ABD Flashcards
causes of ascites
malignancy
portal HTN
hypoalbunemia
ESRD
complications of ascites
resp compromise due to pushing on diaphragm
SBP - nml gut flora translocates into periotneum
dx of SBP
WBC >1000
neut >250
low glucose
high protein
tx of SBP
cefotaxime 1st line
admit
ogilvie syndrome
large bowel obstruction with no distal colonic obstruction
recent sx, neuor disorder, chronic illness,
tx of cdiff
oral vanc
oral fidaxomicin
oral metro
fulminant is oral vanc and parenteral metro
scrombroid toxin
tuna/mackeral fish histamine like toxin peppery fish metallic taste facial flushing HA cramps
tx antihistamines
ciguatera toxin
grouper/snapper/barrucuda muscle weakness reversed temp sensation neuro symptoms - parasthesisas v/d
tx supportive
dieulafoy lesions
abberant artery of GI tract that protrudes through the submucosa
spigelian hernia
between rectus abdominus and semilunate line
direct hernia
medial to inf epigastric vessels
bulge through
weakened fascia
behind superficial inguinal ring
indirect hernia
mc
lateral to inf epigastric vessels
enter inguinal canal at deep inguinal ring
can go into scrotum or labia majora
management of incarcerates or strangulated hernias or bowel obstructed hernias
consult sx
do not try to reduce due to risk of reducing necrotic bowel back into abdomen
types of hiatal hernia
sliding - displacement of GE junction above diaphragm
paraesophageal - displacement of gastric fundus above diaphgraphm (GERD pts)
gold standard for dx of infectious esophagitis
upper endoscopy visualization
eosinophilic esophagitis
most common
men 20-30s GERD
strictures, associated with asthma and eczema
dysphagia (MC), food impaction
tx of eosinophilic esophagitis
antacids
ppi trial
concerning signs in GERD
dysphagia
bleeding
weight loss
gold standard is pH monitoring
risk of PPIs
increased risk of osteoporosis
PNA
C diff
caustic agents
acids - superficial, strictures due to coagulation necrosis
alkali - severe injury, liquefactive necrosis, perf, mediastinitis, peritonitis, death (bleach)
achalasia
loss of esophageal peristalsis with failure of LES to relax
progressive dysphagia
dilated esophagus with beak like narrowing
barium
mcc of boerhaaves syndromes
iatrogenic post endocospy
late symptoms- fever sepsis, shock due to mediastinitis
management of boerhaaves
dx early due to mortality
broad spec abx: vanc, pip/tazo and metro
thoracic sx consult
management of adult food FBs
Glucagon (1st line)
carbonated bevs
nitro
nifedipine
endoscopy definitive
radiographs for peds trach vs esophagus
Esophagus
- AP - circle
- lateral - sliver
Trachea
- AP - sliver
- Lateral - circle
management of Peds FB
<5cm x 2cm likely to pass
require immediate endoscope if:
- in esophagus, sharp, too long, caustic, magnetic
button battery management
<1hr witness + asymptomatic –> 10ml honey or sucalfate water to get into stomach
if in esophagus = emergent endoscope for removal
symptomatic - pip/tazo or amp/sulf
dx of SBP
wbcs >1000
neut >250
low glucose
high protein
management of SBP
early paracentesis (delays increase mortality)
abx (cefotaime or ceftriaxone 2gIV)
admit
management of hepatic encephalopathy
lactulose - titrated to 2-3 loose stools/day
rifaximin or neomycin to decrease bacterial production of ammonia and other toxins
risk factors for liver abscess
mcc peritonitis
diabetes
liver transplant
ppi use
conjugated bilirubin is associated with
liver and biliary pathology
unconjugated bilirubin is associated with
extrahepatic pathology
when should N-acetylcystein be given
within 8 hrs of ingestion if acetaminophen level above Rumack matthew nomogram
risk factors for acalculous cholecystitis
immunosuppresion
diabetes
renal failure
cholangitis
fever abd pain jaundice confusion hypotension
tx of cholangitis
pip/tazo
or
fluroquinolone and metro
drugs that cause pancreatitis
tetracycline
valproic acid
metro
markers for severe pancreatitis
age
symptoms of ARDS
elevated WBC, LDK, AST
elevated glucose
imaging for pancreatitis
CT not for stable pts
CT mod -sev
US abdomen r/o gallstones
pancreatitis mortality score
BISAP B- BUN >25 I - impaired mental S- SIRS crit >1 A-age >60 P-pleaural effusion
complications of pancreatitis
pancreatic necrosis pseudocyst hyperglycemia ARDS Renal Failure Death
causes of abd compartment syndrome
trauma burns w/ aggressive fluid resuscitation liver transplant acute pancreatitis ruptured AAA sepsis
dx and tx of abd compartment syndrome
dx - measure abd pressure via bladder pressure
tx support, bladder decompression, ascites removal
tx of gastritits
r/o dangerous things topical antacids histamine 2 blockers (famotadine) or PPI
tx of Peptic ulcer dz (PUD)
uncomplicated PUD
- sucralfate
- topical antacids
- H2 blockers or PPI
perf
ceft, metro
emerg sx consult
pyloric stenosis presentation
nonbilious forceful projectile vomit in baby 2-10wks
dehydration, lethargy, poor perfusions, sunken fontanelle, olive like mass in epigastric
dx and tx of pyloric stenosis
dx hypokalemic hypochloremic met alkalosis (late) + US preferred study
tx IVF, sx consult
gastroparesis
delayed gastric emptying, diabetes complication (some norwalk virus)
medication induced gastroparesis
CCBs
clonidine
TCAs
post sx
tx of gastroparesis
IVF
metoclopramide and erythromycin (prokinetics)
optimize glucose control
haloperidol for severe
mcc of Upper GI bleed
peptic ulcers
lab signs of upper GI bleed
elevated BUN due to digestion of blood
management of upper GI bleed
transfusion (prn)
PPI IV
(if variceal = octreotide and if refractory vasopressin)
ceftriaxone (if pt cirrhotic to prevent sbp)
sengstaken-blakemore
tx of etec
cipro
bactrim
if preg azithromycin
tx of campylobacter diarrhea
azithro
or
cipro
tx of cryptosporidium
azithromycin or parmomycin
hiv/immunocompromised individual
causes of SBO
post op adhesions hernias malignancy crohns disease volvulus bezoar gallstones
dx of SBO
metabolic acidosis
abd tympany
tachycardia
dehydration
US - >2.5cm diamter of loops of bowel over collapsed bowel with absent peristalsis activity
aortoenteric fistula
types and RFs
native aorta (1) secondary (prior sx or intervention on aorta)
RF: stent migration, post op complications, bowel injury
presentation of aortenteric fistula
GI bleeding occasionally a herald bleed precedes massive GI bleed
abd pain
weakness
LE ischemia
management of aortenteric fistula
ceftriaxone and metro
emergent stabilization
malrotation
1st year BILIOUS vomiting hematochezia (painless) peritonitis hemodynamic instability
dx of malrotation
gold standard is upper GI series - corkscrew or duodenal beak appearance due to obstruction
meckels presentations
rule of 2’s
mcc of Lower GI bleed
stools can bright red or tarry
intussusception and obstruction
meckels workup and tx
cbc for anemia
normal radiograph
meckels scan (gold)
tx IVF, r/o volvulus, enteritis, intuss
dx of fulminant c diff colitis
elevated WBCs
lactic acidosis
elevated Cr
hyponatremia
large bowel dilation >7cm or >12cm in cecum
complication of c diff
toxic megacolon can lead to bowel perf
obturator sign
pain on flexion and internal rotation of right hip
iliopsoas sign
pain on extension of right hip
management of appendicitis non ruptured
abx (cefoxitin or ceftriaxone) + metro
sx (lap)
abx only in some stable pts w/out evidence of perf (30% require future appy)
management of ruptured appendicits
broad spec abx (pip/tazo and metro)
septic or unstable = emergent lap
stable = IR drainage of abscess with delayed appy
complications of crohns
fistula
perf
abscess
sepsis
multiple sx –> short gut syndrome
hirschsprungs dz
aganglionic colon
failure to pass meconium
abd distension
BILIOUS emesis
dx of hirschsprungs dz
barium contrast enema in ED
rectal bx is gold standard
NEC presentation
preterm/low birth weight
sudden changes: decreased feeding, abd distensions, BILIOUS vomiting, diarrhea, hematochezia
sepsis, lethargy, apnea, hypotension
dx of NEC
abd x-ray pneumatosis intestinalis
US abd fluid and changes in bowel motility
management of NECt
supportive
bowel rest
gastric decompression
broad spec abx (vanc, gentamicin + metro)
emerg sx consult
radiation colitis pathophys
radiation can injure vessel –> ischemia, ulceration, stricture, fibrosis
radiation colitis presentation and dx
n/v/abd pain
post 3 months
dx: exam, CT segmental inflam bowel thickening, mesenteric stranding
management of radiation colitis
symptomatic
antidiarrheal agents and abx if bacterial overgrowth present
diverticulosis vs diverticulitis
diverticulosis - painless hematochezia
diverticulitis - F, LLQ pain, ttp on exam
management of diverticulosis and diverticulitis
supportive
transfuse
abx for diverticulitis - augmentin or cipro + metro
volvulus
sigmoid: older pts, bedbound, constipation
cecal: congenital deefect, mcc of bowel obstruction in preg pts
presentation of volvulus
abd pain
distension
progressive obstipation (aka severe constipation)
poss pain due to ischemia
dx of volvulus
x-ray (first line)
sigmoid = coffee bean appearance
cecal = birds beak deformity
management of sigmoid and cecal volvulus
cecal = sx consult
sigmoid = sigmoidoscopy with decompression
complication of HSP
intussusception
presentation of intussusception
colicky abd pain
vomiting
currant jelly stools (late sign)
crying, pulling legs up
sausage like mass
dx of intussusception
barium enema (gold standard for dx and therapy
US donut sign or target sign
tx of intussusception
IVF
r/o meckels inguinal hernia and malrotation
air contrast or barium enema
GI bleed with elevated BUN suggests
upper GI bleed since blood is being digested
causes of anorectal abscesses
obstruction of anal crypt glands
IBD
TB
Lymphogranuloma venereum
trauma
perianal abscess
involves superficial tissues of the anus
perirectal abscess
involves deep tissue space of the pelvis
when to drain an anorectal abscess
stable well localized perianal abscess that does NOT extend into perirectal space
tx = I and D
management of a pilonidal cyst
I and D
abx for skin flora and MRSA coverage –> doxy OR cephalexin + TMP-SMX(bactrim)
management of anal fissures
fiber (psyllium) colace promotility agents (senna) sitz bath topical nifedipine and nitro
when to excise a hemorrhoid
thrombosed hemorrhoids <48hrs (hard to palpation)
make elliptical incision
management of rectal prolapse
apply sugar to reduce edema
manual reduction
post reduction: fiver (psyllium) colace and senna
rectal FB removal
if palpable on DRE attempt removal in D with analgesia
(NO procedural sed it inhibits pt ability to valsalva)
foley placement beyond object then inflate balloon to help relived vacuum effect
tx of HPV genital warts
podophyllotoxin
imiquimod
trichloracetic acid
(usually not prescribed from ed)
etiologies of splenomegaly
hemolytic anemia (hereditary spherocytosi)
portal HTN
infection (EBV, lupus, malaria, endocarditis)
splenic sequestration due to sickle cell
causes of pancreatitis in children
CF
HUS
diameter of a nml gallbladder wall
<3mm
false elevations in amylase
preg
renal failure
transfusing in Upper GI bled
stable transfuse if Hgb <7
commorbidities Hgb <9
SBO bowel sounds
high pitched
hypoactive bowel sounds
distended loops of bowel
typhilitis
neutropenic pts
ileocecal region
HIV/Heme cancers
fever abd pain distension paralytic ileus
ANC<500
typhilitis dx and tx
dx CT abd pelvis with IV and oral contrast (avoid rectum)
tx- bowel rest, ng suction, pip/tazo or cefepime + metro
