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senior - surgery 1 > 2 - ABD Overview > Flashcards

2 - ABD Overview Flashcards

1
Q

Study radiographs in sequence (ABCDEF):

A

Adequacy

Bones

Calcifications

Deformity / density

Extraluminal / peritoneal air

Foreign bodies / fractures

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2
Q

What film finding may suggest splenomegaly?

A

Gastric bubble displaced medially

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3
Q

Briefly describe CT:

A

Slices of the body available in axial, sagittal, or coronal views

Appears as if we are standing at the patients feet looking toward the head

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4
Q

Marking on the inside of the stomach

A

Rugae

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5
Q

Markings on small intestine

A

Plicae circulares / valvulae conniventes

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6
Q

Markings on the colon

A

Haustra

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7
Q

Air is expected in the stomach and colon - if it’s absent, must r/o:

A

Gastric outlet obstruction

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8
Q

If you have air in the stomach and small bowel but not the colon, must r/o:

A

Obstruction

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9
Q

Air is normally NOT seen in small intestine - if visible, must r/o:

A

Ileus or obstruction

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10
Q

Describe ileus

A

Impaired GI tract motility

Common after surgery (anesthesia) or irritation of the viscera

Presents c N/V, ABD pain, (-) bowel sounds

Air in stomach, small and large bowel (no flatus being passed)

Contrast does not move through to colon

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11
Q

Txt of ileus?

A

NPO, NG-tube, IV-fluid

AVOID NARCS

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12
Q

Prevention of ileus

A

Good OR technique
Minimize bowel manipulation during surgery
Replete electrolytes

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13
Q

What drug is given pre-op as a pro-motility drug to prevent or minimize narcotic-induced ileus?

A

Alvimopan (Mu blocker)

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14
Q

Obstruction presents with:

A 
Pain 
Distention
Present bowel sounds
Fever
Peritoneal signs

Air-fluid levels on upright films

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15
Q

What is open-loop obstruction?

A

Able to decompress (solid mass)

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16
Q

What is closed-loop obstruction?

A

Unable to decompress (volvlus / internal hernia)

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17
Q

How is obstruction treated?

A

NG tube decompression

Close observation

Fluid resuscitation

*higher incidence of surgery compared to ileus

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18
Q

Air seen under the right diaphragm on upright films - suspect:

A

Pneumoperitoneum

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19
Q

Air seen under left diaphragm on upright films - suspect:

A

Pneumoperitoneum OR possibly just a stomach bubble

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20
Q

Name some intraabdominal organs that can have either pathologic or benign calcifications:

A

Gall bladder
Kidney
Ureters
Arteries

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21
Q

Before giving any kind of contrast, you wanna order what labs?

A

BUN/Creatinine to assess kidney function

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22
Q

What med do we hold for 48-72 hrs after administration of contrast?

A

Metformin

23
Q

Describe barium contrast:

A

Thick, chalky

Coats the walls of hollow organs well

24
Q

Describe Gastrografin:

A

Thinner, not as caustic if extravasated

Used in suspected perforation

BAD IF ASPIRATED

25
Q

Describe the upper GI tract studies

A

X-rays

Barium swallow (evaluate esophagus)

UGI - esophagus, stomach, duodenum

UGI with small bowel follow-through (UGI plus add’l timed radiograph to assess small bowel)

26
Q

A barium enema is used to asses:

A

The lower GI tract (bowel)

ACBE - requires prep

BE - requires no prep, used to r/o obstruction, can be therapeutic

27
Q

US best for:

A

Fluid-filled and semi-solid structures

Good for detecting free air / fluid in the abdomen

28
Q

US poor for:

A

Air-filled structures

29
Q

What are the three main areas to divide the abdomen into?

A
  1. GI tract (mouth to anus)
  2. Biliary (liver, gall bladder, pancreas)
  3. Genito-Urinary-Kidney -> urethra
30
Q

General ROS q’s:

A

Fever
Appetite changes
Malaise
Trauma

31
Q

GI ROS Q’s:

A

N/V/D
Hematochezia / melena
Prior colonoscopy or EGD

32
Q

Biliary ROS Q’s:

A

Jaundice
Hepatitis
Gall stones
Pancreatitis

33
Q

GU ROS Q’s

A 
Hernia
LMP
OCP’s
Gravida/parity
STI’s
BPH
Testicular pain
UTI
34
Q

Chest ROS Q’s

A

Cough
COPD
URI

35
Q

Patient moving vs lying still - differentials:

A

Lying still - peritonitis

Moving/restless - obstructive

36
Q

Name the four general abdominal appearances:

A

Scaphoid
Flat
Rounded
Protuberant

37
Q

Cullen’s Sign and Grey’s Turner’s Sign - suggestive of:

A

Acute pancreatitis

38
Q

What is peristalsis:

A

Segmental contraction and relaxation of the muscles within the GI tract

39
Q

ABD percussion - how do solid organs and fluid sound?

A

Lower tones

40
Q

ABD percussion - how does free air sound?

A

Hypertympanic

41
Q

Tenderness to percussion may suggest:

A

Peritonitis (follow-up with a heel tap to evaluate for rebound tenderness)

42
Q

ABD palpation - pain out of proportion in older CAD patient suggests:

A

Bowel ischemia - suspect mesenteric ischemia

43
Q

Most ABD complaint patients will get which labs:

A 
CBC
CMP
HCG
Amylase/lipase
UA

(If surgical - PT/INR, aPTT)

*if critical, ABG

44
Q

Return criteria for patients with home disposition:

A

Fever, increased N/V, intractable pain

45
Q

If surgery is likely:

A

Order consult
NPO
Start maintenance fluids

46
Q

Interventions for patients admitted for observation:

A 
Pain control
NG tube
Maintenance fluids (mIVF)
Labs (repeat)
Films (repeat)
Vitals (repeat)
47
Q

Examples of emergent (do immediately or they die) surgical candidates:

A

Blunt trauma
Penetrating trauma
Ruptured AAA
Aortic transection

48
Q

Examples of urgent (within 24hrs) surgical candidates

A

Appendicitis
Ectopic pregnancy
Incarcerated hernia

49
Q

3 way abd:

A

Flat
Upright
CXR

50
Q

Transverse view is AKA:

A

Axial view (MC view on CT)

51
Q

Why shouldn’t we see air in the small bowel?

A

Peristalsis is constant, emulsifying the air

52
Q

CVA tenderness - high index of suspicion for:

A

Pyelonephritis

53
Q

ADC-VAN-DISMEL

A

Admit (what unit)

Diagnosis (and comorbities)

Condition (stable, guarded, grave)

Vitals (how often to take, usually q4hrs on regular floor)

Activity (what they can do, fall risk)

Nursing orders (I and O, weights, etc)

Diet (NPO, DM, etc)

IVF

Studies (tests)

Meds

Allergies

Labs

54
Q

Statistically….

A

9 out of 10 injections are in vein.

senior - surgery 1 (8 decks)

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