Abdomen

Question 1

Abscesses occur after (etiologies)

Answer 1

invasive procedures, inflammatory conditions, and traumatic events.

Question 2

Abdominal Abscess dx

Answer 2

CT scan

Question 3

Abdominal Abscess tx

Answer 3

drainage is the only therapy. Percutaneous drainage can be done by CT or ultrasound guidance. Antibiotics must also be given to prevent bacteremia

Question 4

Abdominal pain that radiates to the back has 2 emergent conditions

Answer 4

pancreatitis and aortic dissection.

Question 5

name the 3 important Signs of Appendicitis

Answer 5

Rovsing sign:
Psoas sign:
Obturator sign:

Question 6

Rovsing sign:

Answer 6

RLQ pain elicited on deep palpation of the LLQ [8]

Question 7

Obturator sign:

Answer 7

pain with internal rotation of the right thigh

Question 8

appendicitis dx

Answer 8

CT scan is most accurate test

Question 9

appendicitis tx

Answer 9

laparoscopic surgery

Question 10

appendicitis complications

Answer 10

abscess formation and gangrenous perforation

Question 11

acute pancreatitis dx

Answer 11

CT scan is the best test.
Amylase is sensitive
and Lipase is specific

Question 12

acute pancreatitis tx

Answer 12

Aggressive IV fliuds and NPO until symptoms resolve

Question 13

acute pancreatitis complications

Answer 13

hemorrhagic pancreatitis and pseudocyst formation

Question 14

diverticulitis dx

Answer 14

Ct scan the BEST

Question 15

diverticulitis tx

Answer 15

ATB for the first attack. Qx resection if recurs or perforates.

Question 16

diverticulitis complications

Answer 16

abscess formation. No endoscopy!

Question 17

cholecystitis dx

Answer 17

US: pericholecystic fluid, gallbladder, wall thickening, and stones.
HIDA scan is the MOST accurate

Question 18

cholecystitis tx

Answer 18

Laparoscopic surgery, or open surgery if there is perforation of the gallbladder.

Question 19

cholecystitis complications

Answer 19

perforation of the gallbladder.

Question 20

Bowel Obstruction patho

Answer 20

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

Question 21

The most common cause of small bowel obstruction is

Answer 21

previous abdominal surgeries.

Question 22

Bowel Obstruction types

Answer 22

Partial: A small amount of GI contents can pass.
Complete: No GI contents can pass

Question 23

Bowel Obstruction Signs and Symptoms Auscultation

Answer 23

Hyperactive bowel sounds
High-pitched “tinkling” sounds indicate that the intestinal fluid and air are
under high pressure in the bowel.

Question 24

Bowel Obstruction other signs and symp

Answer 24

Severe waves of intermittent crampy abdominal pain
Nausea and vomiting
Fever
Hypovolemia due to third spacing**

Question 25

Bowel Obstruction Etiology

Answer 25

Adhesions from previous abdominal surgery (MCC)
Hernias
Crohn disease
Neoplasms
Intussusception
Volvulus
Foreign bodies
Intestinal atresia
Carcinoid

Question 26

Bowel Obstruction best initial test

Answer 26

abdominal x-ray, which will show multiple air-fluid levels with dilated loops of small bowel.

Question 27

Bowel Obstruction most accurate test is

Answer 27

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.

Question 28

Bowel Obstruction labs

Answer 28

An elevated white count is sensitive but not specific.

An elevated lactate with marked acidosis is a hallmark sign.

Question 29

________ has been shown to alleviate obstruction from stool impaction in patients on chronic opioids.

Answer 29

Methylnaltrexone (Relistor)

Question 30

Bowel Obstruction Treatment

Answer 30

Make patient NPO
Place NG tube with suction
Medical management: IV fluids
Surgical decompression (not all cases)

Question 31

Bowel Obstruction why NPO and NG tube with suction

Answer 31

Prevents further increase in bowel pressure.

NGTWS lowers it (proximaly)

Question 32

Bowel Obstruction why Medical management

Answer 32

IV fluids to replace volume lost via third spacing

Question 33

Bowel Obstruction tx Surgical decompression. Indicated if:

Answer 33

Complete obstruction (emergent)
Lack of improvement with medical management