1. Cardiac workup in someone who has suspected ischemic heart disease (i.e. has peripheral arterial disease and other risk factors) in high-risk surgery
-EKG
-Persantine Thallium stress test or dobutamine stress echo (in someone who can't walk on a treadmill for the persantine thallium)
-If reversible ischemia is found, do preoperative revascularization
2. Elective surgery in a patient with liver failure
-Child's A is ok, Child's C is a no-go, Child's B could go either way
-Optimize medically before surgery: k sparing diuretics for ascites, monitor electrolyte status, treat coagulopathy with vitamin K, optimize nutritional status, make them stop drinking.
-Be wary of hemorrhoid surgery in these patients, as portal hypertension can lead to uncontrollable bleeding
2. Elective surgery in a patient with kidney failure:
-If they have a transplant and are in the midst of rejection, surgery will accelerate the process. If the organ is salvageable, salvage it first; if not, go on dialysis and wait until everything (electrolytes, creatinine, hydration/fluids, etc) are stable before proceeding.
-Bleeding intraop: may be due to uremia-induced platelet dysfunction. Desmopressin may help, as will FFP. Platelet transfusion will not help.
-Hypotension intraop without sign of beeding: May be due to adrenal dysfunction from a long history of steroid use. Give stress dose steroids: 25mg intraop, 100 mg in the next 24 hrs.
3. Surgery in someone with mitral valve stenosis:
-If compensated, 5% perioperative mortality. Avoid anything to increase pulmonary hypertension (hypoxia, hypercapnia, acidosis), avoid tachycardia as it decreases diastolic filling, and you'll want endocarditis prophylaxis (ie. abx). Intraop, a-line to monitor pressures, TEE to monitor LV filling. Keep their fluids up enough to get cardiac output, not so high for pulmonary edema.
-Workup: look for a-fib, R heart failure with echo. If they have a-fib, b-blockers for rate control and warfarin for anticoagulation.
4. Surgery in someone with bad heart disease such as MVS + CHF (risk of death is 20%). Critical AS, cardiomyopathy, etc. Do a more extensive cardiology workup, do extensive intraop monitoring.
5. Types of gastric ulcers: 

6. Management of type 1 ulcers: due to mucosal erosion, not to overproduction of acid. During EGD, biopsy to rule out cancer. If its benign, try medical management first: stop all NSAIDs, take PPIs, test for H.Pylori (if positive, treat with PPIs and flagyl+clarithromycin or amox). If medical treatment succeeds, follow up clinical symptoms. If medical treatment fails after 12-18 weeks, consider surgery: distal gastrectomy with some re-anastomosis: billroth I/II or roux en y. NO vagotomy, because theres is no acid overproduction

7. Management of type IV ulcers: also not due to acid overproduction, but erosion. Same medical management, with biopsies. If surgery is needed, you'll need to do close to a total gastrectomy: can connect remaining stomach to jejunum, or just do roux-en-y with esophagus-jejunum anastomosis. 

8. Management of type II ulcers; Usually due to acid overproduction. In addition to the abovementioned medical treatment modalities, consider testing blood gastrin levels to r/o zollinger ellison. Surgery would be highly selective vagotomy plus antrectomy. 

9. Management of type III ulcers; same as type II, also due to acid overproduction. Surgery would be vagotomy & pyloroplasty.

10. Gastric cancer:

-You need a 6cm margin, so if its at the G-E junction you may need to resect the entire esophagus (intrathoracic anastamoses spare more esophagus, but are a disaster if they leak, whereas neck anastomotic leaks are more easily managed) with an interposition graft.

-Comes in 2 types: intestinal and diffuse; Intestinal is glandular and presents like an ulcer, diffuse is signet ring cells that at their worst cause linitis plastica, which is a poor prognostic indicator, and cure is rare even with a total gastrectomy/japanese D2 nodal dissection (incl spleen)