13. Appendicitis, G.I. Bleeds, And More

Question 1

What is the most common general surgical emergency of the abdomen?

Answer 1

Acute Appendicitis

Question 2

Most common age range for appendicitis.

Answer 2

10 to 19

70% < 30 yrs old

Question 3

What is the most common position of the appendix?

Answer 3

Retrocecal (behind the cecum and directed upward)

Question 4

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.

Answer 4

Acute Appendicitis

Question 5

Nonspecific complaints during appendicitis.

Answer 5

ANOREXIA.
Malaise
Change in bowel habits

Question 6

When does nausea usually occur during acute appendicitis?

Answer 6

AFTER abdominal pain has developed

Question 7

If you are trying to differentiate the abdominal pain between appendicitis and gastroenteritis, what question might you ask?

Answer 7

When did you experience nausea? Was it before or after the abdominal pain.

Before: Gastroenteritis
After: Appendicitis

Question 8

In a patient with appendicitis who presents with a temp of 101F and the shaking chills, what should you be concerned about?

Answer 8

Perforation or abscess

Question 9

What is important to remember in regards to giving meds for appendicitis?

Answer 9

Do exam BEFORE meds

Question 10

3 parts of the acute appendicitis work up

Answer 10

1) WBCs (elevated 70% of time)
2) Urinalysis (rule out genitourinary conditions)
3) Pregnancy test in women of child bearing age.

Question 11

Do you need to do imaging for a classic presentation of appendicitis?

Answer 11

NO: can go straight to O.R. For appendectomy (with lab results)

Question 12

What are your choices if a patient presents with atypical hx and P.E. for acute appendicitis?

Answer 12

1) Observe w/ serial abdominal exams Q6-8 hrs
OR
2)CT (imaging of choice)

Question 13

When can a pt. Be discharged after a Lap Appy?

Answer 13

24-20 hrs

Question 14

What are the most common post-op complications of appendicitis?

Answer 14

Fever + Leukocytosis

Question 15

What is the most common complication of acute appendicitis?

Answer 15

Perforation

*Can lead to PERITONITIS and SEPSIS

Question 16

What is “Loss of peristalsis in the intestine in the absence of any obstruction.”?

Answer 16

Acute Paralytic Ileus

Question 17

Meds that can cause Ileus?

Answer 17

OPIODS
Anticholinergics
Phenothiazines

Question 18

What would you expect the bowel to sound like in Ileus?

Answer 18

Diminished to absent

Question 19

A patient presents with mild, diffuse abdominal discomfort, no tenderness, and absent bowel sounds. What might you suspect?

Answer 19

Acute Paralytic Ileus

Question 20

Tx for acute Paralytic Ileus

Answer 20

• Bowel rest
• +/- NG
• IV for fluid
• Min. Opioid and anticholinergic
• May need TPN

Question 21

A patient presents with cramping abdominal pain that COMES IN WAVES. Suspect______

Answer 21

Small Bowel Obstruction

Question 22

Risk factors for small bowel obstruction

Answer 22

• H/O surgery
• Crohn’s
• Neoplasm
• Hernia

Question 23

You see air-fluid levels on upright abdominal x-ray. Suspect.

Answer 23

Small bowel obstruction

Question 24

Tx. for small bowel obstruction

Answer 24

Bowel rest
NG decompression
+/- surgery depending on etiology

Question 25

Most common causes of large bowel obstruction.

Answer 25

1) Left sided neoplasms

2) Crohn’s disease

Question 26

Diagnosis of large bowel obstruction

Answer 26

Colonoscopy

CT

Question 27

Tx for large bowel obstruction

Answer 27

Same as for small

Question 28

Most important take home point for volvulus.

Answer 28

SURGICAL EMERGENCY!!!

Question 29

A twist in the bowel that causes obstruction.

Answer 29

Volvulus

Question 30

What kind of volvulus is more common in children?

Answer 30

Small Bowel

*Due to congenital malformation

Question 31

A newborn presents with an acute onset of bilious vomiting, consider_______

Answer 31

Midgut volvulus

Question 32

A patient complains of vomiting “coffee grounds” and has black tarry stools.

Answer 32

Upper GI bleed

Question 33

Upper GI bleeds occur ABOVE the ligament of _______

Answer 33

Treitz

Question 34

Diagnosis of upper GI bleed.

Answer 34

Endoscopy

Question 35

Tx. Of UPPER GI bleed

Answer 35

HEMODYNAMIC STABILIZATION!!!

Then, stop the bleeding.

Question 36

Lower GI bleeds are located _______the ligament of Treitz.

Answer 36

Below

Question 37

A 59 year old patient presents with bright red blood in his rectum. Consider:

Answer 37

Lower GI blood, possibly from colonic diverticula

Question 38

What would you use to diagnose a lower GI bleed in a patient under 45?

Answer 38

Anoscopy and sigmoidoscopy

Question 39

What would you use to diagnose a lower GI bleed in a patient >45?

Answer 39

Colonoscopy

Question 40

Tx of lower GI bleed.

Answer 40

Discontinue NSAIDS
Therapeutic colonoscopy
Surgery-for ongoing bleeding >4-6 units of blood loss