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Surgery EOR (billie) > Appendicitis, bowel obstruction, ileus, diverticulitis, GI bleed, toxic megacolon > Flashcards

Appendicitis, bowel obstruction, ileus, diverticulitis, GI bleed, toxic megacolon Flashcards

1
Q

what is the cause of appendicitis

A

fecalith (MC)
neoplasm
inflammation
foreign body

Obstruction leads to increased intraluminal pressure, venous congestion, infection
Can progress to gangrene and perforation develops within 36 hours left untreated

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1
Q

signs/symptoms of appendicitis

A
  • epigastric pain localizing to RLQ
  • fever
  • N/V
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2
Q

what is the diagnostic imaging of choice for appendicitis

A

CT abdomen

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3
Q

what is the treatment of choice for appendicitis

A

laparoscopic appendectomy

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4
Q

what are the preoperative preparations for an appendectomy

A
  • IV hydration
  • abx (Cefoxitin or bactrim)
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5
Q

what is the presentation of a small bowel obstruction

A
  • collicky pain
  • N/V (distal = fecal matter, prximal = undigested food)
  • distention
  • s/s of dehydration (tachy/hypotension)
  • “tinkling” on abdominal exam
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6
Q

If there is strangulation/instestinal ischemia present in SBO, what will exam show

A
  • fever
  • peritonitis symptoms such as guarding, rigid abdomen, rebound tenderness, pain out of proportion to the examination
  • tachycardia
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7
Q

what is the diganostic study of choice for small bowel obstruction

A

abdominal xray showing ladder like appearance

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8
Q

what is the treatment of SBO

A
  • surg consult
  • NG tube
  • IV fluids
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9
Q

what is the difference in treatment for a SBO with perforation/necrosis/compromise

A
  • immediate surgery
  • broad spectrum ABX
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10
Q

what is ileus

A

A condition in which there is neurogenic failure or loss of peristalsis in the intestine in the absence of any mechanical obstruction

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11
Q

What can cause ileus

A
  • recent surgeries
  • recent peritoneal inflammation
  • severe illness
  • meds (opioids/anticholinergics)
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12
Q

what is the clinical presentation for ileus

A
  • N/V/obstipation, abdominal discomfort
  • Abdominal distention with tympany to percussion
  • Diminished/Absent bowel sounds
  • Diffuse abdominal pain
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13
Q

what diagnostics are used to diagnose ileus

A
  • plain ab xray (dilated, gas filled bowels)
  • if cant distinguish between ileus and obstruction, use ct abdomen
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14
Q

what is the treatment for ileus

A
  • remove cause
  • NPO w NG tube
  • slowly advance diet

NOT surgery

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15
Q

what are some preventative measures for paralytic ileus

A
  • If possible, avoid IV opioids
  • Early ambulation, initiation of clear liquid diet
  • Gum chewing
16
Q

where is diverticulitis MC

A

LLQ (sigmoid colon)

17
Q

What causes diverticulitis

A
  • Chronic constipation
  • Low Fiber Diet
  • Colonic musculature works to move hard stools, develops hypertrophy, thickens, gets rigid, and fibrotic

things tht incerase intraluminal pressure

18
Q
A
19
Q

what is the clinical presentation of diverticulitis

A

Acute LLQ abdominal pain
Low grade Fever
Bowel changes (diarrhea or constipation)
N/V
Blood in stool
LLQ tenderness on exam +/- palpable mass
leukocytosis

20
Q

what diagnostic tools are used in diverticulitis

A

CT abdomen

21
Q

which patients should be managed outpatient for diverticulitits and what is the treatment

A
  • pts with no fever, peritoneal signs and who are able to tolerate fluids.
  • tx: clear liquid diet for 2-3 days then high fiber diet
22
Q

who should be placed inpatient with diverticulitis

A
  • large abscesses
  • fever
  • intoelrable pain/cant keep fluids down
23
Q

what is the treatment for inpatient diverticulitis

A
  • NPO w fluids
  • Pip/Taz IV then metro+cipro oral for 7-14 days

surgery for non-improving or extremely severe patients

24
Q

what is the MCC of a lower GI bleed

A

Diverticular disease

25
Q

what is the treatment of a lower GI bleed secondary to diverticular disease

A

colonoscopy with cauterization

26
Q

GI bleed

A

???????

27
Q

what is the cause of toxic megacolon

A

IBS or inflammatory colitis

28
Q

what is the diagnostic criteria of toxic megacolon

A

total or segmental nonobstructive colonic dilation of at LEAST 6 cm PLUS systemic toxicitiy

29
Q

what is the basic pathophysiology of toxic megacolon

A

paralysis of smooth muscle tone = dilation of colon.

30
Q

what is the presentation of toxic megacolon

A
  • s/s of colitis for 1+ weeks
  • MC severe bloody diarrhea
  • abdominal pain/tenesmus
  • s/s of toxicity/dehydration

tachy, hypotension, AMS, fever

31
Q

what is the diagnostic of choice for toxic megacolon

A

abdominal CT scan

32
Q

what is the treatment for toxic megacolon

A

NPO w fluids/electrolytes + this->

Surgery EOR (billie) (17 decks)

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