8. DSA Clinical Approach to the Patient Presenting with Abdominal Trauma and GI Emergencies

Question 1

Dx…?
RLQ abd pain, anorexia, nausea vomiting, fever, visceral pain intially and localized to RLQ, +mcburney, +rovsings +obturator +psoas

Answer 1

Appendicitis

Question 2

Testing with appendicitis includes CBC, CMP, UA, pregnancy test, imaging: adults do a CT abd/pelvis w IV/oral contast, kids do?

Answer 2

US of RLQ and CT if US is negative

Question 3

80% of foreign bodies (FB) ingestions occur in children, 1% need surgery. Kids usually objects, adults usually food bolus. What is the most frequent site of obstruction in the GI tract?

Answer 3

Esophagus-impacted at sites of physiologic or pathologic luminal narrowing

Question 4

If there is drooling and inability to swallow liquids it is indicative of an esophageal obstruction and requires an?

Answer 4

emergent endoscopic evaluation

fever, abd pain, vomiting warrant further work up

Question 5

If there are signs of airway compromise (choking, stridor, wheezing, difficulty breathing) must be addressed immediately, otherwise treatment for FB is mainly?

Answer 5

Expectant - watch and wait (stomach or duodenum) weekly xray

Question 6

What are the most common type of hernias, 75%?

Answer 6

Indirect inguinal hernias

Question 7

Epigastric and umbilical are the most common ventral hernias, indirect hernias are the MC type which passes from internal to external inguinal ring thorugh the patent process vaginalis and into the?

Answer 7

Scrotum

Question 8

A hernia is reducible if the hernia sac itself is soft and easy to replace back through the hernia neck. A hernia is classified as what if the hernia is firm, painful, nonreducible by direct manual pressure and no signs of illness?

Answer 8

Incarcerated

Question 9

What is it called when a hernia sack is firm, very painful, usually with signs of system ILLNESS present (fever, nausea, vomiting) implying impairment of blood flow (A/V or both)?

Answer 9

Strangulated Hernia - severe pain

**acute surgical emergency

Question 10

AAA is disease of older person, screen all men who have smoked 65+. diagnosed by a diameter of larger than 3cm. Asymptomatic, Symptomatic but not rupture, and symptomatic and rupture has a classic triad known as?

Answer 10

Abdominal/Flank Pain
Hypotension
Shock

Question 11

If the AAA is asymptomatic, monitor with US yearly, Symptomatic but stable = CT abd w IV contrast, if symptomatic and unstable with hx of AAA what do you do?

Answer 11

OR NOW

*surgery for AAA >5.5

Question 12

What are the most commonly injured solid orgins due to abdominal traumas (MVA)?

Answer 12

Spleen and Liver

Question 13

Primary survery upon a trauma patient is:
Airway
Breathing
Circulation (hemorrhage control)
Disability/neurologic status
Exposure/environmental control

Answer 13

MEOW

Question 14

What is MC on the left due to blunt high impact MVA, suspect thoracoabdominal trauma, DONT USE TROCHAR w CHEST TUBE?

Answer 14

Diaphragm Rupture (air seen under diaphragm)

Question 15

Pelvic fractures are bad- lots of bleeding and high mortality. testing: CBC, CMP, UA, Lateral C spine, CXR, AP pelvis, FAST scan, CT scan abd + IV(only if stable), ***DO NOT delay?

Answer 15

transger to definitve care in order to obtain diagnostic studies

Question 16

The purpose of FAST SCAN is to detect free intraperitoneal fluid, pericardial fluid, hemothorax and pneumothroax in trauma patients. When used in the right flank, what can be seen**?

Answer 16

Morrison’s Pouch can see Liver and kidney and space between would be blood

Question 17

What is the classic triad for Ectopic Pregnancies?

Answer 17

Abd Pain (90%)
Amenorrhea (missed period) (70%)
1st trimester vaginal spotting or bleeding (50%)