Arnce DSA Flashcards
Who most commonly get appendicitis?
10-19 yr old age group
What imaging do you do for appendicitis in adults and kids?
adults: CT abdomen and pelvis w/ IV and oral contrast
Kids: US of RLQ first, if US negative need CT
What can mimic early appendicitis?
GI or viral illnesss
*can have normal CBC or abnormal UA and still have appendicitis
Where are physio spaces of narrowing of the esophagus?
upper eso sphincter
level of aortic arch
diaphragmatic hiatus
What do you do if someone w/ esophagus food impaction is drooling and can’t swallow liquids?
emergent EGD w/in 6 hrs
most likely complete obstruction
When should foreign bodies in the esophagus be removed?
within 24 hrs
what happens to most foreign bodies in the stomach?
When would you do emergency EGD?
most pass in 4-6 days
do egd if sharp > 5 cm in length at or above proximal duodenum, magnets, > 2cm in diameter, batteries, or lead-containing
What do you do for foreign object distal to ligament of treitz?
expectant management
resume normal diet
What types of hernias are most common?
75% are inguinal
2/3 of all inguinal hernias are indirect
What are direct and indirect inguinal hernias?
direct: passes directly thru weakness in transversalis fascia thru hesselbach triangle
indirect (most common): thru internal and external inguinal rings thru patent process vaginalis and then to scrotum
When is an AAA diagnosed?
when the aortic diameter exceeds 3.0 cm
What is the classic triad of a ruptured AAA?
abdominal/ flank pain
hypotension
pulsatile abd mass
If someone has hx of AAA and is symptomatic, what do you do?
to OR without imaging
for other suspected AAAs, CT abd/pelvis
When do you do conservative management of a AAA?
asymptomatic infrarenal < 5.5 cm
What are the most commonly injured solid organs?
spleen and liver
What type of injuries occur in an explosive injury?
blunt and penetrating
blast injury to lung and hollow viscus
inhalation
What do you do in a primary trauma survey?
ABCDE airway Breathing Circulation w/ hemorrhage control Disability/neuro status Exposure/ environmental control - completely undress pt, prevent hypothermia
Where do diaphragm injuries occur most often and what do you NOT do to tx them?
most often on left
result from high impact MVC
DONT use trochar when putting in chest tube
When do traumatic duodenal injuries often occur?
imaging?
unrestrained drivers frontal impact
bicycle handlebar injury
CT abd/pelvis w/ IV and oral contrast
When do pancreatic lacerations occur?
direct blow to the pancreas that compresses it against vertebral column
When do you suspect a GU trauma?
gross or microscopic hematuria
direct blows to back or flank
(suspect urethral disruption w/ anterior pelvic injuries)
When do hollow viscus injuries occur?
sudden deceleration injuries or chance fracture
*early US and CT are often not diagnostic
Why are pelvic fractures so dangerous?
can disrupt pelvic venous plexus/ splanchnic vessels and occasionally the internal iliac A system
ppl used to bleed out and die all the time before interventional radiology
Who goes to surgery in an abdominal trauma?
hypotension, + FAST scan, or clinical evidence of bleed
blunt or penitrating injury w/ + DPL (diagnostic peritoneal lavage)
What are the 4 parts of a FAST scan?
RUQ - liver and kidney, morrison’s pouch
LUQ - splenorenal pouch
subxyphoid cardiac view
bladder scan (longitudinal and transverse views)
