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GIGU 2 Exam 1 > Abd Trauma And GI Emergencies - Dr. Arnce > Flashcards

Abd Trauma And GI Emergencies - Dr. Arnce Flashcards

1
Q

Appendicitis prevalence

A

Most common cute abd surgery and 3rd-4th decade , or 10yo-19yo age
= can be missed during dx

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2
Q

Appendicitis SX

A
  1. RLQ pain, N/V, anorexia, can have fever
  2. Starts visceral = nonspecific cramping abd pain ——> then localizes sharp pain
  3. Elevated WBCs usually
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3
Q

Testing for appendicitis

A
  1. McBurneys ** most useful and specific
  2. Rovsing’s sign
  3. Obturator sign
  4. Psoas Sign
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4
Q

Imaging for appendicitis

A

CT abd and pelvis with IV and Oral contrast (adults)
US RLQ then CT scan to rule out appendicitis (children)
MRI (pregnant)

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5
Q

TX for appendicitis

A
  1. NPO
  2. IV fluids
  3. Antiemetics
  4. Pain medication
  5. Abs if needed
    = for surgery
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6
Q

Early appendicitis looks like

A

Viral gastroenteritis

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7
Q

Ingested Foreign Bodies prevalence for intervention

A

80% in children
80%-90% pass with no intervention
10%-20% need endoscopic removal
1% surgery removal

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8
Q

Prevalence of Ingested Foreign Bodies in children

A

6mo-3yrs mostly

Coins, buttons, batteries, toys, safety pins

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9
Q

Ingested Foreign Bodies prevalence in adults

A

95% accidental (food like meat, can cause esophageal obstruction, bones, toothpicks)
- more in elderly
5% intentional : Jain inmates, psychological problems, intoxicated, drugs

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10
Q

Most common site of Ingested Foreign Bodies stuck

A

UES, at level of aortic arch, diaphragm hiatus

= or webs, strictures, achalasia, rings, esophageal eosinophilia

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11
Q

SX or Ingested Foreign Bodies that is emergency

A

Drooling, can’t swallow liquids, fever, abd pain, V

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12
Q

Ingested Foreign Bodies Imaging

A

Endoscopy : FIRST

= if pt if doing fine then do Plain radiographs, or CT if pt has swallowed drugs or sharp object

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13
Q

Ingested Foreign Bodies TX

A
  1. Remove immediately if object is in esophagus or EM situation (drooling ,wheezing, strider, SOB, fever, abd pain, sharp, drugs, battery)
  2. Watch and monitor if in stomach
  3. Only remove if sharp or drugs, battery if past lig and Treiz
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14
Q

EM endoscopy

A

Within 6hrs

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15
Q

Urgent Endoscopy

A

Within 24hrs : anything in esophagus

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16
Q

How long for Ingested Foreign Bodies to pass

A

4-6 days

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17
Q

Hernias prevalence

A

10% population develops a hernia

75% are inguinal and (2/3 of those are Indirect)

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18
Q

Hernia :
Reducible
Incarcerated
Strangulated

A
  1. Fat contents so is reducible
  2. Bowel content so not reducible
  3. Loss of blood supple so necrosis
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19
Q

Most common ventral hernias

A

Epigastric and Umbilical

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20
Q

Incisional hernia

A

Any place there is an incision

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21
Q

Inguinal hernia
Indirect
Direct

A

Indirect : passes from interval to external inguinal ring through the patent process vaginalis and into scrotum
Direct : passes through the weak transversalis fascia in the Hasselbach Triangle

22
Q

SX of Hernia :
Reducible
Incarcerated
Strangulate

A
  1. Soft and can push in
  2. Firm needs painful, no systemic illness
  3. Firm and very painful, systemic illness (fever, N, V), skin changes, impaired BF
23
Q

Strangulated Hernia TX

A

= OR emergency surgery
= IV ABs broad spectrum
= fluid resuscitation
= obtain labs

24
Q

Incarcerated hernia TX

A

Try to reduce and if you cant do surgery

25
Q

Reducible hernia TX

A

Outpatient surgery follow up

26
Q

ABD Aortic Aneurysm prevalence

A

= top 15 cause of dearth 85yo-89yo
= not common under 60yo
= 7% over 50yo

27
Q

Dx ABD Aortic Aneurysm

A

** when Aortic Diameter is over 3.0cm (normal is 1.4cm-3.0cm)

28
Q

ABD Aortic Aneurysm where is it usually located and risks

A
  1. Below renal arteries before it splits

2. Smoking

29
Q

ABD Aortic Aneurysm SX

A

= asymptomatic usually
= symptomatic only not ruptured : larger enough to compress structure ——> abd pain, limb ischemia, fever, flank pain…)
= symptomatic and ruptured : high mortality, TRIAD :
1. severe ABD or/and back pain
2. Pulsatile abd mass
3. Hypotensive

30
Q

Triad for ruptured Abd Aortic Aneurysm

A
  1. severe ABD or/and back pain
  2. Pulsatile abd mass
  3. Hypotensive
    = fast and almost 100% death do something fast
31
Q

Abd Aortic Aneurysm risk factors besides smoking

A
  • age
  • make
  • Caucasian
  • FH
  • had in past in other vessels
  • atherosclerosis
32
Q

Abd Aortic Aneurysm ruptured can look like

A
  1. Renal colic
  2. Perforated viscous
  3. Diverticulitis
  4. GI hemorrhage
  5. Ischemic bowel
    = if you think any of these always screen for Abd Aortic Aneurysm
33
Q

ABD Aortic Aneurysm DX and screening

A
  1. 1 time for at risk pt over 65
  2. Every 6mo or 1 yr if pt has asymptomatic AAA = CT / US
  3. CT with IV contract if stable symptomatic AAA
  4. OR no imaging if Hx AAA unstable AAA, CT IV contrast if possible if unstable unknown AAA
34
Q

TX for ABD Aortic Aneurysm

A
  1. Wait and watch if asymptomatic
  2. Surgery if over 5.5cm or rapidly expanding
    - Open or endovascular which is more tolerated
35
Q

Number one cause of death worldwide

A

Trauma

36
Q

Most trauma to abd is what

A

Blunt trauma to Spleen or Liver (accidents, falls)

37
Q

ATLS

A

Advanced Trauma Life Support course for all trauma surgeons, ER doctors = so they know how to approach care for a trauma patient

38
Q

How to take care of Trauma pt

A
  1. Airway maintenance (C-spine control), do you need to intubate
  2. Breathing and ventilation
  3. Circulation + hemorrhage control (esp abd trauma)
  4. Disability/neuro stability
  5. Exposure/Environment control (undress pt to prevent hypothermia
39
Q

What other part should you look at for an abd Trauma

A

Urethral, perinatal, renal, vaginal discharge bleeding or problem

40
Q

Diaphragm Injury

A

Usually on left side
= from blunt high speed MVC accident (abd organs go into chest cavity)
= DONY use trochanter when putting in chest tube

41
Q

Trochar is what and what to do in trauma situation

A

Metal spear used as a chest tube

= dissect down and fell around for contents and then place it in

42
Q

Duodenal Injuries

A

= unrestrained drivers (frontal impact)
= Bicycle handle bar
= DO CT with IV and ORAL CONTRAST to see the hematoma in the duodenum

43
Q

Pancreatic Injury

A

= direct blow to pancreas a giant vert wall
= check amylase and lipase levels
= CT or ABD and pelvis IV + Oral

44
Q

Genitourinary Injury

A

= direct blow to back or flank
= suspect microscopic hematuria
= blood coming out ——> anterior pelvic fracture, problem with ureter, bladder, kidney

45
Q

Hollow Viscus Injury

A

= sudden braking injury in MVC
= Chance fracture should be looked at (from bottom seat belt)
= US and CT done

46
Q

Solid Organ Injury

A

= Liver, Kidney, Spleen
= FAST scan for leaks
= hemodynamcally stable : general surgeon observation conservative, CT scan
= hemodynamically unstable / continued bleeding : OR , laparotomy

47
Q

Pelvic Fractures

A

= MVC, falls
= hypotension + pelvic fracture ——> high mortality
= pelvic ring disruption : tear in venous plexus disrupting internal iliac A

48
Q

Death rate of pelvic fractures

  1. All
  2. Closed book fracture + hypotension
  3. Open book pelvic fracture
A
  1. 1 : 6
  2. 1 : 4
  3. 1 : 2
49
Q

Imaging for trauma

A
  1. Lateral C spine, CXR, AP Pelvis
  2. FAST scan
  3. CT abd/pelvis + IV (if pt is stable and not in rural place needing trauma surgeon (free fluids, pelvic fracture, pneumothorax) so has to be transferred, that will waste time)*
50
Q

Who gets laparotomy

A
  1. Blunt trauma + hypotension + positive FAST scan **
  2. Diagnostic Perotineal Lavage (DPL) : + , stick catherter in below umbilicus and see if there is blood
  3. Gunshots past peritoneum
  4. Bleeding, air
51
Q

FAST scan

A

US that Detect free intraperitoneal fluid (morrises punch, spleen / renal recess , around bladder, pericardial sac)

52
Q

FAST scan views and how to hold it

A
  1. Subxiphoid view : right belo xiphoid and aim to shoulder (see heart)
  2. Morrison’s Pouch : right flank RUQ side (hepatorenal view), + = Fluid in between liver and kidney
  3. Perisplenic View : left flank LUQ side (fluid between spleen and kidney)
  4. Pelvic (retrovesicular view) : look behind bladder, scan longitudinally and transversely by umbilicus

GIGU 2 Exam 1 (12 decks)

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