Abdomen Flashcards
Abscesses occur after (etiologies)
invasive procedures, inflammatory conditions, and traumatic events.
Abdominal Abscess dx
CT scan
Abdominal Abscess tx
drainage is the only therapy. Percutaneous drainage can be done by CT or ultrasound guidance. Antibiotics must also be given to prevent bacteremia
Abdominal pain that radiates to the back has 2 emergent conditions
pancreatitis and aortic dissection.
name the 3 important Signs of Appendicitis
Rovsing sign:
Psoas sign:
Obturator sign:
Rovsing sign:
RLQ pain elicited on deep palpation of the LLQ [8]
Obturator sign:
pain with internal rotation of the right thigh
appendicitis dx
CT scan is most accurate test
appendicitis tx
laparoscopic surgery
appendicitis complications
abscess formation and gangrenous perforation
acute pancreatitis dx
CT scan is the best test.
Amylase is sensitive
and Lipase is specific
acute pancreatitis tx
Aggressive IV fliuds and NPO until symptoms resolve
acute pancreatitis complications
hemorrhagic pancreatitis and pseudocyst formation
diverticulitis dx
Ct scan the BEST
diverticulitis tx
ATB for the first attack. Qx resection if recurs or perforates.
diverticulitis complications
abscess formation. No endoscopy!
cholecystitis dx
US: pericholecystic fluid, gallbladder, wall thickening, and stones.
HIDA scan is the MOST accurate
cholecystitis tx
Laparoscopic surgery, or open surgery if there is perforation of the gallbladder.
cholecystitis complications
perforation of the gallbladder.
Bowel Obstruction patho
Upon occlusion of the lumen, gas and fluid build up, severely increasing pressure within the lumen. This leads to decreased perfusion of the bowel and necrosis
The most common cause of small bowel obstruction is
previous abdominal surgeries.
Bowel Obstruction types
Partial: A small amount of GI contents can pass.
Complete: No GI contents can pass
Bowel Obstruction Signs and Symptoms Auscultation
Hyperactive bowel sounds
High-pitched “tinkling” sounds indicate that the intestinal fluid and air are
under high pressure in the bowel.
Bowel Obstruction other signs and symp
Severe waves of intermittent crampy abdominal pain
Nausea and vomiting
Fever
Hypovolemia due to third spacing**
Bowel Obstruction Etiology
Adhesions from previous abdominal surgery (MCC) Hernias Crohn disease Neoplasms Intussusception Volvulus Foreign bodies Intestinal atresia Carcinoid
Bowel Obstruction best initial test
abdominal x-ray, which will show multiple air-fluid levels with dilated loops of small bowel.
Bowel Obstruction most accurate test is
CT scan of the abdomen. It will show a transition zone from dilated loops of bowel with contrast to an area of bowel with no contrast.
Bowel Obstruction labs
An elevated white count is sensitive but not specific.
An elevated lactate with marked acidosis is a hallmark sign.
________ has been shown to alleviate obstruction from stool impaction in patients on chronic opioids.
Methylnaltrexone (Relistor)
Bowel Obstruction Treatment
Make patient NPO
Place NG tube with suction
Medical management: IV fluids
Surgical decompression (not all cases)
Bowel Obstruction why NPO and NG tube with suction
Prevents further increase in bowel pressure.
NGTWS lowers it (proximaly)
Bowel Obstruction why Medical management
IV fluids to replace volume lost via third spacing
Bowel Obstruction tx Surgical decompression. Indicated if:
Complete obstruction (emergent) Lack of improvement with medical management
