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Surgery Clerkship- Amboss Study Plan > Abdominal Surgery- Intestine Part A > Flashcards

Abdominal Surgery- Intestine Part A Flashcards

1
Q

Causes of Anastomosis insufficiency

A
  • Emergent surgery or prolonged operative time
  • Decreased perfusion of the anastomosed bowel segments
  • Increased pressure within the anastomosis (anastamosis bowel end not mobile enough)
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2
Q

Anastomosis Insufficiency Clinical Features

A
  • Postoperative fever, tachycardia (usually 5–7 days following surgery)
  • Abdominal distention, pain, and peritoneal signs
  • Tender incision wound, purulent (or feculent) drainage
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3
Q

Anastomosis Insufficiency

Complications/ Tx

A

Complications:

  • abscess formation,
  • peritonitis,
  • SIRS, sepsis

Treatment

  • Revision surgery
  • Treating complications (e.g., by giving broad-spectrum antibiotics in the case of infection)
  • Endoluminal vacuum-assisted closure therapy
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4
Q

Wound Dehiscence

A

spontaneous wound rupture along an incision with fascial dehiscence and possible prolapse of underlying structures/organs; seen particularly often following laparotomy in abdominal surgery.

  • Partial wound dehiscence; insufficiency of deep sutures while the superficial sutures remain intact
  • Complete wound dehiscence: insufficiency of all suture layers
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5
Q

Wound Dehiscence

Causes

A
  • Postoperative inflammatory processes in the abdomen
  • Wound healing disorders
  • Insufficient surgical sutures or poor suturing technique
  • coughing or gas
  • Premature mobilization of the patient
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6
Q

Wound Dehiscence

TX

A

Preoperatively

  • Use of adhesive tapes as adjunctive wound support and abdominal binders to prevent further wound dehiscence.
  • Mobilization of the patient with great care to avoid an increase in pressure

Urgent revision surgery (multiple irrigations and debridement of the wound margins) to prevent evisceration or a hernia later on

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7
Q

Meckel Diverticulum

A
  • the most common congenital anomaly of the gastrointestinal tract and is caused by an incomplete obliteration of the omphalomesenteric duct.
  • mucosal lining of the diverticulum may be either native ileal mucosa or heterotopic mucosa (most commonly gastric)
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8
Q

Meckel’s Diverticulum Epidemiology

A
  • Prevalence: most common congenital gastrointestinal tract anomaly
  • Sex:♂ > ♀
  • Age:< 2 years of age
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9
Q

Meckel’s Diverticulum Pathophysh

A
  • The omphalomesenteric (vitelline or vitellointestinal) duct is a patent tubular structure connecting the yolk sacto the alimentary tract in the embryo.
  • The duct is normally obliterated by the 6th week of intrauterine life.
  • Incomplete obliteration of the omphalomesenteric duct → persistence of the proximal (intestinal) segment of the duct → Meckel diverticulum
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10
Q

Meckel’s Diverticulum Anatomy

A
  • Meckel diverticulum is a true diverticulum.
  • Located ∼ 2 feet proximal to the ileocecal valve
  • Usually ≤ 2 inches in size
  • There may be 2 types of mucosal lining:
    • Native ileal mucosa
    • Heterotopic mucosa
  • Blood supply: vitelline artery
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11
Q

Rule of 2s for Meckel’s

A
  • 2% of the population,
  • 2% are symptomatic,
  • mostly in children < 2 years
  • 2:1 males:females
  • located 2 feet proximal to the ileocecal valv,
  • ≤ 2 inches long,
  • 2 types of mucosal lining
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12
Q

Meckel’s Diverticulum Clinical Features

A
  • Asymptomatic
  • Symptomatic (2–4%)
    • Painless lower gastrointestinal bleeding (most common presentation)
      • Currant jelly stools
      • Tarry stools
      • Hematochezia
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13
Q

Meckel’s Diverticulum Diagnosis

A
  • The initial work-up follows the same protocol as that for lower gastrointestinal bleeding and/or acute abdomen.
  • Imaging
    • Meckel scintigraphy scan (Meckel scan): a noninvasive nuclear medicine imaging technique using radiolabelled technetium (99mTc), which is preferentially absorbed by the gastric mucosa and can identify ectopic gastric mucosa
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14
Q

Meckel’s Diverticulum with risks for comlications

A

A Meckel diverticulum that is > 2 cm long, has a broad base (> 2 cm wide), has a palpable abnormality, or a fibrous band attaching it to the umbilicus

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15
Q

Meckels Diverticulum Tx

A

Asymptomatic

  • Incidentally detected on laparotomy/laparoscopy
  • Children or young adults: surgical resection always
  • Adults <50: if high risk
  • adults >50: Never (symptomatic rare)

Symptomatic or complicated

  • Surgical resection
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16
Q

Meckel’s Diverticulum Complications

A
  • Hemorrhage
  • Bowel obstruction (usually affects terminal ileum) due to
    • Intussusception
    • Volvulus
  • Bowel perforation
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17
Q

Uncomplicated Appendicitis

A

no evidence of an appendiceal fecalith, an appendiceal tumor, or complications, such as perforation, gangrene, abscess, or mass

1.

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18
Q

Complicated Appendicitis

A

associated with perforation, gangrene, abscess, an inflammatory mass, an appendiceal fecalith, or an appendiceal tumor

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19
Q

Acute Appendicitis

A

acute inflammation of the vermiform appendix typically due to an obstruction of the appendiceal lumen.

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20
Q

appendiceal fecalith

A

concretion of feces that develops in the appendix. Can obstruct the appendiceal lumen, which increases the risk of developing acute appendicitis (especially perforated appendicitis).

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21
Q

Appendicitis Epidemiology

A

Peak incidence: 10–19 years of age [3]

Sex: ♂ > ♀

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22
Q

Appendicitis Etiology

A

obstruction of the appendiceal lumen

  • Lymphoid tissue hyperplasia; most common children and young adults
  • Fecalith; most common adult
  • Neoplasm; patients > 50 years of age
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23
Q

Physical Exam Findings of appendicitis

A

McBurney point tenderness

RLQ guarding and/or rigidity

Rebound tenderness

Rovsing sign

Psoas sign

Obturator sign

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24
Q

Clinical Features of appendicitis

A

Migrating abdominal pain:

  • Initial diffuse periumbilical pain
  • Localizes to the RLQ within ∼ 12–24 hours

Associated nonspecific symptoms

  • Nausea
  • Anorexia
  • Vomiting
  • Low-grade fever
  • Diarrhea
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25
Q

Alvarado Score for Appendicitis

MANTRELS

A
  • Migration of pain to RLQ = 1
  • Anorexia = 1
  • Nausea and/or vomiting = 1
  • Tenderness in RLQ = 2
  • Rebound pain = 1
  • Elevated temperature > 37.3°C (99.1°F) = 1
  • Leukocytosis (> 10,000/mm3) = 2
  • Shift to the left (≥ 75% neutrophils) = 1

Likelihood of appendicitis

  • ≤ 4: Low
  • 5–6: Moderate
  • ≥ 7: High
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26
Q

Pediatrics Appendicitis Score

A
  • Migration of pain to RLQ = 1
  • Anorexia = 1
  • Nausea/vomiting = 1
  • RLQ tenderness = 2
  • RLQ pain elicited on coughing/jumping/percussion = 2
  • Temperature ≥ 38°C (100.4°F) = 1
  • Leukocytosis (≥ 10,000/mm3) = 1
  • PMN ≥ 75% = 1

Likelihood of appendicitis

  • ≤ 3: Low
  • 4–6: Moderate
  • ≥ 7: High
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27
Q

Appendicitis Imaging

A

CT abdomen with IV contrast

  • preferred initial imaging modality in adults
  • Supportive findings
    • Distended appendix (diameter > 6 mm)
    • Edematous appendix with periappendiceal fat stranding

Abdominal ultrasound

  • Preferred initial imaging modality in children or pregnant patients
  • Supportive findings
    • Distended appendix (diameter > 6 mm)
    • Target sign

MRI without Contrast

  • Pregnant Patients
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28
Q

Abx Treatment of Uncomplicated Appendicitis

A
  • Required coverage: against gram-negative and anaerobic organisms
  • Combination therapy with a first-generationcephalosporin (e.g., cefazolin ) PLUS metronidazole
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29
Q

Operative Management with Appendectomy

A
  • Indications:
    • Emergency appendectomy is the current standard of care for acute appendicitis (without periappendiceal mass or abscess).
  • Contraindications
    • Appendiceal mass
    • Appendicular abscess
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30
Q

Indications for NONOP Managment of appendicitis:

A

Periappendiceal abscess > 4 cm: image-guided percutaneous drainage

  • Inflammatory appendiceal mass
  • Appendiceal abscess
  • Patient refusal of surgery
  • High surgical risk due to comorbidities
  • History of previous surgical/anesthesia complications
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31
Q

Appediceal Abscess

A

Description:

  • pus and necrotic tissue around an inflamed appendix follows an untreated perforated appendix

Clinical features:

  • manifests as a tender mass in the RLQ in an acutely ill patient

Treatment

  • Abscess < 4 cm: antibiotic therapy alone is usually sufficient.
  • Abscess > 4 cm: image-guided percutaneous drainage
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32
Q

Gangrenous appendicitis

A

Description:

  • irreversible necrosis of the appendiceal wall

Clinical features

  • High-grade fever, tachycardia, severe RLQ pain and tenderness

Treatment:

  • emergency appendectomy (mottled purple apendix)
  • IV antibiotics
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33
Q

Pylephlebitis

A

Description: septic thrombosis of the portal vein

Etiology: due to perforated appendicitis, diverticulitis, or necrotizing pancreatitis

Clinical features: fever

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34
Q

Appendicitis in pregnancy

A
  • Atypical (higher) pain localization
  • Perforated appendix is associated with a higher risk of fetal loss.
  • Ultrasound is the diagnostic procedure of choice.
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35
Q

Chron’s Disease Epidemiology

A

Typical age of onset: bimodal distribution with one peak at 15–35 years and another one at 55–70 years

  • Populations with higher prevalence
    • Individuals of Northern European descent
    • Individuals of Ashkenazi Jewish descent
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36
Q

Chrons Risk Factors

A
  • Active and passive smoking of tobacco
  • Familial aggregation
  • Genetic predisposition
    • (e.g., mutation of the NOD2 gene, HLA-B27 association)
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37
Q

Chrons Constitutional Symptoms

A
  • Low-grade fever
  • Weight loss
  • Fatigue
38
Q

Chrons Intestinal Symptoms

A
  • Chronic diarrhea, typically nonbloody
  • Abdominal pain, typically in the RLQ
  • Malabsorption
  • Palpable abdominal mass
  • Enterocutaneous perianal fistulas, often associated with abscess formation
  • Oral aphthae
39
Q

Chrons Extraintestinal Symptoms

A
  • Joints:
    • enteropathic arthritis (e.g., sacroiliitis, spondylitis, inflammation of peripheral joints)
  • Eyes
    • Uveitis
    • Iritis
    • Episcleritis
  • Skin
    • Erythema nodosum
    • Pyoderma gangrenosum
    • Pyostomatitis vegetans
40
Q

Pyoderma gangrenosum

A
  • Associated with various conditions (e.g., IBD, rheumatoid arthritis, and trauma)
  • very painful, rapidly-progressive, red spots that can change into purulent pustules or deep ulcerated lesions with central necrosis
  • located at extensor side of the lower limbs
  • Treated with immunosuppressants
41
Q

Approach to Chrons Diagnosis

A
  1. Symptoms suggestive of CD, conduct blood tests and stool tests
  2. Confirm diagnosis with endoscopy and/or radiographic imaging and/or biopsy.
  3. Perform contrast radiological studies and/or ultrasonography to assess extent, severity, and complications
42
Q

Labs for Chrons

A

Blood work

  • CBC may show signs of pernicious anemia
  • ↑ Inflammatory markers (↑ CRP, ↑ ESR, ↑ thrombocytes, and ↑ leukocytes)

Serology:

  • ↑ Anti-Saccharomyces cerevisiae antibodies (ASCA)
  • pANCA most likely negative

Stool analysis

  • Rule out bacterial gastroenteritis
  • Microscopy to examine presence of worm larvae or eggs (ova and parasites)
  • Identification of bacterial toxins
43
Q

Imaging for Chrons

A
  • Upper GI series with barium swallow and small bowel follow-through
    • String sign
    • Creeping fat
  • Ultrasound findings
    • Gastrointestinal wall thickening
    • abscesses/fistulas
  • MR enterography
    • Characteristic findings are an edematous thickening of the intestinal wall
44
Q

String Sign

A

contrast-filled bowel segment that resembles a string on x-ray

45
Q

Snail Trails

A

physical examination finding characterized by longitudinal ulcerations in the oral mucosa.

46
Q

Creeping Fat

A

pathognomonic hyperplasia of adipose tissue that results in accumulation of mesenteric fat around the circumference of the intestine

47
Q

Endoscopy of Chrons

A
  • Endoscopy confirms the diagnosis and may also be used as a therapeutic tool (e.g., dilatation of ducts, intestinal loops).
  • Cobblestone sign: inflamed sections followed by deep ulcerations that resemble cobblestones
  • Erythema and transmural inflammation
48
Q

Chrons Pathology

A
  • Skip lesions: a pattern of patchy, discontinuous inflammation in the bowel (affected areas interspersed with normal tissue)
  • Creeping fat
  • Transmural inflammation
    • Noncaseating granulomas
    • Distinct lymphoid aggregates of the lamina propria
49
Q

Approach to Chrons Tx

A
  1. Treating acute disease
  2. Inducing clinical remission
  3. Maintaining response/remission
  • Patients should be stratified according to their specific prognostic risk factors.
  • individually tailored as possible.
  • Disease activity should be monitored regularly based on objective markers.
50
Q

Surgical Managment of Chrons

A

Surgical intervention alone cannot cure Crohn disease and is last resort to avoid complications in which significant amounts of bowel are lost (e.g., short bowel syndrome)!

Overview

  • Minimally-invasive resection of affected and nonfunctional intestinal loops while preserving as much intestinal length and function as possible
  • Indicated when medical therapy fails or patient develops severe complications (e.g., obstruction, stricture, abscess)

Methods

  • Strictureplasty
    • A surgical procedure that opens up a bowel stricture without having to resect the bowel (bowel-sparing technique)
    • Indicated after multiple resections
  • Limited resection (e.g., proctocolectomy): in case of obstructions or strictures
51
Q

Chrons Complications

A
  • Colorectal cancer (especially in the case of pancolitis)
  • Short bowel syndrome and associated issues after surgery
  • Stenosis/strictures → bowel obstruction
  • Primary sclerosing cholangitis
  • Impaired bile acid reabsorption
    • Bile acid diarrhea
    • Bile acid malabsorption → steatorrhea and deficiencies in fat-soluble vitamins
  • Abscess formation/phlegmons
  • Intestinal fistulas and abscesses
52
Q

Chrons VS Ulcerative Colitis

Surgery

A

Chrons

Noncurative surgery may become necessary to alleviate symptoms

UC

Curative surgery possible (proctocolectomy)

53
Q

Chrons VS Ulcerative Colitis

Histology

A

Chrons

  • Transmural inflammation
  • Noncaseating granulomas
  • Giant cells
  • Lymphoid aggregates

UC

  • Confined to mucosa and submucosa
  • No granulomas
54
Q

Chrons VS Ulcerative Colitis

Diagnostic Findings

A

Chrons

  • Cobblestone sign
  • Pinpoint lesions
  • Snail trails
  • Creeping fat
  • String sign

UC

  • Friable mucosa
  • Mucosal ulcerations can be deep or superficial
  • Crypt abscesses
  • Loss of haustra (lead pipe sign)
55
Q

Chrons VS Ulcerative Colitis

Pattern of Inflamation

A

Chrons

  • Discontinuous (skip lessions)

UC

  • Continuous
56
Q

Chrons VS Ulcerative Colitis

Antibodies

A

Chrons

  • ASCA

UC

  • p-ANCA
57
Q

Chrons VS Ulcerative Colitis

Cancer Risk

A

Chrons

  • Small intesine
  • colon
  • non-hodgkin lymphoma

UC

  • Cholangiocarcinoma
  • colorectal cancer
58
Q

Chrons VS Ulcerative Colitis

Complications

A

Chrons

  • abscess
  • strictures
  • perianal fissures

UC

  • toxic megacolon
  • perforation
  • fulminant colitis
59
Q

Chrons VS Ulcerative Colitis

Fistulas

A

Chrons

  • Common

UC

  • rare
60
Q

Chrons VS Ulcerative Colitis

Extraintestinal Manifestations

A

Chrons

  • nephrolithiasis
  • cholelithiasis

UC

  • primary sclerosing cholangitis
61
Q

Chrons VS Ulcerative Colitis

Physical Exam

A

Chrons

  • Mostly constant pain in RLQ
  • Palpable abdominal mass
  • Low-grade fever

UC

  • Painful defecation, pain located in LLQ
  • Abdominal cramps and tenderness
  • Tachycardia
  • Orthostatic hypotension
62
Q

Chrons VS Ulcerative Colitis

Nutritional Status

A

Chrons

Poor/Malnurished

UC

Normal

63
Q

Chrons VS Ulcerative Colitis

Stool

A

Chrons

  • Increased
  • Typically nonbloody, watery diarrhea

UC

  • Greatly increased
  • Bloody diarrhea with mucus
  • Tenesmus
  • Urgency
64
Q

Ulcerative Colitis Epidemiology

A

PrevalenceEthnicity

  • Higher in the white than in the black, Hispanic, or Asian populations
  • Highest among individuals of Ashkenazi Jewish descent.

Peak incidence

  • 15–35 years
65
Q

Ulcerative Colitis

Pathophysiology

A

Dysregulation of the immune system:

  1. upregulation of lymphatic cell activity (T cells, B cells, plasma cells) →
  2. enhanced immune reaction and cytotoxic effect →
  3. inflammation with local tissue damage (ulcerations, erosions, necrosis)
  • Autoantibodies (pANCA) against cells of the intestinal epithelium
  • Ascending inflammation beginning in the rectum and spreading continuously proximally throughout the colon
66
Q

Ulcerative Colitis Risk Factors

A
  • Genetic predisposition (e.g., HLA-B27 association)
  • Ethnicity (white populations, individuals of Ashkenazi Jewish descent)
67
Q

Ulcerative Colitis

Intestinal Symptoms

A
  • Bloody diarrhea with mucus
  • Fecal urgency
  • Abdominal pain and cramps
  • Tenesmus
68
Q

Tenesmus

A

distressing and persistent but ineffectual urge to empty the rectum or bladder

69
Q

Ulcerative Colitis Extraintestinal Symptoms

A
  • Skeletal: osteoarthritis, ankylosing spondylitis, sacroiliitis
  • Ocular: uveitis; episcleritis
  • Biliary: primary sclerosing cholangitis (PSC)
    • Rare for patients with UC to develop PSC, but up to 90% of all patients affected by PSC will also be affected by UC.
  • Cutaneous: erythema nodosum, pyoderma gangrenosum, aphthous stomatitis,
  • General: fatigue
70
Q

Labs for Ulcerative Colitis

A
  • ↑ ESR, ↑ CRP, leukocytosis
  • Anemia
  • Thrombocytosis in some cases
  • ↑ Perinuclear ANCA (pANCA)
  • In case of concurrent PSC: elevated gamma-glutamyl transferase
71
Q

UC Endoscopic findings

A

Early stages

  • Inflamed, erythematous, edematous mucosa
  • Friable mucosa; bleeding on contact with endoscope
  • Fibrin-covered ulcers
  • Small mucosal ulcerations
  • Loss of superficial vascular pattern

Chronic disease

  • Loss of haustra
  • Pseudopolyps
    • Raised areas of normal mucosal tissue that result from repeated cycles of ulceration and healing
72
Q

Imaging for Ulcerative Colitis

A

Plain radiography

  • Loss of colonic haustra (lead pipe appearance)

Barium enema radiography

  • Pseudopolyps
73
Q

Ulcerative Colitis Tx

A
  • Oral/ topical 5-ASAs (5-aminosalicylic acid derivatives)
  • Oral/ Topicalcorticosteroids
  • Anti-TNF therapy; infliximab
  • surgical proctocolectomy with an ileal pouch-anal anastomosis
74
Q

Ulcerative Colitis Complications

A
  • Gastrointestinal bleeding (both acute and chronic)
  • Toxic megacolon
  • Perforation
  • Fulminant colitis; abdominal pain
  • ↑ Risk of cancer (see colorectal carcinoma)
    • Prevention: Screening colonoscopy with biopsies every 1–3 years starting 8 years after the initial diagnosis to screen for colorectal cancer
75
Q

Bowel Obstruction

A

Interruption of the normal passage of bowel contents either due to a functional decrease in peristalsis or mechanical obstruction.

  • Paralytic ileus: is a temporary disturbance of peristalsis in the absence of mechanical obstruction.
  • Mechanical bowel obstruction: is due to a structural barrier.
76
Q

Mechanical Bowel Obstruction

Clincal Features: Exam Findings

A

SBO/ LBO

  • Dehydration and possible hypovolemia
  • Diffuse abdominal tenderness
  • Tympanic percussion
  • Increased high-pitched, tinkling bowel sounds (early) or absent bowel sounds (late)
  • Collapsed, empty rectum on digital rectal examination
77
Q

Mechanical Bowel Obstruction

Clincal Features: Distentions

A

SBO

  • Less Significant

LBO

  • Early and Significant
78
Q

Mechanical Bowel Obstruction

Clincal Features: Constipation

A

SBO

  • Late Onset

LBO

  • Early ONset
79
Q

Mechanical Bowel Obstruction

Clincal Features: Vomiting/ Nausea

A

SBO

  • Early onset
  • Large volume
  • Billious

LBO

  • Late Onset
  • Initially Billious
  • Progresses to fecal vomiting
80
Q

Mechanical Bowel Obstruction

Clincal Features: Pain

A

SBO

  • Colicky
  • Periumbilical

LBO

  • Colicky or Constant
81
Q

Mechanical Bowel Obstruction

Pediatric Causes

A

SBO

  • Congenital intestinal atresia
  • Intussusception
  • Congenital strictures and bands

LBO

  • Hirschsprung disease
  • Congenital strictures and bands
  • Meconium ileus
  • Rectal atresia
82
Q

Mechanical Bowel Obstruction

Most Common Causes

A

SBO

  • Adhesions (e.g., prior abdominal surgery, abdominal tuberculosis)
  • Incarcerated hernias: second most common

LBO

  • Malignant tumors (e.g., colorectal carcinoma)
  • Volvulus: second most common
83
Q

Mechanical Bowel Obstruction

Diagnostics Labs

A

If recurrent vomiting

  • Hypochloremic hypokalemic metabolic alkalosis
  • Hyponatremia

If bowel strangulation

  • Metabolic acidosis
  • Hyperkalemia
84
Q

Mechanical Bowel Obstruction

Diagnostic Imaging

A

Abdominal series

  • hemodynamically unstable patients
    • Dilatation of bowel loops proximal to the obstruction
    • Minimal/no air within the bowel loops distal to the obstruction
    • Stepladder sign (x-ray)

CT abdomen and pelvis

  • hemodynamically stable patients

Abdominal ultrasound

  • Pendular peristalsis
  • Keyboard sign

Barium or water-soluble contrast enema

  • Bird beak sign seen in volvulus
  • Apple core sign seen in colonic malignancy
85
Q

Keyboard Sign

A
  • hyperechoic finger-like projections within the bowel lumen are the plicae circulares
  • resemble the keys of a keyboard and are a sign of bowel obstruction
  • The result of edema of the valvulae conniventes (circular mucosal folds in the wall of the jejunum).
86
Q

Stepladder sign (x-ray)

A
  • Multiple air-fluid levels and a stacked appearance of dilated small bowel loops
  • Best seen on an erect abdominal x-ray
87
Q

Mechanical Bowel Obstruction Tx

A

Conservative management

  • Partial or Complete with no signs of ischemia/necrosis
  • Fluid resuscitation, correction of electrolyte imbalance
  • Intestinal decompression: nasogastric tube insertion
  • Bowel rest (NPO)
    • Peristalsis-inducing medication- contraindicated in complete.

Surgery

  • Complete bowel obstruction with signs of ischemia/necrosis or clinical deterioration
88
Q

Paralytic Illeus

Etiology

A
  • Most common “5 Ps”: Peritonitis, Postoperative, low Potassium, Pelvic and spinal fractures, and Parturition
  • Other:
    • Endocrine Abnormalities
    • Neuropathy
    • Vascular Diseasse
    • Inflamation of intra abdominal organts
    • Drugs (anticholinergics, opiods, antidepressants)
89
Q

Paralytic Illeus

Clinical Features

A
  • Continuous (noncolicky) abdominal pain or discomfort
  • Nausea, vomiting
  • Abdominal distention
  • Percussion: tympany
  • bowel sounds are absent (silent abdomen)
90
Q

Paralytic Illeus

Diagnostics

A

Laboratory

  • Leukocytosis with left shift suggests intestinal infection or ischemia.
  • Hypokalemia, hypomagnesemia

Imaging

  • Abdominal x-ray: best initial test
    • Generalized small and large bowel gaseous distention
    • Visible gas shadows in the rectum
    • retroperitoneal hemorrhage; obliteration of the psoas muscle outline
91
Q

Paralytic Illeus

Treatment

A

Conservative treatment

  • no signs of localized or diffuse sepsis (e.g., appendicitis, secondary peritonitis)
  • Bowel rest
  • Nasogastric tube insertion
  • IV fluids and electrolyte repletion
  • Stop or decrease causative medications (e.g., opioids).

Surgical intervention: in patients with signs of peritonitis

92
Q

Bowel Obstruction Complications

A

Bowel ischemia

Bowel perforation

Peritonitis

Surgery Clerkship- Amboss Study Plan (6 decks)

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