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1.05) SURGERY > 2.2 MTB Step 3 - General (Inflammation - Acute Diverticulitis, Diverticular Abscess, Acute Pancreatitis, Acute Appendicitis, CUC) > Flashcards

2.2 MTB Step 3 - General (Inflammation - Acute Diverticulitis, Diverticular Abscess, Acute Pancreatitis, Acute Appendicitis, CUC) Flashcards

Cards Complete:

1
Q

INFLAMMATION

What are (3) Inflammatory causes of an Acute Abdomen?

A
  1. Acute Diverticulitis
  2. Acute Pancreatitis
  3. Acute Appendicitis
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2
Q

INFLAMMATION

What are (2) common question Descriptions of Abdominal Inflammation?

A
  1. Gradual onset of constant abdominal pain that slowly builds up over several hours.
  2. Initially, ill-defined pain that eventually becomes localized to the site of inflammation.
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3
Q

ACUTE DIVERTICULITIS

What are (4) common Clinical Manifestations of Acute Diverticulitis?

A
  1. Middle age or Older
  2. Fever
  3. Leukocytosis
  4. Peritoneal Irritation/Pain in the LEFT LOWER QUADRANT with a Palpable Tender Mass
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4
Q

ACUTE DIVERTICULITIS

In women, what are (2) other sources of Acute Abdomen that should be considered?

A
  1. Fallopian Tubes
  2. Ovaries

When diagnosing acute diverticulitis, don’t forget to order a Urine Pregnancy Test on all women of childbearing age

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5
Q

ACUTE DIVERTICULITIS

What is the Most Common anatomical location for Diverticulosis?

A

Sigmoid Colon

The Sigmoid Colon has the smallest diameter and therefore the highest intraluminal pressure.

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6
Q

ACUTE DIVERTICULITIS

What is the Most ACCURATE Diagnostic Test for Acute Diverticulitis?

A

CT Abdomen w/ Contrast

  • To look for Abscess or Free Air.*
  • Fat Stranding is common around the inflamed bowel.*
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7
Q

ACUTE DIVERTICULITIS

What Exam is considered an Absolute Contraindication in Acute Diverticulitis, and why?

A

Colonoscopy

because it raises the risk of Perforation.

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8
Q

ACUTE DIVERTICULITIS

What is the Treatment for Acute Diverticulitis in a patient with NO peritoneal signs?

A

Manage as Outpatient with Antibiotics

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9
Q

ACUTE DIVERTICULITIS

What is the Treatment for Acute Diverticulitis in a patient with Localized Peritoneal Signs and Abscess?

A
  • NPO
  • IV Fluids
  • IV Antibiotics
  • CT-guided Percutaneous Drainage of Abscess
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10
Q

ACUTE DIVERTICULITIS

What is the Treatment for Acute Diverticulitis in a patient with Generalized Peritonitis or Perforation?

A

EMERGENCY Surgery

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11
Q

ACUTE DIVERTICULITIS

What is the Treatment for Acute Diverticulitis in a patient with Recurrent Attacks of Diverticulitis?

A

ELECTIVE Surgery

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12
Q

DIVERTICULAR ABSCESS​

What is the Cause of Diverticular Abscess?

A

Pus Collecting in a Diverticular Pouch

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13
Q

DIVERTICULAR ABSCESS​

When should you suspect a Diverticular Abscess?

A

Suspect a Diverticular Abscess in patients with UNCOMPLICATED DIVERTICULITIS who have one of the following despite 3 days of Antibiotic treatment:

  • NO improvement in Abdominal Pain, or
  • Persistent Fever
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14
Q

DIVERTICULAR ABSCESS​

What Test is used to diagnose Diverticular Abscess?

A

CT Abdomen

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15
Q

DIVERTICULAR ABSCESS​

What is the Treatment for a Diverticular Abscess?

A

Percutaneous or Surgical DRAINAGE

Start Antibiotics to Prevent Spread of the Infection

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16
Q

ACUTE PANCREATITIS​

What are (4) Presenting Characteristics in a patient with Acute Pancreatitis?

A
  1. Alcoholic
  2. Acute Upper Abdominal Pain (over several hours)
  3. Radiation to the Back
  4. Nausea and Vomiting
17
Q

ACUTE PANCREATITIS​

What are the (3) Types of Acute Pancreatitis?

A
  1. Edematous
  2. Hemorrhagic
  3. Suppurative (pancreatic abscess)
18
Q

ACUTE PANCREATITIS​

What are (6) Risk Factors for Acute Pancreatitis?

A
  1. Alcoholism
  2. Gallstones
  3. Medications
  4. Hypertriglyceridemia
  5. Trauma
  6. Post-ERCP
19
Q

ACUTE PANCREATITIS​

What are (6) MEDICATIONS considered Risk Factors for Acute Pancreatitis?

A
  1. Didanosine
  2. Pentamidine
  3. Flagyl
  4. Tetracycline
  5. Thiazides
  6. Furosemide
20
Q

ACUTE PANCREATITIS​

What are (2) Late Complications of Acute Pancreatitis?

A
  1. Pancreatic Pseudocyst
  2. Chronic Pancreatitis
21
Q

ACUTE PANCREATITIS​

What is the Best INITIAL Diagnostic Test for Acute Pancreatitis?

A

Amylase or Lipase (serum or urinary)

Amylase = Highest Sensitivity

Lipase = Highest Specificity

  • Serum from 12 - 48 hours*
  • Urinary from 3rd - 6th days*
22
Q

ACUTE PANCREATITIS​

What is the Most ACCURATE Diagnostic Test for Acute Pancreatitis?

A

CT Abdomen

Perform if diagnosis is uncertain.

23
Q

ACUTE PANCREATITIS​

What are (3) Warning Signs for HEMORRHAGIC Pancreatitis?

A
  1. Lower Hematocrit that continues to fall the day AFTER presentation.
  2. Very High WBC ( > 18,000), Glucose, BUN
  3. Very Low Calcium
24
Q

ACUTE PANCREATITIS​

How can Pancreatitis lead to Hypocalcemia?

A
  • Pancreatitis can lead to Hypocalcemia due to the presence of Insoluble Calcium Salts in the Pancreas.
  • The Free Fatty Acids (FFAs) avidly Chelate the salts, resulting in Calcium deposition in the Retroperitoneum>
25
Q

ACUTE PANCREATITIS​

What are the (3) Treatments used for Acute Pancreatitis?

A
  1. NPO
  2. NGT Suction
  3. IV Fluids
26
Q

ACUTE PANCREATITIS

What are (3) Complications of Acute Pancreatitis?

A
  1. Abscess - often appears 10 days after onset with persistent fevers and high WBC count. Surgical drainage.
  2. Pseudocyst - appears 5 weeks after initial symptoms, when a collection of pancreatic juice causes anorexia, pain, and a palpable mass.
  3. Chronic Damage - causes Diabetes and Steatorrhea. Treat with Insulin and Pancreatic Enzyme supplements.
27
Q

ACUTE APPENDICITIS

What are (4) Steps in how Acute Appendicitis presents?

A
  1. Begins with Anorexia.
  2. Followed by vague Periumbilical Pain.
  3. Several hours later becomes Sharp, Severe, Constant, and Localized to the Right Lower Quadrant (RLQ) of the Abdomen.
  4. Tenderness, Guarding, and Rebound are found to the Right and Below the Umbilicus (but not elsewhere in the abdomen).
28
Q

ACUTE APPENDICITIS

What is a Rovsing Sign?

A

Palpation of LLQ Increases the Pain felt in RLQ

29
Q

ACUTE APPENDICITIS

  1. What is the Best INITIAL Method for Diagnosing Acute Appendicitis?
  2. Which Diagnostic Tests should be performed if the Diagnosis is unclear after the initial method?
A
  1. Look for Fever and Leukocytosis (10,000 - 15,000 range) with Neutrophilia and Immature forms
  2. CT Abdomen or US Abdomen
30
Q

ACUTE APPENDICITIS

What are (4) Antibiotic combinations that can be given IV prior to Appendectomy?

A
  1. Ciprofloxacin + Metronidazole
  2. Ampicillin/Sulbactam
  3. Levofloxacin + Clindamycin
  4. Cefoxitin or Cefotetan
31
Q

ACUTE APPENDICITIS

How is the Treatment determined for a Perforated Appendix?

A
  • Continue IV Antibiotics
  • Treatment is determined by CT Scan finding:
    • Phlegmon is treated with Antibiotics
    • Abscess is Drained
    • Frank Performation is treated Surgically
32
Q

CHRONIC ULCERATIVE COLITIS (CUC)

TREATMENT

How is Chronic Ulcerative Colitis (CUC) usually managed?

33
Q

CHRONIC ULCERATIVE COLITIS (CUC)

TREATMENT

Under which (4) situations is Elective Surgery the answer for Chronic Ulcerative Colitis (CUC)?

A
  1. > 20 years of Disease present (high incidence of malignant degeneration)
  2. Multiple Hospitalizations
  3. High-dose Steroids or Immunosuppressant necessary
  4. Toxic Megacolon (abdominal pain, fever, leukocytosis, epigastric tenderness, massively distended transverse colon on x-rays with gas in the wall of the colon)
34
Q

CHRONIC ULCERATIVE COLITIS (CUC)

BASIC SCIENCE CORRELATE

What portion of the Colon does Ulcerative Colitis (UC) affect?

A

Ulcerative Colitis (UC) extends from the Anal Verge in an UNINTERRUPTED pattern through the Entire Colon.

1.05) SURGERY (6 decks)

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