Acute inflammatory disorders of the abd

Question 1

Peritonitis Definition

Answer 1

spontaneous bacterial peritonitis
transmigration of bacteria
enteric gram-negative bacilli is most common
klebsiella, pneumococcus enterococcus are also common

Question 2

secondary peritonitis definition

Answer 2

peritonitis from sx,
polymicrobial
penetrating trauma
perforation dt appendicitis, colitis, peptic ulcer dz, diverticulitis, pancreatitis, and cholecystitis

Question 3

Peritonitis S&S

Answer 3

fever, abd pain w change in mental status dt hepatic encephalopathy

Question 4

secondary Peritonitis S&S

Answer 4

acute abd pain
high fever,
N/V
constipation
abd exam reveals: distention, rebound tender, generalized rigidity, decreased bowel sounds, hyperresonance, Ascites, dyspnea/tachypnea, dehydration

Question 5

peritonitis diagnostic test

Answer 5

Paracentesis (ascitic fluidO
bld cultures: + 25% time
WBC: elevated in secondary
BUN: increased
abd xray: free air, bowel dilation
Chests xray: elevated diaphragm

Question 6

peritonitis paracentesis

Answer 6

evaluate ascitic fluid

Question 7

peritonitis BUN

Answer 7

increased

Question 8

peritonitis Bld cultures

Answer 8

+ 25% of time

Question 9

Peritonitis abd x ray findings

Answer 9

free air, bowel dilation

Question 10

peritonitis chest xray findings

Answer 10

elevated diaphragm

Question 11

management of primary peritonitis

Answer 11

ABx: 3rd gen cephalosporin

10 days

Question 12

management of secondary peritonitis

Answer 12

operative to eliminate source, empiric abx, monitor cultures, IV fluid, monitor vs, urinary output

Question 13

common cause of appendicitis

Answer 13

fecalith
intestinal parasite
inflammation
neoplasm

Question 14

early S&S of appendicitis

Answer 14

vague, colicky, periumbilical abd pain, n/v

12-48 hrs pain migrates to RLQ, fever

Question 15

atypical s&s of appendicitis

Answer 15

indigestion, flatulence, diarrhea, malaise

Question 16

classic sign of appendicitis

Answer 16

McBurney sign: ae

Question 17

where is Mcburney sign

Answer 17

: a deep tenderness locatred 2/3 of distance from umbilicus to r anterior superior iliac spine

Question 18

Rovsing sign

Answer 18

pain illicited on the rlq when you palpate the llq

Question 19

iliopsoas test

Answer 19

straight leg test that causes pain when you lift the right leg straight up

Question 20

obturator test

Answer 20

lift a bended knee/ leg upwards

Question 21

what is peritonitis

Answer 21

Rupture: obstruction persists, pressure increases and wall of lumen becomes weak until it ruptures,
spills bacteria into peritoneum causing peritonitis

Question 22

S&S of appendicitis

Answer 22

ABd gaurding: early sign of peritoneal irritation

Rebound tenderness

Question 23

diag labs for appendicitis

Answer 23

lab: wbc, increased CRP, dehydration or fluid/electrolyte imbalance,
UA: r/o genitourinary cond
Urine or serum preg test

Question 24

diag test for appendicitis

Answer 24

plain abd film: no useful
US: show enlarged appendix w/ diameter >6
abscess: increased echogenic periappendiceal fat and appendicolith
CT: done as fu, if US inconclusive
enlarged appendix, appendiceal wall thickened
>2mm

Question 25

appendicitis differentials

Answer 25

confused with gastroenteritis and GYB disorders
resemble: diverticulitis, carcinoid of appendix, perforated colon ca, Crohns, perforated peptic ulcer, cholecystitis, mesenteric adenitis

Question 26

appendicitis tx

Answer 26

classic findings: sx without imaging

atypical presentation: further test to r/o bowel obstruction, ovarian/testicular torsion, kidney stones

Question 27

appendectomy

Answer 27

acute perforated should be done within 12 hrs of dx

preop tx: iv rehydration, rebalance electrolytes

Question 28

prophylactic abx for appendicitis

Answer 28

start at diagnosis and <30 min before sx incision
iv dose 2gm cefoxitin/cefotetan
or
3 gm cefazolin + 5 Flagyl
if allergic:
clindamycin + ciprofloxacin, levofloxacin or gentamicin

Question 29

perforation or gangrene S&S

and tx

Answer 29

generalized peritonitis,
hemodynamic instability
requires: emergency appy w/ irrigation/drainage of abd cavity

Question 30

appendicitis: post op care

Answer 30

clear liq adv to reg diet as tolerated
dc when afebrile and tolerating diet
abx are not needed post sx

Question 31

appendicitis: nonoperative tx

Answer 31

stable w/ perforated appendix
local symptoms w/ no general peritonitis can be tx non operative.
phlegmon tx w/ ivf, abx
repeat imaging to follow
CT guided percutaneous drainage
may need appy anyways