13. Appendicitis, G.I. Bleeds, And More Flashcards
What is the most common general surgical emergency of the abdomen?
Acute Appendicitis
Most common age range for appendicitis.
10 to 19
70% < 30 yrs old
What is the most common position of the appendix?
Retrocecal (behind the cecum and directed upward)
A patient presents with vague, intermittent, cramps abdominal pain that begins in the periumbilical region before migrating to the RLQ and becoming sharper and more intense over the course of 12-24 hrs.
Acute Appendicitis
Nonspecific complaints during appendicitis.
ANOREXIA.
Malaise
Change in bowel habits
When does nausea usually occur during acute appendicitis?
AFTER abdominal pain has developed
If you are trying to differentiate the abdominal pain between appendicitis and gastroenteritis, what question might you ask?
When did you experience nausea? Was it before or after the abdominal pain.
Before: Gastroenteritis
After: Appendicitis
In a patient with appendicitis who presents with a temp of 101F and the shaking chills, what should you be concerned about?
Perforation or abscess
What is important to remember in regards to giving meds for appendicitis?
Do exam BEFORE meds
3 parts of the acute appendicitis work up
1) WBCs (elevated 70% of time)
2) Urinalysis (rule out genitourinary conditions)
3) Pregnancy test in women of child bearing age.
Do you need to do imaging for a classic presentation of appendicitis?
NO: can go straight to O.R. For appendectomy (with lab results)
What are your choices if a patient presents with atypical hx and P.E. for acute appendicitis?
1) Observe w/ serial abdominal exams Q6-8 hrs
OR
2)CT (imaging of choice)
When can a pt. Be discharged after a Lap Appy?
24-20 hrs
What are the most common post-op complications of appendicitis?
Fever + Leukocytosis
What is the most common complication of acute appendicitis?
Perforation
*Can lead to PERITONITIS and SEPSIS
What is “Loss of peristalsis in the intestine in the absence of any obstruction.”?
Acute Paralytic Ileus
Meds that can cause Ileus?
OPIODS
Anticholinergics
Phenothiazines
What would you expect the bowel to sound like in Ileus?
Diminished to absent
A patient presents with mild, diffuse abdominal discomfort, no tenderness, and absent bowel sounds. What might you suspect?
Acute Paralytic Ileus
Tx for acute Paralytic Ileus
- Bowel rest
- +/- NG
- IV for fluid
- Min. Opioid and anticholinergic
- May need TPN
A patient presents with cramping abdominal pain that COMES IN WAVES. Suspect______
Small Bowel Obstruction
Risk factors for small bowel obstruction
- H/O surgery
- Crohn’s
- Neoplasm
- Hernia
You see air-fluid levels on upright abdominal x-ray. Suspect.
Small bowel obstruction
Tx. for small bowel obstruction
Bowel rest
NG decompression
+/- surgery depending on etiology
Most common causes of large bowel obstruction.
1) Left sided neoplasms
2) Crohn’s disease
Diagnosis of large bowel obstruction
Colonoscopy
CT
Tx for large bowel obstruction
Same as for small
Most important take home point for volvulus.
SURGICAL EMERGENCY!!!
A twist in the bowel that causes obstruction.
Volvulus
What kind of volvulus is more common in children?
Small Bowel
*Due to congenital malformation
A newborn presents with an acute onset of bilious vomiting, consider_______
Midgut volvulus
A patient complains of vomiting “coffee grounds” and has black tarry stools.
Upper GI bleed
Upper GI bleeds occur ABOVE the ligament of _______
Treitz
Diagnosis of upper GI bleed.
Endoscopy
Tx. Of UPPER GI bleed
HEMODYNAMIC STABILIZATION!!!
Then, stop the bleeding.
Lower GI bleeds are located _______the ligament of Treitz.
Below
A 59 year old patient presents with bright red blood in his rectum. Consider:
Lower GI blood, possibly from colonic diverticula
What would you use to diagnose a lower GI bleed in a patient under 45?
Anoscopy and sigmoidoscopy
What would you use to diagnose a lower GI bleed in a patient >45?
Colonoscopy
Tx of lower GI bleed.
Discontinue NSAIDS
Therapeutic colonoscopy
Surgery-for ongoing bleeding >4-6 units of blood loss
