acute care surgery and general surgery Flashcards
describe how visceral pain usually presents
- dull, achy
- poorly localized
describe how parietal pain usually presents
- sharp
- well-localized
- ex: peritoneal irritation
describe how referred pain usually presents
- aching
- percieved near surface of body
sites of pain (inc referred) for gallbladder
- RUQ
- right mid back
- right shoulder
sites of pain (inc referred) for pancreas
- mid epigastric pain
- mid back pain
clinical presentation
- anorexia
- abd pain
- bloating
- N/V
- obstipation
- high pitched or absent bowel sounds
- tympany on percussion
- obstruction
extrinsic causes of small bowel obstruction
- adhesions
- hernia
- volvulus
clinical presentation
- patients lie still
- rebound tenderness, tenderness to percussion
- pain with light palpation
- diminished bowel sounds
peritonitis
what imaging should you get if you suspect bowel obstruction
- abd plain films: dilated bowel loops, free air
- CT without oral contrast: provides better information
what imaging should you get if you suspect peritonitis
- US
- CT
what is a positive murphys sign
- performed by asking pt to breathe out and then placing the hand below the costal margin on the right side at the mid-clavicular line.
- The patient is then instructed to breathe in.
- If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner’s fingers) and winces with a ‘catch’ in breath, the test is considered positive
when should cholecystectomy be performed once acute cholecystitis is diagnosed
- within 3 days of symptom onset
- high risk pt (DM, chronic steroid use) need immediate operative tx
non-operative management of acute cholecystitis
- IV fluid
- Abx (1st or 2nd generation cephalosporin)
- lack of improvement within 1-2 days -> operative intervention
what structures make up the triangle of calot
- cystic artery
- cystic duct
- common bile duct
what is the most common cause of choledocholithiasis
- secondary
- stones formed in gallbladder and get stuck in common bile duct
treatment of choledocholithiasis
- ERCP
what is cholangitis
- ascending bacterial infection -> medical emergency
- due to obstruction of the biliary ducts
what is the most common cause of cholangitis
choledocholithiasis
what is charcot’s triad and what condition is it associated with
- cholangitis
- fever
- RUQ pain
- jaundice
what is Reynold’s pentad and what condition is it associated with
- cholangitis
- fever
- RUQ
- jaundice
- hypotension
- altered mental status
clinical presentation
- acute upper abd pain radiating to the back
- N/V
- pain relieved with sitting or leaning forward
- amylase, lipase elevated
pancreatitis
grey-turner sign
- refers to bruising of the flanks
- retroperitoneal hemorrhage seen with acute pancreatitis
culen’s sign
- bruising in the subcutaneous fatty tissue around the umbilicus
- observed with acute pancreatitis
management of pancreatitis
- ICU
- NPO
- IV fluids
- pain management
what is a pancreatic pseudocyst
- collection of pancreatic fluid within wall of inflammatory tissue
- no epithelial lining
- seen in 1/3 pts with chronic pancreatitis
treatment of pacnreatic pseudocyst
- resolve spontaneously (50%)
- percutaneous drainage (after 6 weeks)
most common type of gastric cancer
adenocarcinoma
splenic abscess typically results from
- endocarditis
- or seeding from other infection site
classic symptoms of splenic abscess
- fever
- LUQ pain
- +/- splenomegaly
typical symptom of splenic infarct
- acute LUQ pain
- without fever
what vaccine should a patient with splenectomy be given
- pneumococcal
define dehiscence
- partial or total disruption of any or all layers of the operative wound
define evisceration
- rupture of all layers and extrusion of abdominal viscera
when is dehiscence most common
- between 5th and 8th day post-op
what medication should be avoided in initial management of an acute abd pain in the ER
- NSAIDs
pain before vomiting typically associated with
- surgical abdomen
