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GI Final > Acute Abdomen Surgery-Safaoui/Davis > Flashcards

Acute Abdomen Surgery-Safaoui/Davis Flashcards

1
Q

What is acute abdominal pain?

A

Severe abdominal pain with an acute onset (<8 hours) that lasts for several hours

  • 2/3 of hospital admissions for this are associated with high morbidity and mortality
  • surgical evaluation is warranted*
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2
Q

What is the difference in the presentation of visceral vs parietal pain? (trigger, characteristics of pain, autonomics, surgical intervention needed?)

A

Visceral:

  • Triggered by inflammation, ischemia, distention, traction, and pressure
  • pain is vague, deep, dull and poorly localized
  • bilateral autonomics
  • intra-abd disease but not necessarily surgical

Parietal:

  • triggered by irritation of the parietal peritoneum
  • sharp, severe, well-localized
  • unilateral somatics
  • frequently needs surgical intervention
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3
Q

What is the most common cause of acute abd pain in young people? Old people? In pregnancy?

A

young=appendicitis

old=biliary disease then SBO

pregnancy=appendicitis (might be in location other than RLQ)

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4
Q

What type of pain do foregut problems present with? Midgut? Hindgut?

A

Foregut (stomach, duodenum, liver, pancreas, spleen, biliary tract) =epigastric pain

Midgut (small bowel to proximal 2/3 of transverse colon) =periumbilical

Hindgut (Distal 1/3 of transverse colon to anal verge) =suprapubic pain

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5
Q

What comes first in a surgical conditions, pain or nausea and vomiting? Medical conditions?

A

surgical =pain first then n/v

medical=n/v then pain

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6
Q

What problems can present with RUQ pain? (3)

A
  • Cholecystitis
  • PNA
  • Pyelonephritis
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7
Q

What problems can present with LUQ pain? (5)

A
  • PUD
  • Splenic infarct
  • pancreatitis
  • PNA
  • Pyelonephritis
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8
Q

What problems can present with RLQ pain? (5)

A
  • appendicitis (late)
  • IBD
  • OB/GYN
  • Pyelonephritis
  • Hernia
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9
Q

What problems can present with LLQ pain? (4)

A
  • OB/GYN
  • Pyelonephritis
  • Diverticulitis
  • Hernia
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10
Q

What problems can present with suprapubic pain? (4)

A
  • IBD
  • OB/GYN
  • Diverticulitis
  • UTI
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11
Q

What problems can present with periumbilical pain? (4)

A
  • appendicitis (early)
  • SBO
  • Mesenteric ischemia
  • AAA
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12
Q

What is the differential for colicky, crampy, intermittent pain?(4)

A
  • Biliary colic
  • Ureteral colic (kidney stones)
  • Small bowel obstruction
  • Large bowel obstruction
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13
Q

What is the differential for gradual progressive pain? (7)

A
  • Hepatitis
  • Cholecystitis
  • Pancreatitis
  • Appendicitis
  • Diverticulitis
  • Tubo-ovarian abscess
  • Ectopic pregnancy
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14
Q

What is the differential for sudden, severe abd pain? (3)

A
  • Ruptured AAA
  • Perforated ulcer
  • ureteral colic
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15
Q

What refers pain to the right shoulder? (3)

A
  • liver
  • gallbladder
  • right hemidiaphragm
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16
Q

What refers pain to the left shoulder? (3)

A

-Heart
-Tail of pancreas
Spleen
-Left hemidiaphragm

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17
Q

What refers to scrotum and testicular pain?

A

Ureter

18
Q

What is the most common type of hernia in males and females?

A

Indirect inguinal hernia

19
Q

What are the borders of Hesselbach’s triangle? What does this determine?

A
  • Inferior epigastrics
  • Lateral edge of the rectus abdominis m.
  • Inguinal ligament
  • Inside triangle (Medial to epigastrics)=DIRECT hernia
  • Lateral to epigastrics=INDIRECT hernia
20
Q

What is the most frequently encountered surgical disorder of the small intestine? What is the most common cause in pts with previous surgery? Pts without previous surgery?

A

Small bowel obstruction

  • previous surgery: adhesions
  • without surgery: hernia
21
Q

What does air in the biliary tree indicate?

A

Gallstone ileus

22
Q

How does a Partial SBO present?

A
  • Continued passage of flatus and/or stool beyond 6 to 12 hours after onset of symptoms
  • Occurs slowly
  • Strangulation is less likely to develop (much more/faster in a closed loop SBO)
23
Q

What is the presence of fat wrapping, mesenteric fat creeping onto the serosal surface of the bowel pathognomonic for?

A

Crohns

can have a “beefy-red appearance of terminal ileum

24
Q

What is toxic colitis? What can it lead to?

A
  • > 6 bloody stools/d
  • fever
  • tachycardia
  • inc WBC
  • dec Hgb/Hct

can get toxic megacolon (all of the above symptoms w/ abd pain, tenderness and distention)

25
Q

What is the key to finding the appendix?

A

finding the tenia

26
Q

What are the complications of acute appendicitis?

A
  • perforation (normally on ante mesenteric border)–> peritonitis
  • abscess or phlegmon
  • sepsis
27
Q

What is the most common cause of acute appendicitis in children? In adults?

A

Children=hypertrophied lymph tissues

adult=fecalith

28
Q

If carcinoid is found >2 cm and involving the base on the path report of an appendectomy, what should be done?

A

right hemicolectomy

29
Q

What is the most common cause of fistulas in the GI tract?

A

diverticulitis

LLQ pain, obstipation, fever, leukocytosis

30
Q

What is the best imaging to diagnose diverticulitis?

A

CT with contrast

31
Q

What is the first line treatment for uncomplicated diverticulitis?

A
  • antibiotics (metronidazone + cipro or amoxicillin)

- bowel rest

32
Q

When should surgery be consulted for diverticulitis?

A

Perforation with Peritonitis

Decompensated Clinical Status

Failure to respond to Medical Management after 72 hrs.

33
Q

What is the most common cause of a large bowel obstruction (distal to ileocecal valve)?

A

cancer

34
Q

How does acute mesenteric ischemia present? What is the most common cause?

A
  • > 60 yo
  • 3x more common in women
  • sudden onset of mid abdominal pain OUT OF PROPORTION TO PE
  • esp in pts with hx of CV disease, CHF, MI or arrhythmias, or stroke
  • most common cause=atherosclerotic vascular disease
  • 80% mortality

–> needs early recognition

35
Q

What is acute mesenteric ischemia?

A

-Reduction in intestinal blood flow

  • Most commonly due to:
  • Occlusion (arterial embolus or thrombosis or venous thrombosis)
  • Vasospasm (least likely)
  • Hypoperfusion
36
Q

What is the gold standard for acute mesenteric ischemia?

A

mesenteric arteriography

37
Q

What is chronic mesenteric ischemia?

A
  • Lack of blood supply in splanchnic region.
  • From atherosclerotic lesions
  • Develops slowly allowing for the development of collaterals.
  • Rarely causes intestinal infarction.
  • At least 2 of the arteries are occluded or stenosed.
38
Q

How does Chronic Mesenteric Ischemia typically present? what often happens with these pts?

A
  • Postprandial abdominal pain
  • “food-fear”
  • weight loss.

-These patients are often thought to have a malignancy and are misdiagnosed.

39
Q

What is the gold standard for chronic mesenteric ischemia?

A

angiography

40
Q

What is the most common cause of mesenteric ischemia? What areas are normally affected?

A
  • ischemic colitis (colonic ischemia)

- watershed areas with limited collateral blood supply (splenic flexure and left colon)

41
Q

What is the typical presentation of ischemic colitis? What test makes the definitive diagnosis?

A

-Acute onset of LLQ pain followed by
Mild to moderate rectal bleeding or bloody diarrhea within the first 24 hours
-Physical examination reveals mild to moderate abdominal tenderness over the affected bowel, most often left-sided

*colonoscopy with biopsy

GI Final (18 decks)

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