Abdomen - General Flashcards by Jared Getzlaff

Perf appy with >3cm abscess

Perc drainage and abx

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<3cm abscess s/p appy

IV abx

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Imaging for penetrating flank trauma

CT IV/oral/rectal contrast

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HypoT on insufflation, next step

Go slow, convert to open if intolerant

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Origin mucin-secreting omental growths

Appendix

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Biochemical workup, adrenocortical Ca

Dex suppression test, plasma meta, aldo:renin ratio

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Syndrome assoc Desmoid tumors

FAP and Gardner

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Spindle shaped cells, abundant collagenous matrix

Desmoid tumor

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Unresectable desmoid, tx

Tamoxifen and NSAIDs

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Paracentesis milky, leuks with lymphatic predominence

Chylous ascites

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Hemodynamics of pneumoperitoneum (MAP, SVR, CI, renal flow, splachnic flow)

Inc MAP, SVR. Decr CI, renal flow, splachnic flow

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SBP organisms

E Coli, Klebsiella, pneumococci

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Chylous ascites, tx

Medium chain fatty acids -> TPN and Octreotide

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Ventral hernia and going for PD cath placement

Repair at the same time with extraperitoneal mesh

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Mesenteric cyst, tx

Cyst excision

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Indications for open drainage intraabdominal abscess

No perc or failed perc access, no source control, interloop or multiple abscesses, loculated, necrosis, unstable

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Peritoneal dialysis catheter outflow dysfunction, common cause

Constipation

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Painless, unilateral scrotal mass, next step

Scrotal US, Testicular cancer until proven otherwise

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Pseudomyxoma peritonei, tx

Cytoreduction, debulking, HIPEC

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Mesenteric ischemia, dx

CT angio abd/pelv

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Salmon colored fluid from surgical wound, tx

OR for wound exploration (fascial dehiscence)

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Abd pain, bowel wall thickness in setting of cocaine, hypovolemia or CHF

Mesenteric ischemia

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Abd pain, bowel thickness in setting of PVD, arrhythmia, valvular dx

Arterial occlusion

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Abd pain, bowel thickening in setting of portal HTN, rHF, hypercoagulable

Venous occlusion

Abd pain, whirl sign

Mechanical strangulation

Young healthy with bradycardia on insufflation, cause

Vasovagal stretch peritoneal membrane

Chronic Mesenteric ischemia, dx

CT angio

Anticoagulants, coughing, tender abdominal mass

Recurs sheath hematoma

Difference in robotic vs lap chole

Cost

Indications for diag lap

Gyn eval, onc staging, bx node, chronic abd pain

Dense fibrosis, high cellularity, low mitotic index, dx and associations

Desmoid tumor, FAP and Gardner

Indication for right hemi for appendiceal neoplasm

>2cm, AdenoCa, involve base, 1-2cm with lymphovasc invasion, pos margin, high proliferation(grade 2 Ki-67), mixed histo(goblet cell, adenocarcinoid)

Complicated appendicitis with fluid collection, tx

Perc drainage, colonoscopy 6wks

Appendicitis in pregnancy; tx and how

Lap appy entering abdomen via Hasson technique, bump left lateral decubitus

Biggest indication for interval appendectomy

Appendicolith

Most common malignant tumor of the appendix

Carcinoid

Absolute contraindications PEG

Poorly controlled ascites, uncorrectable coagulopahthy, peritonitis, inability to appose wall, gastric outlet obstruction, expected survival <4weeks

Most common complication PEG

Infection at PEG site

CT-proven symptomatic bleeding mass in small bowel; tx

Surgical exploration and resection

Initial treatment for ischemic orchitis

NSAIDs

Where to sew inferior aspect of mesh during IHR and what is at risk

Shelving edge of inguinal ligament, iliac vessels

Hesselback triangle; boundaries and what type of hernia

Inguinal ligament, rectus and inferior epigastrics, direct IH

Howship Romberg sign, pathognomonic for what

Increased hyperesthesia from the medial crease through medial thigh towards knee with extension, adduction and internal rotation, obturator hernia

Ilioinguinal nerve location

Anterior to the spermatic cord

Iliohypogastric nerve location

Between int/ext oblique superior to cord

Genital br of genitofemoral, location and supply

posterior to cord in cremasterics, scrotal and medial thigh sensation

Best way to reduce seroma formation s/p abd hernia repair

Drain placement

Tx for seroma

Observe, pressure dressing, possibly aspirate

At risk for injury during lateral tacking of mesh in IHR; deficit

Ant femoral cutaneous nerve, lateral thigh sensation

Repair for both inguinal and femoral hernias; describe

McVay, Conjoint to Coopers

Chronic inguinodynia resfractory to conservative management; tx

Local injection with bupivacaine, corticosteroids and hyaluronic acid

Hernia with highest risk for strangulation

Femoral

Diastasis recti; tx

Weight loss, core strengthening

Best technique to repair parastomal hernia

Sugarbaker mesh repair

Treatment for >4cm incisional hernia

Permanent or long acting mesh with 3-4cm overlap, PDS suture

Rives-Stoppa-Wantz repair

Retrorectus repair

Access to abdomen in patient with hx of sigmoidectomy

Veress at Palmer's

Lap IHR with mesh; where to avoid tacks

Inferior to the iliopubic tract and lateral to the gonadal vessels

Adult with intussusception; tx

Ex lap with resection