Abdominal Surgery Flashcards
GERD symptoms (6)
burning, chest pain, pain radiating to jaw, occult blood (ulcer), dysphagia, odynophagia
how to diagnose ?
EGD and/or barium swallow
what is barrett’s esophagus? what does this make people at risk for?
esophageal epithelium is injured by reflux and “healed” with the wrong cell type: COLUMNAR
makes people at risk for CA and need more frequent follow-up
Tx of GERD (2)
patient education: fix diet, reduce constricting garments, elevate HOB, weight loss
meds: OTC antacids, H2 blockersl PPI, reglan
Tx of ulcers
PPI BID for at least two weeks (see if meds need to be continued after depending on pt’s symptoms)
tx for ulcer perforation
urgent open surgery
tx for H pylori
two ABX, PPI 2x daily, and bismuth (pepto)
*ABX depends on patient
what type of pt do you see a hiatal hernia in?
those with increased intra-abdominal pressure
what are the 3 types of hiatal hernias?
type 1: retro-peritoneal portion of proximal stomach slides up through the diaphragm type 2 (paraesophageal): herniated gastric fundus rolls up through the esophageal hiatus type 3: type 1 and type 2 combo
which hernia type is most common? type 1 is worse in what position? what is significant about type 1 vs type 2?
type 1; worse when supine or bending over; reflux into lower esophagus during type 1
type 2 hernia is prone to? tx of it?
prone to incarceration or strangulation; repair
how to diagnose hiatal hernia?
barium swallow w fluro- continuous xray taken of esophagus after barium’s swallowed OR
EGD w biopsy (specialist’s office)
type of surgery for hiatal hernia?
thoracotomy or laparotomy
usually preserve vagal nerve (unless want to reduce reflux); use mesh
what are the two types of cholecystitis?
gallstones and acalculous
gallstones are most commonly formed from what? what type of people are they commonly found in?
- cholesterol
- female, fertile, fat, rapid weight loss, hypertriglyceride, western diet, DM
acalculous cholecystitis is more common in what pt pop?
critically ill (think of random fever with no source)
acalculous cholecystitis has an increased incidence of ______ __________ and _________
infection, gangrene, and perforation
sign of cholecystitis? how to diagnose?
murphy’s sign; US of RUQ, HIDA scan, or MRCP
whats biliary dyskinesia?
if the gallbladder ejects less than 30%
what two things are pancreatitis likely from? is pancreatitis always a surgical problem?
obstruction of a stone and alcoholism; NO
lab values to test for pancreatitis? treatment?
Lipase and amylase (lipase more important tho bc amylase can decrease during the course)
-tx: treat the cause of it, as symptoms resolve try food challenges
three causes of biliary obstruction?
CBD stones, pancreaticobiliary malignancy, benign inflammation
two presentations of biliary obstruction?
1) . RUQ pain to charcot’s triad (jaundice, fever, RUQ pain)
2) . Reynold’s pentad (charcot’s + shock and AMS)>
management of biliary obstruction?
if a gallstone = MRCP, ERCP, lap chole with CBDE
if malignancy or stricture= CT or MRI and then ERCP
Appendicitis pain location
pain that starts at umbilicus and migrates to RLQ (McBurney’s point)
appendicitis symptoms?
anorexia, N/V, diarrhea, low-grade fever
appendicitis dx gold standard for adults VS kids
adults = CT abdomen (IV and oral contrast) kids = US if possible
TX for appendicitis
ABX to cover gram - and anaerobic bacteria prior to or
AND laparoscopic removal (maybe opened if perforation)
what is the key symptoms for acute mesenteric ischemia?
pain out of proportion to physical exam
associated risk factors with AMI? (4) KNOW
1) . age > 70
2) . heart disease
3) . smoking and HTN in >50% of pts
4) . COPD in >1/3
most cases of AMI is due to? what mesentary is affected?
arterial embolism (50%); typically SMA (bc secondary to high flow rate and more open anatomic angle)
what do pressers do?
they vasoconstrict all blood vessels (so affects the flow to the gut as well- pts might not be fed while taking these meds)
four types of AMI?
arterial embolism
arterial thrombosis
non occlusive
mesenteric venous thrombosis
arterial thrombosis AMI is usually due to?
mesenteric atherosclerosis
non occlusive AMI is usually due to?
flow is low in the vessels, such as in shockk or vasoconstricting agents (digoxin or cocaine)
mesenteric venous thrombosis usually affects what vessel? what happens in this type of AMI?
usually affects SMV
outflow occlusion leads to bowel wall edema, which leads to microvascular hypoperfusion, and then infarct occurs
(hypercoagulable states)
how to diagnose AMI? tx for embolic AMI?
CT/CTA
tx- resection of necrotic tissue and reperfusion (might require bypass grafting)
abdominal surgical conditions specific to elderly (KNOW) 2
AMI and hollow viscus perforation
elderly patients with abdomen pain post-operatively might have that pain because of what things we do to them perioperatively? (5) KNOW
1) . any surgery near abdomen causes adhesions…can lead to small bowel obstruction
2) . post-op fecal impaction
3) . giving pain meds can cause constipation
4) . post-op ileus from anesthesia
5) . incisions- risk of hernia
Causes of small bowel obstruction? (7) most common?
1). ADHESIONS
2). maligancy
3). inflammatory strictures
4). incarcerated hernias
less common: congenital lesions, volvulus, intussusception
TX for partial vs complete SBO
partial: mostly no surgery, NG tube placement to decompress, hydrate and moniotr volume status
complete: usually need surgery
how to diagnose SBO?
CT or MRI
where is diverticulitis most commonly found?
sigmoid colon (highest pressure area with small diameter)
what is right colon diverticuli most often due to?
congenital process (usually involve all layers of the wall)
what usually gets stuck in diverticuli pockets to cause inflammation? Most important to prevent this?
feces; PREVENTION: have regular BMs
how to diagnose diverticulitis?
CT abd/pelvis
how to tx diverticulitis (management and surgically)
ABX- anaerobes and E coli, strep
surgical- resection, hartman’s (resection with end colostomy)
how to treat colitis?
treat underlying cause of inflammation
perforation of colon is ________ than perf of small bowel
WORSE (less sterile, more feces/bacteria)
what is a hollow viscus perf? where does pain present?
intraluminal contents leak into sterile peritoneal cavity; pain presents near site of perf
how to diagnose and tx hollow viscus perf?
diagnose: plain film (free air >1ml) or CT
tx: emergent surgery
what is the leading cause of colonic obstruction? if you have a competent ileocecal valve, how do you tx?
colon mass; emergent surgery
symptoms of colonic obstruction? diagnose? tx?
s/s: melena, weight loss, abd distention
diagnose with CT
tx: perfed? then resect w/ ostomy and then delayed anastomosis
non perf? resection or stent
how to diagnose a hernia? tx for it?
Dx: US or CT (also, recreate hernia by increasing intraabdominal pressure)
Tx: strangulated = emergent repair if necrotic bowel
reducible or incarcerated = elective repair
