiting and a small amount of blood from his mouth 1 day after taking non-steroidal
anti-inflammatory drugs due to headache  Upper GIT endoscopy
• The most common cause of upper GIT bleeding  Duodenal ulcer
• which is the least likely to cause lower GI bleeding around the age of sixty  Meckel's diverticulum
• Pathology least likely to cause massive upper GIT bleeding  Reflux esophagitis
• 1st thing to be done in the patient who comes with the complaint of massive hematochezia  nasogastric tube
• 1st diagnostic procedure in 18Y patient with massive rectal bleeding  Rectal examination & anoscopy after
nasogastric tube
• The most common cause of massive lower GI bleeding in a 65Y patient  Diverticulosis (old information
Angiodysplasia, nowadays diverticulosis)
25. GI FISTULES AND SURGERY
• The most common cause of enterocutaneous fistulas  Surgical intervention
• Conditions that facilitate spontaneous closure of the enterocolic fistula.
o Open distal and have a passage,
o Low output,
o Fistula longer than 2 cm,
o Not secondary to inflammatory bowel disease,
o Absence adjacent to the fistula and draining to the fistula
• Factors that reduce the possibility of spontaneous closure of enterocutaneous fistula 
o Obstruction in the distal of the fistula,
 o presence of radiation enteritis,
o length of the fistula tract <2 cm,
o Undrained abscess cavity,
o epithelialization of the fistula tract
• Methods used in the treatment of enterocutaneous fistula 
o Ensuring fluid-electrolyte balance,
o fighting infection,
o preventing sepsis,
o parenteral nutrition,
o skin protection
26. LIVER DISEASES AND SURGERY
• Structures compressed with the Pringle maneuver  Portal vein - Hepatic artery - Common bile duct (choledoch)
• Structures contained in the hepatoduodenal ligament  Portal vein, Hepatic artery, Common bile duct
• According to the Brisbane 2000 liver terminology based on Couinaud's segmental anatomical classification, the liver
segments that should be included in the resection in right posterior sectionectomy  Segments 6 and 7
• The Couinaud classification of liver anatomy  divides the liver into eight functionally independent segments.
Each segment has its own vascular inflow, outflow and biliary drainage. In the center of each segment there is a
branch of the portal vein, hepatic artery and bile duct.
• The most common cause of multiple pyogenic liver abscess is  cholangitis
• The most common cause of pyogenic liver abscess is Ascending biliary infection
• Most common causes of pyogenic liver abscesses Bile duct infections  Cryptogenic infections
• Right hypochondriac pain, fever, hepatomegaly on examination, only alkaline phosphatase increased in the
laboratory, right diaphragm pushed up on chest X-ray, and air-fluid level  Pyogenic liver abscess
• If there is gas in the portal vein on the direct X-ray, the first thing to consider is  Necrotizing enterocolitis
• Related to pyogenic liver abscesses 
o It is more common in developed countries and is often single.
o Biliary system pathologies and inflammatory pathologies in organs draining into the portal vein are the
main causes.
o In some patients, no cause can be found.
o Treatment is primarily medical.
• The most probable diagnosis in a patient with right upper quadrant pain and fever, tenderness in the right
hypochondrium, & minimal elevation of leukocyte 16,000/mm3, AST, ALT and bilirubin  Pyogenic liver abscess
• Diagnosis in a patient who had diarrhea with bloody mucus three weeks ago, presented to the emergency room
with complaints of general condition deterioration, pain in the right upper quadrant, fever, and a cystic mass in the
left lobe of 5 cm in the liver on ultrasonography with total bilirubin level of 4 mg/dL  Amoebic abscess
• The most appropriate treatment for previous  The abscess is drained, metronidazole is given
• Useful test in the differential diagnosis of amebic or pyogenic abscess  Indirect hemagglutination test
• Methods applied in the diagnosis of liver hydatid cysts  Eliza scans, Upper abdominal US, Abdominal CT
• Medicine used in the medical treatment of hydatid cyst  Mebendazole and albedozol
• Regarding hydatid cyst 
o Mebendazole and albendazole are not curative.
o If it is small and multiple, surgery is not performed.
o It is often asymptomatic.
o Diagnosis is made by liver US.
o The most common complication of hydatid cyst  Opening (rupture) into the bile ducts
• If a murmur is heard at the place where the liver is dulled, the most likely diagnosis is  Hemangioma
• The most common solid benign mass in the liver during organ examinations for any reason  Liver hemangiomas
• The lesion with the highest probability of thrombocytopenia among benign liver diseases  Hemangioma
• Liver lesion with the highest risk of rupture and intra-abdominal bleeding  Adenoma
• Benign liver tumor in which oral contraceptive use plays a role in its etiopathogenesis  Adenoma
• Right upper quadrant pain, using oral contraceptives for 8 years, had no pathology in her physical examination, and
had a well-circumscribed, heterogeneous, early-enhancing mass lesion in the liver in the abdominal computed
tomography  hepatocellular adenoma
• Benign liver lesion in a pregnant patient with a higher risk of spontaneous rupture and bleeding  Adenoma
• The patient who presented with right upper quadrant pain. He has been using oral contraceptives for about 7-8
years, but has stopped for the last 1 year, no pathology was found in his physical examination, his laboratory
examinations were normal, multiple nodules were detected in the liver in abdominal ultrasonography and dynamic
contrast magnetic resonance imaging was performed for differential diagnosis, the smallest one was 7 cm in the
liver. and the most appropriate treatment option for a patient with multiple masses that have spread to both lobes,
biopsy of two of these masses as adenoma, and no other pathology  Liver transplantation
• Fainted with sudden-onset right upper quadrant pain, brought to the emergency room, had no previous health
problems and had been taking oral contraceptives for the last 5Y, had tachycardia and hypotension in her physical
examination, and widespread abdominal tenderness, more prominent in the right upper quadrant, in laboratory
examinations. Most likely diagnosis in a patient with a hemoglobin value of 6 g/dL  Rupture of liver adenoma
• Benign liver tumor with characteristic central fibrous scar on CT & macroscopic exam  Focal nodular hyperplasia
• Causes of hepatocellular carcinoma 
o Alcoholic cirrhosis,
o hepatitis B infection,
o hemochromatosis,
o alpha-1 antitrypsin deficiency
• The most probable diagnosis in a male patient whose serum alpha feto protein level was found to be 450 mg/ml 
Primary liver cancer
• The one with the highest risk of developing liver carcinoma  Cirrhosis
• Major risk factors for hepatocellular carcinoma 
o Hepatitis B infection,
o Non-alcoholic Steatohepatitis,
o Aflatoxin,
o Hemochromatosis
• Clinical and laboratory criteria used in the Child-Pugh Scoring system used in the evaluation of chronic liver
patients  Presence of Encephalopathy, ascites, Serum bilirubin level, Serum albumin level, INR
• Indications suitable for transplantation in the treatment of hepatocellular cancer 
o Single tumor focus < 5 cm,
o maximum 3 tumor foci < 3 cm,
o total tumor diameters < 9 cm,
o no portal vein invasion,
o no extrahepatic spread,
• Abdominal swelling, weight loss, weakness and occasional clouding of consciousness, it was learned that he had
been diagnosed with hepatitis B infection 30Y ago, but he never used his medications, a large amount of free fluid
was detected in the abdomen on MRI, the liver shrunk, the surface of the liver was reduced, nodular and had a 4 cm
mass in the left lobe with very good blood flow in the arterial phase and lost its contrast in the venous phase.
Most effective treatment for this patient  Liver transplantation
 • Regarding hepatocellular cancer 
o Determining the stage of liver disease is vital when planning the treatment.
o It is the most common primary malignant disease of the liver.
o It is significantly more common in men.
o Cirrhosis accompanies 60% of the cases.
• Features of fibrolamellar hepatocellular cancer (variant with standard hepatocellular cancer) 
o More common in young people.
o AFP elevation in is lower than in the standard type.
o The rate of resection in standard hepatocellular cancer is lower than in the fibrolamellar type.
o Hepatitis B positivity is less than in the standard type.
o Occurs at similar rates in men and women.
• It is the most suitable treatment for solitary liver carcinoma with intestinal adenocarcinoma  Evaluating the
resectability and excising the mass
• Carcinoma with improved prognosis after partial lobectomy in liver metastasis  Colorectal carcinoma
• The type of cancer in which metastasectomy is most beneficial in metastatic liver cancers  Colorectal cancer
27. PORTAL HYPERTENSION AND SURGERY
• Structures that form the portal vein as a result of their union  Superior mesenteric vein - splenic vein
• Hepatofugal collateral circulation 
o Esophageal varices,
o retroperitoneal varices,
o paraumbilical varices,
o rectal varices,
o anastomoses around the spleen
• Regarding splenic venous hypertension 
o Blood returns to the portal system via the coronary vein.
o Varicose veins occur in the gastric fundus.
o Isolated splenic vein thrombosis is the most common etiologic cause.
o Collaterals develop between the spleen and the fundus of the stomach.
o Congenital and acquired thrombophilia are causes of splenic venous hypertension.
• Presinusoidal intrahepatic obstruction leading to portal hypertension  Schistosomiasis
• Postsinusoidal intrahepatic causes of portal hypertension  Veno-occlusive diseases
• Causes of post-hepatic portal hypertension  Vein of the inferior vena cava, congestive heart failure, constrictive
pericarditis, Budd-chiari syndrome (hepatic vein thrombosis)
• Postsinusoidal extrahepatic type portal hypertension is caused by  Constrictive pericarditis
• The most likely cause of GIT bleeding in a patient who was followed up with a diagnosis of liver failure due to
chronic viral hepatitis, had sudden nausea and vomiting with copious amounts of blood, and had splenomegaly
and a pulse of 12O/min on physical examination  Portal hypertension
• To determine location of bleeding in previous patient  Esophagogastroduodenoscopy is the most useful method.
• Name of the special balloon tube used to stop bleeding in severe esophageal bleeding  Sengstaken-Blakemore
• Use of vasopressin is contraindicated in bleeding from esophageal varices in  Coronary ischemia
• Drug used to reduce splanchnic pressure in bleeding from esophageal varices  vasopressin
• Its level is most useful in relation to the depth of coma and prognosis in hepatic coma  Ammonia
• Possible pathologies in a patient with chronic liver failure who was brought to the emergency room with confusion
and loss of cooperation  Gastroenteritis, GIT bleeding, use of diuretics, constipation
 • HBsAg positive, liver cirrhosis, hospitalized for the purpose of reducing acid and edema in the abdomen, diuretic
therapy was started, but daily urine flow decreased to 400 ml/24 hours while the treatment continued, BUN 100
mg/dl, creatinine 2.6 mg/dl The most likely diagnosis in a patient whose urine sodium falls below 5 mEq/24 hours
 Hepatorenal syndrome
• The portocaval shunt type with the least hepatic encephalopathy  Distal splenorenal shunt
• Situations where peritoneovenous shunt is beneficial in the treatment of ascites 
o Cirrhosis,
o hypoproteinemia,
o cancer-related ascites,
o Meigs syndrome
• A patient free of liver disease, whose history was learned to have been hospitalized for biliary pancreatitis 4 times
in the last 10 years, was hospitalized again with the diagnosis of necrotizing pancreatitis, developed hematemesis
and melena during treatment, was found to be bleeding from fundus varices in gastroscopy and bleeding was
stopped endoscopically. most likely diagnosis for the patient  Splenic vein thrombosis
28. GALLBLADDER-BILEWAYS DISEASES AND SURGERY
• Arteries from which the cystic artery may originate 
o Main hepatic artery,
o left hepatic artery,
o superior mesenteric artery,
o gastroduodenal artery
• The first examination to be requested in a patient with cholestasis  ultrasonography
• 1st diagnostic procedure for a patient with right upper quadrant pain and nausea-vomiting  Abdominal US
• The first examination to be requested in obstructive jaundice  Upper abdominal US
• The first and most sensitive radiological examination for the diagnosis of cholelithiasis.  Ultrasonography
• Situation in which the use of percutaneous transhepatic cholangiography is not appropriate  bleeding diathesis
• Diseases that can be diagnosed by percutaneous transhepatic cholangiography 
o Choledochal stone,
o common bile duct tumor,
o pancreatic head tumor,
o biliary tract stricture
• Performed for diagnostic purposes in a patient with coagulopathy and jaundice, and dilated intrahepatic and
extrahepatic bile ducts  Endoscopic retrograde cholangiopancreaticography (ERCP)
• ERCP indications 
o Palliative treatment of bile fistulas,
o hydatid cysts in the bile ducts,
o choledochal stones,
o biliary tract tumors
• Diagnostic method used to evaluate the physiological secretion of bile in liver and biliary tract diseases  Hepatic
iminodiacetic acid (HIDA) scintigraphy
• Causes of intrahepatic jaundice  Toxic drugs, chronic active hepatitis, pregnancy, primary biliary cirrhosis
• Conditions with jaundice  Subphrenic abscess, acute pancreatitis, anesthetic toxicity, bile leakage into the
peritoneal cavity
• Conditions seen in the early period in biliary obstruction  Pain, increased alkaline phosphatase, jaundice, itching
• The most common cause of secondary biliary cirrhosis  Bile duct stenosis
• Predisposing factors for gallstone development  Gastric surgery, Terminal ileum resection, Obesity, Pregnancy,
Female gender
• Conditions in which surgical treatment is applied in asymptomatic gallbladder stones
o In the presence of diabetes mellitus,
o calcified gallbladder,
o when stone larger than 2 cm,
o in non-functional gallbladder
o high risk of gallbladder cancer,
o diabetic neuropathy,
o patients undergoing heart transplantation,
o porcelain gallbladder (inner gallbladder wall is encrusted with calcium)
• The most common infection causing bacteria after cholecystectomy surgery  Escherichia coli
• Abdominal pain, nausea and vomiting that started the day before, gradually worsening and predominantly
spreading to the right scapula, WBCs 15 000/mm3, serum glucose level 197 mg/dl, serum amylase level 300 U/L,
lactate dehydrogenase 312 U/L and an AST level of 350 U/L The most probable diagnosis  Acute cholecystitis
• Findings supporting the diagnosis of acute cholecystitis in bile duct US  Gallbladder wall thickening and fluid
collection in the pericholecystic area
• Syndrome in which a stone located in the infundibulum of the gallbladder causes obstructive jaundice due to
common hepatic duct obstruction as a result of severe pericholecystic inflammation  Mirizzi syndrome
• Regarding acute acalculous cholecystitis 
o The rate of complication development is higher than stony cholecystitis.
o It constitutes 5-10% of acute cholecystitis.
o It is usually observed in elderly and debilitated patients.
o US is generally used for diagnosis.
o Where the diagnosis is in doubt, percutaneous cholecystostomy has diagnostic and therapeutic value.
• The disease that should be considered first in a patient who is intubated in the intensive care unit due to burns,
has been fed parenterally for 15 days, has a fever, and a laboratory examination reveals elevated leukocytosis,
alkaline phosphatase and bilirubin  Acalculous cholecystitis
• In a patient with air-fluid levels and small air foci in the gallbladder and wall on abdominal CT  The most likely
diagnosis is emphysematous cholecystitis
• Diabetic and mildly overweight, who applied with the complaint of pain in the right upper quadrant for about 2
days, symptoms such as nausea, loss of appetite, fatigue, tenderness, defense and rebound findings, who said that
they had similar but much milder complaints before, The most likely diagnosis for a patient with 21.000/mm3, AST
110 IU, ALT 200 IU, serum alkaline phosphatase and amylase levels slightly elevated, and serum total bilirubin
level 3 mg/dL  Gangrenous cholecystitis
• In acute cholecystitis, it is preferred to perform early cholecystectomy to reduce mortality  diabetes mellitus
• If pneumobilia is seen in a patient who has not previously had biliary tract surgery, the most likely diagnosis to be
considered  Bilioenteric fistulas
• The most probable diagnosis in a patient with nausea and vomiting, mechanical intestinal obstruction, air-fluid
level on direct abdominal X-ray and air in the gallbladder  Gallstone ileus
• Intestinal part most frequently associated with bilioenteric fistulas caused by gallstones  duodenum
• The most common site of intestinal obstruction in gallstone ileus  Terminal ileum
• A patient who presented with the complaints of abdominal pain, distension and difficulty in removing gas and
stool, whose history revealed that a 2.5 cm stone was detected in the gallbladder five years ago, but that he had
not undergone any surgery, and no gallbladder stone could be detected in his US  Gallstone ileus
• In cholangitis secondary to benign causes, the most common pathogen detected in bile  Escherichia coli
• Regarding choledocholithiasis 
 o Its incidence increases with age.
o Most of the stones are formed in the gallbladder and pass-through cystic duct into the common bile duct.
o Definition of 2ry bile duct stones is used for stones that pass from the gallbladder to the biliary tract.
o Primary bile duct stones are usually brown pigment stones.
o Many biliary stones are clinically silent and are recognized during cholangiography.
o After cholecystectomy, 1-2% of patients experience problems due to stones in the biliary tract.
o Choledochal stones can be asymptomatic or cause obstructive jaundice.
o Sphincterotomy can be performed to pass the common choledochal stones into the duodenum.
o May cause cholangitis.
• Conditions leading to acute cholangitis  Bile duct obstruction and Bacteribilia
• The most probable diagnosis in a patient who had cholecystectomy 2 years ago, admitted to the emergency room
with 39°C fever, jaundice, chills and abdominal pain, and laboratory examination found leukocyte 15000/mm3,
amylase 95 IU/L, alkaline phosphatase 350 IU/L  acute cholangitis
• Sudden onset of jaundice, high fever and biliary colic is seen  Acute suppurative cholangitis
• Disease with Charcot triad (jaundice; fever, and right upper quadrant abdominal pain) Acute cholangitis
• Related to cholangitis 
o It most often develops secondary to benign obstructions.
o Presence of bilioenteric anastomosis is a risk factor for cholangitis.
o The most frequently isolated bacteria in culture is Escherichia coli.
o Endoscopic biliary decompression is one of the basic applications in the treatment.
o Blockage in the bile ducts alone is not enough to cause this condition.
• Emergency (within 24-72 hours) cholecystectomy indications  Gallbladder perforation, emphysematous
cholecystitis, gallbladder empyema, gangrenous cholecystitis
• The most common postoperative complication after bile duct surgery  Subhepatic collection
• Regarding laparoscopic cholecystectomy 
o The risk of bile duct injury is higher.
o It can be done in acute cholecystitis.
o It is the first choice in symptomatic cholelithiasis.
o Labor loss is less.
o The risk of postoperative ileus is lower.
• The most common factor that can cause bile duct strictures  Iatrogenic injuries
• Regarding Caroli's disease 
o It is a disease characterized by cystic dilatation of the intrahepatic biliary tract.
o If it cannot be controlled following diagnosis, liver transplantation can be performed.
o The disease may be accompanied by cystic kidney pathologies.
o Patients often have cholangitis and stones in the biliary tract.
o Cholangiocarcinoma is a serious complication.
• Operations causing benign bile duct strictures  Laparoscopic cholecystectomy, open cholecystectomy, liver
transplantation, hepaticojejunostomy
• The most common type of choledochal cyst, (fusiform or cystic dilatation of the extrahepatic bile ducts)  Type I
• Indications for choledochotomy 
o Thickening and enlargement of the common bile duct,
o presence of many stones in the gallbladder and enlargement of the ductus cysticus,
o palpation of stones or masses in the common bile duct,
o presence of intermittent jaundice in the patient's history
• Regarding gallbladder cancers 
o Porcelain gallbladder is a risk factor for the development of cancer.
 o When there are gallstones, especially large gallstones can lead to gallbladder cancer.
o Adenocarcinoma is the most common histological type.
o In cases incidentally diagnosed, regional lymph node involvement is not detected
o Survival in T4 tumors is 5%
• Palpation of the gallbladder due to bile buildup in a patient with obstructive jaundice due to tumoral cause in the
distal part of the main bile duct  Courvoisier's sign
• Preferred diagnostic method in diagnosis of Klatskin tumor (hepatic bifurcation tumor)  Percutaneous
cholangiography
• Yellowing in his eyes, darkening of the urine color, weight loss and weakness, was diagnosed with cholangitis,
known to have ulcerative colitis but did not come to regular follow-ups, and 1 mass with a diameter of 6 cm in the
right lobe of the liver was detected in MRI  Cholangiocellular carcinoma
• The first examination to be performed in sclerosing cholangitis  US
• If jaundice, melena & colic-like pain are present 2 weeks after blunt trauma to the upper abdomen  Hemobilia
• the most reliable examination to be requested in previous patient is  Arteriograph
• About the etiology and treatment of hemobilia 
o While abdominal trauma was the most common cause until the last 20-30 years, iatrogenic traumas
constitute the majority in the recent period.
o If the bleeding is in the gallbladder, cholecystectomy is required.
o Most minor bleeding stops with adequate biliary drainage and correction of coagulopathy
o Transarterial embolization is the first choice for major bleeding.
o If bleeding is due to percutaneous interventions, emergency surgery is not required.
• Hospitalized because of obstructive jaundice, stones detected in the extrahepatic bile ducts, therapeutic ERCP
failed, many stones were removed from the biliary tract by percutaneous transhepatic cholangiography, direct
bilirubin level was elevated in the follow-up, pre-existing right upper quadrant pain was exacerbated, and melena
was diagnosed.  hemobilia
29. DISEASES OF THE PANCREAS and SURGERY
• Regarding pancreatic duct variations 
o Pancreas divisum is an embryological fusion anomaly that can be seen in 10% of normal population.
o The ventral bud canal forms  Wirsung canal, and dorsal bud canal forms  Santorini canal.
o The main pancreatic duct is usually 2-3 mm in diameter.
o The Santorini canal opens approximately 60% into the minor papilla.
o Intestinal rotation is necessary in embryological life for the fusion of both ducts.
• Examinations primarily considered in diagnosis of acute pancreatitis  Ca, lipase, amylase, plain abdominal X-ray
• Its increase is more important than others in the diagnosis of acute pancreatitis  Lipase
• The most common cause of acute pancreatitis in our country  Gallstones
• Causes of acute pancreatitis  Gallstones, alcohol, hyperlipidemia, trauma
• Aetiology of acute pancreatitis  Alcoholism, hypercalcemia, hyperlipidemia, trauma
• Abdominal pain, nausea and vomiting after a scorpion sting, and widespread abdominal tenderness in physical
examination  Acute pancreatitis
• Disease seen with Gray Turner (ecchymosis or discoloration of the flanks)  Acute hemorrhagic pancreatitis
• Factor affecting prognosis in acute pancreatitis  Hypocalcemia
• Ranson criteria in acute pancreatitis  Over 55 years old, Leukocyte over 16000/mm3, glucose above 200mg/dL,
S60T250 IU/dl above, LDH over 35OIU/dl
• Which of the Ranson criteria is checked at the time of first application  Glucose > 200 mg/dl
• Factors that negatively affect the prognosis in acute pancreatitis 
o Blood glucose level of 250 at first admission,
o Ca+ < 7 mg,
o PO2 partial pressure below 55 mmHg,
o leukocytosis above 20.000/mm3
• After a heavy meal, the patient complains of epigastric pain that starts suddenly and radiates to the back, and has
nausea and vomiting. In the physical examination, mild fever, epigastric tenderness and decreased bowel sounds
were detected, localized dilatation in the upper duodenum and a small amount of fluid in the left pleural cavity
were observed in the abdominal X-ray. The first things to consider for diagnosis and prognosis in a patient with
multiple gallbladder stones on USG  LDH, amylase, leukocyte, glucose, AST
• Ranson criteria, used in the first admission to determine the prognosis of acute pancreatitis 
o Age > 55,
o Glucose > 200 mg/dL,
o Leukocyte > 16 000/mm3,
o Lactate dehydrogenase > 350 IU/L
• A radiological examination that should be requested for diagnosis in a patient hospitalized with the diagnosis of
acute pancreatitis, with a mass in the epigastrium and 100 U in blood amylase in the urine, 500 U in the
examination performed 3 weeks later  Ultrasonography
• What to be considered in case of elevated amylase 2 weeks after acute pancreatitis  Pseudocyst
• After a heavy meal, the patient complains of stomach-pigastric pain that starts suddenly and radiates to the back,
and has nausea and vomiting. In the physical examination, mild fever, epigastric tenderness and decreased bowel
sounds were detected. The most probable diagnosis in a patient with a localized smooth-surfaced 10 cm diameter
mass in the epigastrium after 4 weeks  Pancreatic pseudocyst
• Spontaneous regression probability is higher in pancreatic pseudocyst  Pseudocyst < 4 cm, unrelated to the duct
• Conditions useful in distinguishing pancreatic pseudocysts from serous cystic neoplasms of the pancreas 
o Patient's history,
o amylase level of cyst content,
o endoscopic retrograde cholangiopancreatography,
o computed tomography
• The most probable diagnosis in a patient with acute pancreatitis developing 3 weeks ago, with a rapid course of
abdominal upper quadrant pain, fever, leukocytosis, and a palpable mass localized to the left side of the
epigastrium  Abscessing pseudocyst
• The most common complication of acute pancreatitis  Pseudocyst formation
• Systemic complications of acute pancreatitis  Respiratory failure, acute renal failure, sepsis, hypovolemic shock
• The complication of acute pancreatitis with the highest mortality rate  Infected pancreatic necrosis
• The organ with the highest HCO3 loss in fistula  Pancreas
• Useful factors in determining the severity of acute pancreatitis  C-reactive protein and Interleukin-6
• Used in treatment of acute pancreatitis  Dolantin, peritoneal dialysis, nasogastric administration, aprotinin
• What should not be done in the treatment of mild acute pancreatitis  Prophylactic antibiotic treatment
• The most appropriate approach for a patient who has been followed up with acute pancreatitis for 4 weeks,
diagnosed with infected pancreatic necrosis, whose general condition is observed to deteriorate gradually, and
collections are found in the area of necrosis  Retroperitoneal drainage catheter placement
• Those with chronic alcohol use, who applied to the emergency department with the complaint of abdominal pain
that hit the back, were followed up with medical treatment in the emergency room for 3 days, and were admitted
to the emergency room again with complaints of abdominal pain, early satiety, nausea, weight loss and bloating 3
months after discharge. The most probable diagnosis for a patient with cyst appearance on computed tomography
 Pancreatic pseudocyst
• A condition that requires surgical treatment in the early period  Gallstone pancreatitis
• Used in a mild acute pancreatitis without comorbidities  Fluid resuscitation, pain control, CRP monitoring,
nutritional support
• The most common cause in the etiology of chronic pancreatitis  Alcohol
• Indirect tests used to evaluate pancreatic exocrine secretion 
o Schilling test,
o bentiromide test,
o fecal fat measurement,
o fecal elastase measurement (unanswered; answer: bicarbonate measurement from duodenum)
• Cause of pain in chronic pancreatitis 
o Increased pancreatic ductal pressure,
o intrapancreatic nerve inflammation,
o pancreatic ischemia,
o pseudocyst
• Indications for surgery in chronic pancreatitis 
o Suspicion of pancreatic carcinoma,
o portal hypertension,
o bile duct obstruction,
o presence of pseudocyst
• Indications for surgical treatment alone in chronic pancreatitis 
o Pain causing narcotic habit,
o portal vein obstruction causing portal hypertension,
o pseudocyst,
o choledochal obstruction
o suspicion of pancreatic cancer,
o duodenal obstruction,
• Tumor suppressor genes and oncogenes involved in the development of pancreatic adenocarcinoma  BRCA2,
p53, KRAS, PDX1, DPC4
• Periampullary region cancers with the worst prognosis  Pancreatic adenocarcinoma
• Intermittent jaundice and epigastric pain, and a positive fecal occult blood test  Cancer of the Ampulla Vater
• Painless jaundice and a palpable mass in the right hypochondrium  Carcinoma of the head of the pancreas
• Without fever rising with shivering; The most likely diagnosis in a patient with jaundice and hydrops gallbladder 
Periampullary tumor
• Condition with Courvoisier-Terrier sign (jaundice & enlarged gallbladder but is not painful) Pancreatic carcinoma
• Elderly patient has jaundice & palpable gallbladder, the most likely diagnosis is  Cancer of the pancreatic head
• The most probable diagnosis in a patient with weight loss, jaundice, faecal discoloration, and pain in the right
hypochondriacal region  Cancer of the pancreatic head
• Jaundice and abdominal pain, a tight and painless gallbladder is palpable in the right upper quadrant on physical
examination, a total bilirubin level of 6 g/dl and a direct bilirubin level of 4 g/dl in blood biochemistry, the first
examination will be requested  Ultrasonography
• The most probable diagnosis for a patient who presented with the complaints of jaundice and low back pain lasting
for 10 days, gradually increasing, gallbladder palpable on physical examination, and acholic stool detected on rectal
examination  Carcinoma of the head of the pancreas.
• Regarding the patients who are thought to have periampullary region tumors 
o The level of CA19-9 may support the diagnosis.
o It is not obligatory to confirm the pathological diagnosis by biopsy before surgery.
 o Endoscopic ultrasonography is a valuable method in deciding operability.
o Biliary stenting may be required in some patients before surgery
o Pancreaticoduodenectomy can be applied in the treatment.
• The most common morbidity after pancreaticoduodenectomy surgery  Delayed gastric emptying
• The most probable contraindication to surgery in a 70-year-old male patient who presented to the emergency
department with complaints of abdominal pain, weight loss, and weakness, had a history of diabetes diagnosis 3
months ago, had ascites and a mass of 6 cm in diameter surrounding the splenic vein in the tail section of the
pancreas in computerized abdominal tomography.  the presence of acid
• Hormone released from D cells in the pancreas  Somatostatin
• The most common islet cell tumor of the pancreas  Insulinoma
• Hypoglycemia developing with fasting glucose of 40mg/dL is also the most likely diagnosis in a patient who has
symptoms related to hypoglycemia and whose symptoms go away after eating  Insulinoma
• The most likely diagnosis in a very obese, 55-year-old male patient who developed weakness, sweating,
palpitations, confusion, and headache after a few hours of hunger, and these complaints disappeared after eating
 Hyperinsulinemia
• The most useful test for differential diagnosis in a patient with normal blood pressure and pulse rate, who was
brought to the hospital due to loss of consciousness following behavioral changes, and whose blood sugar level was
measured as 40 mg/dL  Insulin/Glucose ratio
• Related to insulinoma 
o 90% are solitary. 9% are benign.
o The ratio of their presence in the head, body and tail of the pancreas is approximately the same.
o 10% of patients have multiple endocrine neoplasia type 1.
o More than 90% of cases can be localized radiologically
• The most likely preliminary diagnosis for a patient who was admitted due to personality change, recurrent episodes
of anxiety, confusion, and loss of consciousness, and whose blood glucose level was measured as 40mg/dl in
laboratory examinations, was observed to disappear when glucose was administered  Insulinoma
• The most likely diagnosis for a patient who was brought to the emergency room due to fainting and
unconsciousness, and whose history was learned that he woke up frequently at night with a feeling of hunger, felt
faint during the day, and that these complaints resolved after eating some sweets  Insulinoma
• Which of the following examinations should be performed in the diagnosis process of a patient who was brought to
the emergency room due to confusion and agitation, whose relatives stated that he had experienced this situation
several times before, and that he had not been fed for about 10 hours, and whose symptoms improved when 10%
dextrose was given  Blood glucose measurement, C- peptide level checking, CT, Endoscopic US
• The most appropriate method for the diagnosis of gastrinoma in a patient followed up with a diagnosis of marginal
ulcer and a fasting blood gastrin level of 350 pg/mL  Secretin provocation test
• Gastrinoma findings 
o Diarrhea,
o treatment-resistant ulcers,
o MEN 1 syndrome,
o gastroesophageal reflux,
o atypical localized ulcer
• Diagnosis that should be considered first if ulcers are detected in the 2nd and 3rd parts of the duodenum in the
upper gastrointestinal endoscopy performed on a patient who has undergone gastric ulcer surgery before 
Gastrinoma
• The most probable diagnosis for a patient with diarrhea and severe dyspeptic complaints, who had been on
antiulcer therapy for about a year without any further investigation, who applied because his complaints never
 decreased, and whose upper gastrointestinal endoscopic examination showed multiple ulcers in both the proximal
and distal duodenum  Zollinger Ellisen syndrome
• The hormone secreted excessively in Zollinger-Ellison syndrome  Gastrin
• The most probable diagnosis in a patient with high blood sugar, necrolytic migratory thrombophlebitis, thinning hair
and diarrhea  Glucagonoma
• Endocrine pancreatic tumor with necrolytic migratory erythema  Glucagonoma
• Neuroendocrine tumor with severe diarrhea, severe hypokalemia and hypochlorhydria, also known as Verner -
Morrison syndrome  VIPoma
• Pancreatic endocrine tumor characterized by steatorrhea, diabetes mellitus and gallbladder stones 
Somatostatinoma
• The most likely diagnosis for a patient who presented with the complaint of excessive fatty stool, was diagnosed
with diabetes, and had undergone laparoscopic cholecystectomy for gallstones 6 months ago  somatostatinoma
30. MESENTERIC VASCULAR DISEASES AND SURGERY
• Severe abdominal pain, history of atrial fibrillation, a hemodynamically stable patient with abdominal tenderness,
guarding & rebound, and a leukocyte count of 20,000/mm  acute mesenteric ischemia
• For A. mesenterica inferior obstruction 
o Pain usually develops suddenly.
o Leukocytosis is seen.
o It can cause bleeding and constipation.
o Sigmoidoscopy - colonoscopy can be done to see mucosal lesions.
o Angiography can be done for definitive diagnosis.
• If there is also an epigastric murmur in a patient who has pain in the epigastric region after eating for about 4
years, and whose abdominal US has normal kidneys, common bile ducts and gall bladder, the most likely diagnosis
is  Mesenteric ischemia-intestinal angina
• For a patient who had coronary by-pass surgery two years ago, drank alcohol occasionally, was found to have pain
around the navel, especially after meals, avoided eating due to these pains, had weight loss and diarrhea
complaints, and had normal physical examination findings. possible diagnosis  Mesenteric ischemia
• Diseases considered primarily as a cause of non-occlusive mesenteric ischemia 
o Congestive heart failure,
o Hypotension, hypovolemia & Shock
o use of digoxin,
o Administration of vasopressor agents
o myocardial infarction,
• Most effective imaging modality for small vessel spasms in nonocclusive mesenteric ischemia  angiography
• Elderly patient with severe abdominal pain, a history of atrial fibrillation, abdominal tenderness, guarding and
rebound, WBCs 18,000/mm3  Acute mesenteric ischemia (embolism is the most common cause)
• Epigastric pain after a meal also has an epigastric murmur  Mesenteric ischemia- intestinal angina
• 80Y patient with atrial fibrillation presents with severe abdominal pain. On examination, abdominal tenderness,
guarding and rebound are detected. WBCs 2OOOO/mm3. Possible diagnosis  Acute mesenteric ischemia
• Most effective imaging showing small vessel spasms in nonocclusive mesenteric ischemia  angiography
• Most useful method in demonstrating mesenteric venous thrombus  Contrast-enhanced CT
• The most important factor increasing the probability of rupture of aneurysm in a 63-year-old patient followed up
with the diagnosis of abdominal aortic aneurysm  Diastolic hypertension
• The most common aneurysm  Abdominal aortic aneurysm
 • not one of the complications of DVT  Cerebrovascular embolism
• From femoral artery aneurysms  Mycotic aneurysms may develop due to graft infection or in IV drug users.
31. SPLEEN DISEASES AND SURGERY
• The most common location for accessory spleen is  hilum of spleen and adjacent to the tail of the pancreas.
• The most reliable test to clarify the underlying problem in a patient underwent splenectomy due to ITP and whose
thrombocyte levels decreased again after 3 months  Technetium-99m sulfur colloid scintigraphy
• Disease not producing gallstones while benefiting from splenectomy  immune thrombocytopenic purpura
• Diseases with indications for splenectomy for treatment 
o Lienalis aneurysm of the artery,
o congenital hemolytic anemia, thalassemia major,
o primary hypersplenism,
o thrombocytopenic hemorrhagic purpura
o Immune thrombocytopenic purpura,
o splenic vein thrombus causing gastric varices
• Disease in which splenectomy is done for symptomatic splenomegaly rather than the treatment of the disease 
Myelofibrosis (agnogenic myeloid metaplasia)
• Disease without indication for splenectomy  G6PD
• Disease in which splenectomy provides the highest clinical improvement  Hereditary spherocytosis
• The most common indication for splenectomy  Trauma
• Biological substances removed from the circulation by the spleen in healthy people 
o Heinz bodies,
o Spherocytes,
o Pappenheimer bodies,
o Howell-Jolly bodies
• Conditions seen in a patient with portal vein thrombosis after splenectomy  Thrombocytosis, anorexia,
abdominal pain, leukocytosis
• The disease in which spontaneous rupture of the spleen is most common 
o Malaria, (most common) o Q fever Lymphoma,
o infectious mononucleosis (most common) o angiosarcoma,
o Cytomegalovirus, o amyloidosis,
o Listeria, o pregnancy
• the most common non-lymphoid primary malignant tumor of the spleen  Angiosarcoma
• Regarding true spleen cysts. 
o It is often asymptomatic.
o It can be palpated as an abdominal mass.
o Ultrasonography can be done for treatment planning.
o It may cause symptoms in the left kidney due to compression.
o May cause left shoulder pain.
• The causative agent of frequent and serious infection in a splenectomy patient  Streptococcus pneumoniae
• To protect a 42Y patient against infection after splenectomy  Give triple vaccination (H. influenza type B,
meningococcal serogroup C, polyvalent pneumococcal) before splenectomy or immediately after in emergency
surgery
• The most common early complication of open splenectomy surgery  Left lower lobe atelectasis
• It is related to late post-splenectomy sepsis in patients with splenectomy 
o The disease progresses rapidly and may cause death within a few hours.
 o Mortality of postsplenectomy sepsis is higher in children under 5 years of age.
o Incidence is higher in patients who underwent splenectomy for hematological disease rather than trauma.
o Capnocytophaga canimorsus, transmitted by dog bite, is one of the causes of postsplenectomy sepsis.
o Fever, fatigue, myalgia, headache in a patient with splenectomy should suggest postsplenectomy sepsis.
32. ABDOMINAL WALL, PERITONE, RETROPERITON AND MESENTERIC DISEASES AND SURGERY
• Regarding primary peritonitis 
o Microorganism can reach peritoneum from distant focus by hematogenous route or by direct inoculation.
o Often a single microorganism is responsible.
o Its treatment is usually medical.
o In paracentesis, the number of WBCs should be above 100/mm3.
• The most common cause of primary peritonitis  Liver cirrhosis
• Diseases causing secondary peritonitis  Peptic ulcer perforation, intussusception, volvulus, appendix perforation
• Disease that is most likely to be seen in the presence or absence of normal bowel sounds  Generalized peritonitis
• The most common bacteria isolated in 2ry peritonitis  Escherichia coli
• The most common location of intraperitoneal abscesses in the upper abdomen  left subdiaphragmatic
• The cause of peritonitis with the highest mortality rate  Nontraumatic small bowel perforation
• Localization where intraperitoneal abscesses are least seen  Bursa omentalis
• Hypochondrium and right shoulder pain after cholecystectomy, right diaphragmatic elevation on chest X-ray, and
right basal fluid.  subhepatic abscess
• The most common cause of retroperitoneal abscess  kidney diseases
• Conditions leading to retroperitoneal infection or abscess development 
o Retrocecal appendicitis,
o diverticulitis,
o iatrogenic perforation during ERCP,
o infected necrotizing pancreatitis
• Abdominal pain, slight darkening of urine color, decreased urine volume, without any known disease, with
thickening of the intestinal mesentery on abdominal CT scan, minimal dilatation of intestinal segments, bilateral
hydronephrosis, and fibrous plaque around the aorta.  Ormond's disease (idiopathic retroperitoneal fibrosis)
• Treatment in intra-abdominal abscesses  Fluid resuscitation, Source control, Appropriate antibiotics, Drainage
• Most important method treatment in intra-abdominal infections secondary to colon perforation  Source control
• The most appropriate treatment in a patient who presents with hypochondrium and right shoulder pain after
cholecystectomy, right diaphragmatic elevation on chest X-ray, and right basal fluid  US guided drainage
• Isolated bacteria from abscess that develops after a pathology originating from the colon  Bacteroides fragilis
• The causative agent of abscess in patient had appendectomy for perforated appendicitis  Bacteroides fragilis
• Antibiotic that can be used alone in the treatment of 2ry peritonitis after perforated appendicitis  Cefoxitin
• After laparoscopic cholecystectomy 5 days ago due to chronic calculous cholecystitis, who was discharged two days
later, who developed right upper quadrant pain, swelling and 38.5°C fever on the 5th day, the leukocyte count was
found to be 12.000/mm3. method  Ultrasonography
• Mesenteric cysts unlike omental syst can only be moved horizontally but not vertically  Tillaux sign
• The most common solid tumor of the omentum  Metastatic carcinoma
• Patient using warfarin for heart valve surgery, presented with abdominal pain that started after severe coughing,
whose vital signs were within normal limits, and a mass that did not change with contraction of the rectus muscle
on abdominal examination and did not exceed the midline was palpated  Fothergill (rectus sheath hematoma)
 • Sudden swelling & pain in abdominal wall, had mitral valve replacement and receiving anticoagulant, a rectus
sheath hematoma was detected in CT, an INR value of 6, and his vital signs were unstable, the first step should be
followed.  Transfusion of fresh frozen plasma, fluid and, if necessary, blood

33. ABDOMINAL WALL HERNIAS AND SURGERY

 The structure strengthened by repair in direct inguinal hernia repair  Fascia transversalis
 Muscle from which the ligamentum inguinale is formed from the aponeurosis  External oblique
 Anatomically separating indirect inguinal hernia and direct inguinal hernia  inferior epigastric artery
 Anatomical formation and pathological condition matching 
o Inguinal ligament - Inguinal hernia,
o Cooper's Ligament - Femoral hernia,
o Arcuate ligament - Spiegel hernia,
o Linea semilunaris - Spiegel hernia
 Those found in "pain triangle" of the inguinal region  Gonadal vessels, femoral nerve, femoral branch of
genitofemoral nerve, deep circumflex iliac artery and vein
 When to perform surgery on a child with an inguinal hernia  immediately when optimal conditions are met.
 Regarding the clinical features of abdominal wall hernias 
o Indirect inguinal hernias give symptoms more frequently than direct inguinal hernias.
o Most of them are indirect inguinal hernias.
o Indirect inguinal hernia is the most common subtype of inguinal hernia in men and women.
o Indirect inguinal hernia is more common in men than women.
o Femoral hernias are more common in women than men.
o Femoral hernias have a higher risk of strangulation than other inguinal hernias.
o Indirect hernias and femoral hernias are more common on the right side.
 Diseases related to hernia formation 
o Osteogenesis imperfecta,
o Ehlers-Danios syndrome,
o Marfan syndrome,
o polycystic kidney disease
 Hernia type formed by the strangulation of a part of the intestinal wall into the hernia sac  Richter's hernia
 Type of hernia occurring in the linea semilunaris  Spiegel hernia
 The case of Meckel's diverticulum in the hernia sac  liter hernia
 Inguinal hernia, in which a wall of the hernia sac is formed by the organ that enters it  Sliding hernia
 Confused with femoral hernia  Psoas abscess, inguinal hernia, Vena saphenous varices, lymphadenopathy
 Hernia type with the highest probability of developing strangulation  femoral hernia
 Types of hernia developing from linea alba  Umbilical hernia, epigastric hernia, incisional hernia
 Conditions that play a role in the pathophysiology of inguinal hernia 
o Opening of the processus vaginalis,
o collagen synthesis disorder,
o reasons that increase intra-abdominal pressure,
o low birth weight
 Advantages of using grafts in hernia repair 
o Eliminating the need for a tight hernia repair,
o less recurrence rates,
 o being able to be placed in front of, behind or between the layers of the abdominal wall,
o allowing the hernia to be repaired laparoscopically
 The most likely cause of ischemic orchitis after inguinal hernia repair in a trauma-induced man  Pampiniform
plexus (network of small veins in male spermatic cord)
 It is related to this clinical picture in a patient who presented with swelling in the anterior abdominal wall and did
not have a history of previous abdominal surgery, and on examination, the anterior abdominal wall was found to be
cambered in the midline by coughing and standing up from the supine position  It may be congenital. It is more
common in women who become pregnant at a later age. Age and obesity may be factors in its development. It can
be treated surgically. In surgical treatment, plication is applied.
 Risk factors for the development of incisional hernia 
o Infection at the incision site,
o tight closure of the fascia,
o obesity,
o use of midline incision,
o advanced age
 Related to obturator hernias 
o It is more common on the right.
o It can be bilateral.
o About 90% of patients present with intestinal obstruction.
o Hannington-Kiff sign can be seen (absent adductor reflex in the presence of patellar reflex.)
o It is more common in women.
34. SURGICAL COMPLICATIONS AND TREATMENT
 The most important pulmonary complication of the early postoperative period  Atelectasis
 First treatment method in a patient with gastric acid fluid aspiration  Emergency bronchial lavage
 a patient who was planned to be operated for stomach cancer and did not use antibiotics, had fever and mental
confusion on the 2nd day of hospitalization, had leukocytosis, had a dark secretion with cough, had infiltrates on
the chest X-ray, and had no history of hospitalization. the least pathogenic  Acinetobacter baumannii
 Comminuted femur fracture with complaints of dyspnea, tachypnea and restlessness on the 3rd day, petechiae in
the retina, supraclavicular region and neck after a while.  fat embolism
 Patient who underwent total abdominal colectomy and postoperative subclavian vein catheterization, developed
hypotension, tachycardia and tachypnea, and tension pneumothorax on the chest X-ray  Mediastinal shift??
 Conditions that increase the risk of developing pulmonary complications after surgery 
o Duration of anesthesia more than 3 hours,
o smoking history,
o malnutrition,
o heart disease,
o obesity (non-increasing diabetes)
o being over 60 years old (without risk factor: thyroid surgery)
 Patient whose PaO2/FiO ratio < 200, pulmonary artery wedge pressure < 18 mmHg, and bilateral infiltration is
detected in the chest radiograph  Acute respiratory distress syndrome should be considered first
 Condition causing hypoxemia due to ventilation / perfusion disorder  Acute respiratory distress syndrome
 For a patient using oral prednisolone at a dose of < 5 mg for long time, has no pathology in hypothalamic pituitary-
adrenal axis, is planned for minor surgery, has no active infection  preoperative steroid replacement therapy
 A situation where there is a significantly increased risk compared to others in determining the cardiovascular risk in
the perioperative period. The presence of unstable angina pectoris
 The cause of fever 24-48 hours after a clean operation  Atelectasis
 The first thing to be requested previous case  Chest X-ray
 a patient had cholecystectomy had fever in first 24 hours after surgery. HR 115/minute, tachypneic, crepitant rales
heard in the middle part of the right lung in physical examination, findings regressed with deep inspiration exercises
and mobilization, blood gas, urine and blood tests are also normal.  atelectasis
 The patient who developed intraoperative and postoperative hypertension and fever  Pheochromocytoma
 Diabetic patient, had hernia in a previous colon surgery, hernia was repaired using prostatic material (mesh), was
discharged with subcutaneous drains removed on the fourth day, and presented to the emergency department with
high fever on the 14th postoperative day.  Intraabdominal abscess
 He had an appendectomy 9 days ago due to perforated appendicitis, in clinical follow-up, body temperature was
38°C, HR 118/min, BP 90/50 mmHg, abdominal pain, bloating, vomiting and diarrhea symptoms were observed in
the right lower quadrant on physical examination. The most likely preliminary diagnosis for a patient with significant
tenderness and guarding findings, WBCs 17,000/mm3  Intraabdominal abscess
 He applied to the emergency department with the complaints of malaise, fever and abdominal pain. It was learned
that he had undergone laparoscopic appendectomy for perforated appendicitis 2 weeks ago and was discharged on
the 3rd postoperative day. On physical examination, BP 110/80 mmHg, pulse: 96/min, temp 38.3. deep palpation
sensitivity in the right lower quadrant, WBCs 24.000/mm3 in laboratory examination  Intra-abdominal abscess
 A laparoscopic cholecystectomy with the diagnosis of acute calculous cholecystitis, discharged on the 1st
postoperative day, 14 days Afterwards, he was brought to the emergency room with complaints of abdominal pain,
nausea, vomiting and fever, body temperature on physical examination: 37.6°C, pulse: 90/minute, tenderness,
defense and rebound in all quadrants of the abdomen, leukocyte count: 13.000/mm3 and serum total Bilirubin 5
mg/dL and diffuse free fluid between intestinal ounces on abdominal ultrasonography  Bile duct injury
 Common cause of postoperative hear failure in a patient with low cardiac reserve  Improper fluid replacement
 Risk factors for the development of cardiac problems in a patient who will undergo non-cardiac surgery 
o Diabetes mellitus,
o kidney failure,
o ischemic heart disease,
o general condition disorders
 Conditions that increase the risk of urinary retention after surgery 
o Anorectal surgery,
o excessive fluid administration,
o advanced age,
o spinal anesthesia
 Diseases with increasing incidence in critically ill patient in ICU for a while after cardiopulmonary bypass 
o Mesenteric ischemia,
o paralytic ileus,
o acute acalculous cholecystitis,
o acute pancreatitis
 Conditions that play a role in wound dehiscence in the early period after abdominal surgeries 
o wrong suture material selection,
o hematoma,
o infection,
o unsuitable surgical technique
 Risk factors for wound dehiscence after abdominal surgery 
o The patient has been using steroids for a long time,
o the patient has chronic renal failure,
o the patient has severe malnutrition,
o the operation performed on the patient is an emergency operation
 Most commonly used method for the indirect determination of intra-abdominal pressure  Intra-bladder
pressure measurement
 Those directly affected in abdominal compartment syndrome 
o Pulmonary functional capacity,
o intracranial pressure,
o central venous pressure,
o renal blood flow
 Abdominal compartment syndrome (ACS) expected conditions 
o Septic patients undergoing massive infusion/transfusion,
o patients with intraperitoneal/retroperitoneal bleeding,
o patients with sudden accumulation of fluid/acid in the peritoneal cavity,
o patients with intestinal edema/distension due to intestinal obstruction
 Situations involved in the informed consent process 
o Benefit/harm ratio,
o treatment methods,
o diagnostic methods,
o alternative treatment methods
 Late stoma complications 
o Parastomal hernia,
o stoma prolapse,
o intestinal obstruction,
o stoma stenosis