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27 Cards in this Set
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What is colicky pain?
If relief post BM, then maybe what organs? If relief post vomiting, then maybe what organs? If improvement with bending forward, then where is the pathology? |
waves of pain, comes and goes (colicky baby)
BM - rectum, small bowel vomiting - stomach, small intestine bending forward - retroperitoneal |
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Board like rigidity of the abdomen implies ___________.
Pt comes in with periumbilical pain shifting to RLQ, elevated WBC/left shift, anorexia - Dx? If pt is vomiting/diarrhea, then _______ likely to have appendicitis. |
general peritonitis
appendicitis less likely |
|
When would you NOT do a laparascopic appendectomy?
pt comes in, sudden/severe epigastric pain, radiating to R scapula, worse with respirations - Dx? |
suspected or diagnosed perforation/rupture
perforates duodenal ulcer |
|
What are some PE findings with a perforated duodenal ulcer?
Why are 70-80% of SBO's caused by adhesions? Presentation of SBO? |
absent bowel sounds, board-like rigidity, epigastric tenderness
more surgeries intestinal colic, abd distention, epigastric pain, feculent vomiting |
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How can you tell on exam if it is a complete or partial SBO?
Tx of a partial obstruction? Tx of a complete obstruction? |
Is the patient farting?
Yes - partial, No - complete partial - NG tube, IVF complete - surgery |
|
Pt with LLQ pain, fever, abd distension, elevated WBC, constipation; Dx?
Where is diverticulitis usually found? Treatment with no perforation? |
diverticulitis
sigmoid colon (90%) IVF, Abx |
|
What tests do you NOT run on diverticulitis patients? Why?
Perforation, peritonitis, colonic obstruction due to diverticulitis/abscess are indications for ________________. |
BE, endoscopy - increased irritation
emergency laparotomy |
|
Pt presents with severe back/flank/abdomen pain, shock, hypotensive, pulsatile abd mass - Dx?
Pt presents with severe abd distension, anorexia, nausea, resp distress - Dx? |
AAA
ascites |
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The _________ test is used to test for ascites.
What procedure should be done? Where? |
Fluid wave test
paracentesis - midline beneath umbilicus, VOIDED BLADDER, patient sitting up (gravity helps) |
|
Characteristic appearance for ascites on CT?
Symptoms of SBP? |
"ground glass" appearance on anterior abdomen
PMN count >250, more immature cells |
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S-A albumin gradient < 1.1 = ________. Why?
S-A albumin gradient > 1.1 = _________. Why? |
<1.1 = exudative process, kidney damage, albumin is pumped into ascites
>1.1 = transudative, liver damage, pumping more albumin into serum |
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Tx for SBP?
_______ peritonitis is spontaneous infection of ascites without any intraabdominal source. ________ peritonitis is caused by disease/injury to intraabdominal organs. |
5-10 d. IV abx
Primary Secondary |
|
SBP is usually what kind of bacteria?
Why do patients with acute peritonitis lay supine with legs flexed? |
Gram- - E. coli, Klebsiella
less tension/gravity effect on peritoneum |
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Findings consistent with acute peritonitis?
Tx for acute peritonitis? |
WBC up, left shift, free air under diaphragm, abrupt onset
IVF, Abx, surgery |
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Pt with dull epigastric pain, steattorhea, N/V/D, increased PTH, alcoholic - Dx?
Diagnostic feature on XR? What radiography is usually ordered for pancreatitis? |
chronic pancreatitis
calcification of pancreas CT |
|
Pt with >10% BW weight loss, abd pain, painless jaundice, hepatomegaly, +Courvoisier's sign - Dx?
What is Courvoisier's sign? Usual treatment? Generally curable? |
pancreatic cancer
palpable non-tender GB with jaundice palliative surgery - Whipple's procedure, pain control - generally untreatable |
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Sign of recent GI bleed, bright red blood in vomit
previous GI bleed black, tarry, loose stools |
hematemesis
coffee ground emesis melena |
|
Major causes of UGI bleeding? (3)
Why are elderly at greater risk for UGI bleeding? Causes of gastritis? (3) |
PUD
Gastric erosions esophageal varices more NSAID use --> ulcers Drugs (NSAIDs, ASA), EtOH, gastric stress |
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Shock occurs when blood loss approaches ____ of total blood.
Postural hypotension implies _____ blood loss. Tx for acute GI bleed? |
40%
20% large bore IV x2, IV rapid infusion, T&X blood, O2 |
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Why is an initial hematocrit not accurate to assess blood loss?
When should you transfuse? What blood products? |
Body compensate by concentrating blood; (IVF dilutes)
Hemoglobin <9, unstable vitals, gross bleeding PRBC's, maybe FFP |
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Two methods to localize an acute GI bleed?
Endoscopy contraindicated in what patients? |
NG tube placement, endoscopy
uncooperative suspected perforation |
|
Most common cause of acute lower GI bleed?
Causes of chronic LGI bleed? (2) What is BRBPR? |
Diverticulosis
hemorrhoids, cancer bright red blood per rectum |
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How do you diagnose angiogysplasia (pathologists hate it)?
Most frequent congenital GI anomaly? Why can Meckel's diverticulum cause ulcers? |
colonoscopy
Meckel's diverticulum may can gastric cells --> produce acid |
|
Adenoma, dark red, smooth surface, dysplastic:
Adenoma, shaggy, cauliflower like, friable |
tubular
villous |
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F/U of polyp disorders:
Time scale for malignant polyps? Benign? No polyps found? |
malignant - q3-6 mo., then 1 yr, then 3 yrs
benign - q 3 yrs. None - q 10 years |
|
Where are the majority of colon cancers found?
Risk factors for colon cancer? Most common colon cancer type? |
descending colon, sigmoid (64%)
genetic, high fat/meat, low fiber diet, vitamin A,C,E deficiency adenocarcinoma |
|
Screening:
How often should a person get: stool guaiac? flexible sigmoid testing? colonoscopy? Most common site of colon cancer metastasis? |
stool guaiac: every year
flexible sigmoid - q 5 yrs colonoscopy - q 10 yrs Liver |
