Appendicitis, bowel obstruction, ileus, diverticulitis, GI bleed, toxic megacolon Flashcards
what is the cause of appendicitis
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
signs/symptoms of appendicitis
- epigastric pain localizing to RLQ
- fever
- N/V
what is the diagnostic imaging of choice for appendicitis
CT abdomen
what is the treatment of choice for appendicitis
laparoscopic appendectomy
what are the preoperative preparations for an appendectomy
- IV hydration
- abx (Cefoxitin or bactrim)
what is the presentation of a small bowel obstruction
- collicky pain
- N/V (distal = fecal matter, prximal = undigested food)
- distention
- s/s of dehydration (tachy/hypotension)
- “tinkling” on abdominal exam
If there is strangulation/instestinal ischemia present in SBO, what will exam show
- fever
- peritonitis symptoms such as guarding, rigid abdomen, rebound tenderness, pain out of proportion to the examination
- tachycardia
what is the diganostic study of choice for small bowel obstruction
abdominal xray showing ladder like appearance
what is the treatment of SBO
- surg consult
- NG tube
- IV fluids
what is the difference in treatment for a SBO with perforation/necrosis/compromise
- immediate surgery
- broad spectrum ABX
what is ileus
A condition in which there is neurogenic failure or loss of peristalsis in the intestine in the absence of any mechanical obstruction
What can cause ileus
- recent surgeries
- recent peritoneal inflammation
- severe illness
- meds (opioids/anticholinergics)
what is the clinical presentation for ileus
- N/V/obstipation, abdominal discomfort
- Abdominal distention with tympany to percussion
- Diminished/Absent bowel sounds
- Diffuse abdominal pain
what diagnostics are used to diagnose ileus
- plain ab xray (dilated, gas filled bowels)
- if cant distinguish between ileus and obstruction, use ct abdomen
what is the treatment for ileus
- remove cause
- NPO w NG tube
- slowly advance diet
NOT surgery
what are some preventative measures for paralytic ileus
- If possible, avoid IV opioids
- Early ambulation, initiation of clear liquid diet
- Gum chewing
where is diverticulitis MC
LLQ (sigmoid colon)
What causes diverticulitis
- Chronic constipation
- Low Fiber Diet
- Colonic musculature works to move hard stools, develops hypertrophy, thickens, gets rigid, and fibrotic
things tht incerase intraluminal pressure
what is the clinical presentation of diverticulitis
Acute LLQ abdominal pain
Low grade Fever
Bowel changes (diarrhea or constipation)
N/V
Blood in stool
LLQ tenderness on exam +/- palpable mass
leukocytosis
what diagnostic tools are used in diverticulitis
CT abdomen
which patients should be managed outpatient for diverticulitits and what is the treatment
- 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
who should be placed inpatient with diverticulitis
- large abscesses
- fever
- intoelrable pain/cant keep fluids down
what is the treatment for inpatient diverticulitis
- NPO w fluids
- Pip/Taz IV then metro+cipro oral for 7-14 days
surgery for non-improving or extremely severe patients
what is the MCC of a lower GI bleed
Diverticular disease
what is the treatment of a lower GI bleed secondary to diverticular disease
colonoscopy with cauterization
GI bleed
???????
what is the cause of toxic megacolon
IBS or inflammatory colitis
what is the diagnostic criteria of toxic megacolon
total or segmental nonobstructive colonic dilation of at LEAST 6 cm PLUS systemic toxicitiy
what is the basic pathophysiology of toxic megacolon
paralysis of smooth muscle tone = dilation of colon.
what is the presentation of toxic megacolon
- s/s of colitis for 1+ weeks
- MC severe bloody diarrhea
- abdominal pain/tenesmus
- s/s of toxicity/dehydration
tachy, hypotension, AMS, fever
what is the diagnostic of choice for toxic megacolon
abdominal CT scan
what is the treatment for toxic megacolon
NPO w fluids/electrolytes + this->
