Abdominal Topics 1 Flashcards
Findings and imaging for appendicitis
Labs: leukocytosis with left shift
Abdomen CT with IV/PO contrast shows > 7 mm appendix
Abx for appendectomy
Cefotoxin
or Cefazolin + Metronidazole
When should asx gallstones be removed?
If immunosuppressed or has DM
What will you see on imaging for acute cholecystitis?
US: gallbladder wall thickening, peri-cholescystic fluid
Positive HIDA scan
Gallbladder polyp sizes
< 5 mm benign 6-9 mm: multiple = benign, solitary = neoplastic 1-2 cm: high malignancy potential 2+ cm: malignant *anything 1+ cm = cholecystectomy
How to dx biliary dyskinesia
HIDA w/ CCK provocation replicates sx or EF < 35% of bile
Charcot’s triad of cholangitis
Fever, abdominal pain, jaundice
Tx for cholangitis
Like sepsis -- Fluid resuscitation Abx (Zosyn or meropenem) Blood cultures ICU - can progress quickly!
Findings for esophageal perforation
Chest pain, SQ emphysema, tachycardia/tachypnea, pneumomediastinum
Tx for esophageal perforation
IV hydration NPO/NG tube IV abx IR drainage Chest tubes
Causes of SBO
70% Intra-abdominal adhesions (kinks, rotations)
20% Tumors: usually a metastasis
10% Hernias
Risk factors for SBO
Surgery, hernia, intestinal inflammation, neoplasm hx, IR, hx of foreign body ingestion
Best imaging for free air in a SBO?
upright CXR
What do you see on abdominal CT in SBO?
Physical point of obstruction Dilated bowel (proximally) gives way to non-dilated bowel (distally) --> transition point
Tx for uncomplicated acute diverticulitis
Oral levo/ciprofloxacin + metronidazole
