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GI/GU II Exam 2 > Approach to the Pt with Abd Trauma & GI emergencies > Flashcards

Approach to the Pt with Abd Trauma & GI emergencies Flashcards

1
Q

what is the first approach to take for Tx of ingested FB

A

expectant (wait/watch) - majority of ingestions

make sure:

signs of airway compromise (choking, stridor, wheezing, difficulty breathing) must be addressed immediately (ENT or GI)

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2
Q

what are the 3 ways to classify hernia by the status of contents

A

reducible: soft & easy to replace back through the hernia neck defect

incarcerated: firm, painful and nonreducible by direct manual pressure, no signs of systemic illness

strangulated: firm, very painful w/ signs of systemic illness present (fever, N/V) implies impairment of blood flow (A, V or both)

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3
Q

when do genitourinary injuries occur

how do you assess these

A

direct blow to back of flank

suspect w/ gross/microscopic hematuria

CT abd/pelvis w/ IV contrast

suspect urethral disruption w/ anterior pelvic injuries

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4
Q

when do hollow viscus injuries occur

how do you assess these

A

sudden deceleartion injury (MVC)

suspect w/ deceleration injuries of chance fracture

early US & CT

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5
Q

what population is most likely to present w/ AAA

A

older pts

7% of > 50 yo, 4-8% M 65-80 yo

one of top 15 causes of mortality in US for 85-89

(USA- ruptured AAA = 4-5% sudden deaths)

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6
Q

what diagnostic imaging is used to evaluate ingestion FB

A

only in pts w/o sign/sxs suggestive of esophageal obstruction (dont delay EGD for imaging)

X-ray: anteroposterior & lateral views from neck, chest, and abd; not all FB can be seen on radiograph (fish/chicken bones, wood, plastic, glass, thin metal objects, food)

CT: suspected perforations, sharp/pointed FB, ingestion of packet of narcotic

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7
Q

which type of hernia is an acute SRG emergency

A

stragulated hernia

=severe, exquisite pain at the hernia site w/ sxs of intestinal obstruction, toxic appearance and possibly, skin changed over the hernia sac

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8
Q

when do duodenal injuries occur

how do you assess these

A

unrestrainted drivers prontal impact

bike handlebar injury

CT abd/pelvis w/ IV/oral contrast

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9
Q

what is the epidemiology of ingested foreign bodies

A

80% in kids

MOST pass W/O need for intervention

<1% require surgical intervention

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10
Q

what is the PE for the abd

A

inspect

ausculatate/percussion

palpation

assess pelvic stabilty

assess other areas: urethral meatus, perineal rectal, vaginal

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11
Q

what diagnostic tests are used for AAA

A

one time screening for at risk pt > 65

asymp (& known): 6 month or annual US/CT abd/pelvis

symp:

  • stable: CT abd/pelvis w/ IV contrast
  • unstable: if known Hx - straight to the OR; if unknown but suspected - CT abd/pelvis w/ IV contrast if possible
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12
Q

compare direct vs indirect inguinal hernias

A

MC = indirect; pass from internal to external thru the patent process vaginalis and then to the scrotum

direct = pass thru weakness in the tranversalis fascia in the hesselback triangle

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13
Q

when do pancreatic injuries occur

how do you assess these

A

direct blow to the pancreas that compress it against the vertbral column

check & trend amylase & lipase

CT of abd/pelvis w/ IV/oral contrast

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14
Q

a ruptured AAA can be misdiagnosed as

A

renal colic

perforated viscus

diverticulitis

GI hemorrhage

ischemic bowel

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15
Q

what is the pathophysiology of ingested FB

A

esophagus = most freq site of obstruction in GIT

often impacted at the sites of physiologic/pathologic luminal narrowing: UES, level of aortic arch and diaphragmatic hiatus

structural/fxnal esophageal abnormalities can increase risk of impaction (diverticula, webs, rings, strictures, achalasia and tumors

about 1/2 impactions - eosinophilic esophagitis

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16
Q

compare ingested FB in kids vs adults

A

kids:

6 months - 3 yrs (coins, buttons, batteries, toys, magnet, safety pins, screws, marbles)

adult:

accidental (95%) - MCC esophageal obstruction by food, more freq in elderly

intentional: psychiatric dz or intoxicated, prison, drug trafficking

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17
Q

what are the anatomic locations of hernias

A

ventral: epigastric, umbilical, spigelian, incisional, parastomal
groin: inguinal (direct/indirect), femoral, obturator

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18
Q

what are the treatments used for the different types of hernias

A

strangulated: SRG consult immediately, broad spectrum IV Abx, fluid resuscitation and adequate narcotic analgesia, preop lab studies
incarcerated: attempt to reduce, if unsuccessful - SRG
reducible: outpt SRG

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19
Q

what will be the historical and physical findings for appendicitis

A

RLQ abd pain (starts w/ visceral pain and then localizes)

anorexia, N/V, (+/-) fever

(+) McBurney’s point tenderness, Rovsing’s sign, Obturator sign and Psoas sign

20
Q

what are RFs for AAA

A

old

male

white

Fhx

smoking

presence of other large vessel aneurysm

artherosclerosis

21
Q

what are hernias

A

a protrusion, bulge or projection of an organ or part of an organ through the body wall that normally contain it

75% = inguinal; 2/3 of these = indirect

constant/intermittent mass in groin, gradually increasing in size

22
Q

What are the mechanisms of trauma

A

blunt trauma: direct blow causes rupture of hollow organs and bleeding; deceleration cause shearing injuries

penetrating trauma: stab wound and low velocity GSW - lacerating and cutting damage; high velocity -increased damage by cavitation

explosive: injuries by several mechanisms (blunt/pentrating, blast injury to lung & hollow viscus from blast overpressure, inhalation injury)

23
Q

What are statistics related to trauma

A

leading cause of mortality globally

road traffic - leading cause death 18-29 yo

USA- leading cause of death in young adults & >50 mil get trauma related medial care annually

10% all deaths among men & women

>45 mil ppl sustain moderate-severe disability each year

30% of all ICU admissions

24
Q

Most AAA have no sxs but is they do, how do they present

A

abd, back, flank pain

syncope

thromboembolism &/or limb ischemia

(if sxs present increased risk of rupture)

25
Q

What is the Tx of FB in the stomach/proximal duodenum

A

most FB that enter the stomach pass in 4-6 days

urgent endoscopy (w/i 24 hours) : sharp object, blunt object >2 cm in stomach, >5 cm at or above proximal duodenum, magnets, bateries, lead

expectant management: asymp pt w/ small blunt object - weekly x-ray until object passes, resume diet and monitor stool

26
Q

What is the pathophysiology of AAA

A

abd aorta > 3 cm in diameter (will progessively dilate over time)

MC below renal As

aortic diameter and ongoing smoking are the most imp factors that influence aortic expansion and risk of rupture

rapid diameter expansion >=5 mm over 6 months or >10 mm over a year also have increased risk for rupture

27
Q

what are the 3 categories of AAA

A

asymp: found incidentally

symp but not ruptured: rapidly expanding and large enough to compress surrounding or is inflammmatory/infectious (abd pain, flank pian, limb ischemia, fever, malaise)

symp & ruptured: BAD, high mortality/morbidity (classic triad: abd/flank/back pain, hypotension/shock & pulsatile abd mass)

28
Q

how do you Tx ingestion of FB distal to L of Trietz

A

most pt: expectant management - asymp pt w/ small, blunt objects - radiograph weekly, resume diet and monitor stool

endoscopic/SRG intervention - sign/sxs of inflam/intestinal obstruction (fever, abd pain, vomit)

29
Q

what is Tx for esophageal FB

A

emergent endoscopy w/i 6 hrs: complete obstruction, drooling, disk batteries in esophagus, sharp-pointed object

urgent endoscopy w/i 24 hrs: all FB in esophagus require removal w/i 24 hours

30
Q

what is apart of the initial evaluation for ingestion of FB

A

presence & severity of Sxs

type of object

location of object

31
Q

how do you Tx appendicitis

A

inital Tx: NPO, IVF, Antiemetics, pain meds, possible preop Abx

surgery

32
Q

what is FAST scan

A

standard set of US exam for evaluation of injured pt

Purpose: Detect free intraperitoneal fluid, pericardial fluid, pleural fluid, Hemothorax and pneumothorax in trauma pts

Limited sensitivity precludes the use of US = definitive test to r/o intraabd injury

33
Q

who gets a laparotomy

A

blunt abd trauma w/ hypotension w/ (+) fast scan or clinical evidence of intraperitoneal bleeding

34
Q

what is the mortality related to pelvis injuries

A

pt w/ hypotension & pelvic fracture - high mortality

all types of pelvic fractures = 1/6

closed pelvic fractures & hypotension = 1/4

open pelvic fracture = 1/2

(disruption of the pelvic ring tears the pelvic venous pelexus and occasionally disrupts the internal iliac arterial system)

35
Q

what is the incidence for appendicitis

A

233 out of 100K ppl

highest in 10-19 y/o

36
Q

When do diaphragm injuries occur

A

blunt high impact (MCV)

most often on L

suspect w/ thoraco-abd trauma

*good reason not to use a trochar when putting in chest tube

37
Q

if solid organs are injured what is the best approach

A

liver & spleen (MC)

if hemodynamically stable - concervative w/ close observation by surgeon

if unstable or continued bleedng -operative management

38
Q

what are most blunt abd trauma related to and what can they injure

A

75% MVC or auto vs pedestrian accidents

15% blows to the abd

6-9% falls

spleen and liver are MC injured

39
Q

what are signs and Sxs of ingested FB

A

may be asymp

acute dysphagia, choking, refusal to eat, hypersaliva, retrosternal fullness, regurgitation of undigested food, wheezing and blood-stained saliva

drooling and inability to swallow liquid - emergent endoscopic evaluation needed

fever, abd pain, repetitive vomiting after ingestion

(be sure to record type of FB, time of ingestion and presence & type of ongoing sxs)

40
Q

what are the 3 possible ways hernias can be classified

A

anatomic location: ventral, groin

hernia content: usually bowel/fat

(most imp) status of those contents: reducible, incarcerated, strangulated

41
Q

what is the treatment for AAA

A

conservative (asym infrarenal AAA < 5.5mm)

elective repair (open/endocasvular)

  • asymp AAA > 5.5 cm in good SRG candidates
  • rapidly expanding (>0.5 cm/6 months or >1 cm/year) infrarenal AA in well-documented serial studies
  • pt w/ associated arterial dz (coexisting iliac, femoeral or popliteal A aneurysm) or symp peripheral A dz undergoing revascularization
42
Q

what does early appendicitis mimic

A

gastroenteritis

viral illness

43
Q

what is the epidemiology of vental hernias

A

epigastric & umbilical = MC ventral hernias

1/4 ppl are either born with it or will develop one in their lifetime

incision hernias may develop anywhere an incision has been made- MC at midline (bc MC used in laparotomy), spigelian and parastromal occur off the midline

USA ->$3.4 billion spent on repair

44
Q

what is the diagnositic testing for appendicitis

A

CBC (increase/nl)

chem profile (electrolytes & LFTs)

UA - could be abnormal

pregnancy test

imaging - adults: CT abd/pelvis w/ IV & oral contrast; kids- US, if (-) and still suspect then use CT; pregnant pt: MRI

45
Q

what are history needed to assess trauma

A

blunt: MVC location, restraints, airbag, intoxication, impact, speed, ejection/rollover, state of passengers

penetrating: time, type of injury, distance, # stab/shots

explosive: enclosed space or not, distance from detonation, combination of blunt and penetrating, possible inhalation injury

46
Q

Appendicitis is known to be one of the most..

A

MCC of acute abd

most freq indications for emergent abd SRG w/w

most freq in 20s-30s

47
Q

what is a great way for taking care of critically ill pts

A

ABCDE

Airway- maintenance w/ c-spine control

Breathing/ventilation

Circulation w/ hemorrhage

Disablity/neurologic status

Exposure/environmental control (completely undress the pt and prevent hypothermia)

GI/GU II Exam 2 (19 decks)

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