1. Pt c/o abdominal pain, especially in the upper right side, which worsens especially after meals. Sometimes she experiences sudden vomiting which appears "green" in color. She has a hx of gastric outlet obstruction due to peptic ulcer disease. What is the most likely diagnosis?
    This is afferent loop syndrome which occurs due to obstruction of a gastrojejunostomy (Bilroth type II).

    • Basically, this surgery connects the stomach to the proximal jejunum in cases where there is gastric outlet obstruction which could be due to an enlarged pylorous, gastric cancer, PUD, gallstone, pancreatic pseudocyst.
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    • But what can happen is that the gastrojejunostomy surgery can cause a block in the afferent loop, backing contents up into the stomach, hence the biliary vomiting, feeling full after meals, abdominal pain. ect
  2. What is blind loop syndrome?
    Bacterial overgrowth of intestine caused by stasis
  3. What is Fitz-Hugh-Curtis syndrome?
    Perihepatic gonorrhea infection (perihepatic adhesions)
  4. Which bacteria cause ever and wound infection in the first 24 hours a er surgery?
    • 1. Streptococcus
    • 2. Clostridium (bronze-brown weeping tender wound)
  5. Treatment of necrotizing fascititis?
    Triple therapy: e.g. Zosyn®, Vancomycin, Clindamycin
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