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