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Gastrointestinal > Ch 4 MDT > Flashcards

Ch 4 MDT Flashcards

1
Q

Diarrhea

How many Bowel movements a day for dx?

A

3

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2
Q

Diarrhea can be diagnosed as:

A

Acute or Chronic

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3
Q

Diarrhea acute in onset and persisting for less than 2 weeks is most commonly caused by:

A

Infectious agents

Bacterial toxins (either produced in the gut)

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4
Q

Infectious sources can be transmitted by fecal-oral contact, food and water and usually have incubation periods between:

A

12 and 72 hours

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5
Q

Percentage of all water absorbed in the GI tract takes place in the small intestine

A

> 90%

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6
Q

What is the major site of water resorption?

A

Jejunum

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7
Q

Colon absorbs additional fluid, transforming a relatively liquid fecal stream in the cecum to a well-formed solid stool in the:

A

Rectosigmoid

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8
Q

Disorders of the small intestine result in increased amounts of diarrheal fluid with a greater loss of:

A

Water

Electrolytes

Nutrients

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9
Q

Infectious agents are the most common causes of:

A

Acute gastroenteritis

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10
Q

Diarrheal disease (three of more times per day or at least 200g of stool per day) of rapid onset that lasts less than 2 weeks

May be accompanied by nausea, vomiting, fever, or abdominal pain

A

Acute Gastroenteritis

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11
Q

Common findings on physical examination of patients with acute viral gastroenteritis include:

A

Mild diffuse abdominal tenderness on palpation

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12
Q

Gastroenteritis that is usually self-limited and is treated with supportive measures (fluid repletion and unrestricted nutrition)

A

Acute viral gastroenteritis

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13
Q

Increase fluid secretion and/or decreased absorption, produces an increased luminal fluid content that cannot be adequately reabsorbed leading to dehydration.

Mechanisms that cause diarrhea:

A

Adherence

Mucosal invasion

Enterotoxin production

Cytotoxin production

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14
Q

Gastritis involves ONLY the:

A

Stomach

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15
Q

Endoscopic or radiologic characteristics of abnormal-appearing gastric mucosa

A

Gastritis

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16
Q

Diagnosis of gastritis is defined as and requires:

A

histopathologic evidence of inflammation

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17
Q

Two most common causes of gastritis

A

Chronic NSAID use

Chronic Alcohol use

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18
Q

Gastritis is typically self limited but patients may benefit from:

A

PPI

Removal of the offending agent

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19
Q

If gastritis does not resolve with conservative management, consider referral for:

A

Endoscopy and H. Pylori testing

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20
Q

Chronic diarrheal illnesses may be classified as follows:

A

Osmotic

Inflammatory

Secretory

Chronic infections

Malabsorption syndromes

Motility disorders

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21
Q

Due to an increase in the osmotic load presented to the intestinal lumen either through excessive intake or diminished absorption

A

Osmotic (Medications/Zollinger - Ellison Syndrome)

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22
Q

Diarrhea

Chronic Parasitic Infection

A

Giardia Lamblia

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23
Q

Malabsorption syndromes:

A

Celiac disease

Whipple

Crohn disease

Lactose Intolerance

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24
Q

Motility disorder:

A

Irritable bowel syndrome

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25
Q

From a diagnostic and therapeutic standpoint, it is helpful to classify infectious diarrhea into syndromes that produce:

A

Inflammatory or blood diarrhea

AND

Non-inflammatory, non-bloody, or watery

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26
Q

The term “Inflammatory diarrhea” suggests colonic involvement by:

A

Invasive bacteria

Parasites

Toxin production

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27
Q

Frequent bloody, small-volume stools

Fever, abdominal cramps, tenesmus, and fecal urgency

A

Inflammatory diarrhea

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28
Q

Common causes of inflammatory diarrhea

A

Shigella

Salmonella

E. Coli

Protozoal: Entamoeba histolytica

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29
Q

Community outbreaks of acute infectious diarrhea suggest:

A

Viral etiology

Common food source

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30
Q

Acute infectious diarrhea in family members suggest:

A

Infectious origin

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31
Q

Acute Infectious Diarrhea

Ingestion of improperly stored or prepared food implicates:

A

Food Poisoning

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32
Q

Acute non-inflammatory diarrhea is generally milder and is caused by:

A

Viruses or toxins that affect the small intestine

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33
Q

The viruses or toxins in acute non-inflammatory diarrhea interfere with ________ balance, resulting in large-volume water diarrhea, nausea, vomiting, and cramps.

A

Salt and water

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34
Q

Food Poisoning with a short incubation

Symptoms 1-6 hours after consumption is from a:

A

Toxin

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35
Q

Short incubation food poisoning symptoms

A

Vomiting is the major complaint

Fever is absent

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36
Q

Longer incubation period of food poisoning (8-16) symptoms:

A

Vomiting is less prominent

Abdominal cramping is frequent

Fever is absent

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37
Q

Treatment for 90% of acute non-inflammatory diarrhea respond with in ___ days to simple rehydration therapy or antidiarrheal agents

A

5

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38
Q

Diarrhea

When should stool be sent for fecal leukocyte, ovum and parasite evaluation, and bacterial culture?

A

More than 7 days

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39
Q

Diarrhea

Prompt medical evaluation:

A

Fever, bloody diarrhea, or abdominal pain

Six or more unformed stools in 24 hours

Profuse watery diarrhea with dehydration

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40
Q

Diarrhea

Pay specific attention to the patient’s level of:

A

Hydration

Mental Status

Abdominal tenderness or peritonitis

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41
Q

Peritoneal findings may be present in infection with

A

C difficile

Enterohemorrhagic E coli

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42
Q

Diarrhea

Hospitalization is required in patients with

A

Severe dehydration

Toxicity

Marked Obesity

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43
Q

Symptoms:

  • Sudden onset
  • Diffuse abdominal tenderness
  • Distention
  • Increased bowel sounds
  • Usually afebrile
  • Positive tilts on fluid loss
A

Diarrhea

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44
Q

Labs for diarrhea

A

CBC/DIFF

Fecal Leukocyte

Fecal Occult

Stool Culture

C Difficile assay if recent hospitalization or antibiotics

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45
Q

Diarrhea labs:

Waterborne and foodborne disease, daycare center outbreaks, and international travelers

A

Stool exam for Giardia Lamblia (Giardiasis suspected)

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46
Q

Initial care of diarrhea

A

Assess vital signs for stability

Treat symptomatically

  • Loperamide
  • Bismuth subsalicylate
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47
Q

Diarrhea

Antibiotic treatment is recommended for:

A

Shigellosis, cholera, salmonellosis, listeriosis, and C. Diff

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48
Q

Diarrhea

Parasitic infection treatment is required for:

A

Amebiasis

Giardiasis

Cryptosporidiosis

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49
Q

Most digestive complaint

A

Constipation

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50
Q

Constipation may primarily originate within the _____ or may originate externally

A

Colon and rectum

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51
Q

Most common cause of constipation

A

Diminishing intake of fiber with decreased fluid intake

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52
Q

Systemic diseases that causes constipation

A

Hypothyroidism

Hyperparathyroidism

Diabetes

Chronic neurologic disorders

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53
Q

Medications that cause constipation

A

CCBs

Iron

Narcotic analgesics

Antipsychotics

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54
Q

Structural abnormalities that cause constipation

A

Colonic mass with obstruction

Neoplasm (Adenocarcinoma)

Anal Fissure

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55
Q

Constipation

Slow colonic transit is present in patient with a history of:

A

Chronic laxative abuse

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56
Q

Slow colonic transit may be:

A

Psychogenic or idiopathic

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57
Q

Symptoms:

  • Infrequent stool
  • Excessive straining
  • Sense of incomplete evacuation
  • Need for digital manipulation
A

Constipation

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58
Q

Labs for constipation

A

CBC for anemia

TFTs for suspected hypothyroidism

Electrolyte abnormalities

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59
Q

RADs for constipation

A

Upright Chest film and Abdominal Flat and erect for intestinal obstruction

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60
Q

First line treatment in constipation

A

Strict dietary changes and an exercise regimen

Increase water & fiber

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61
Q

Second line treatment of treatment for constipation

A

Stool softening or laxative use

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62
Q

Third line treatment for constipation

A

Suppositories or enemies

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63
Q

Hemorrhoids located above the dentate line

Subepithelial Cushions of the anorectum

No nervous innervation

A

Internal Hemorrhoids

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64
Q

Hemorrhoids from inferior hemorrhoidal veins

Below the dentate line

Covered with squamous epithelium

Nervous innervation

A

External Hemorrhoids

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65
Q

Occur in all adults and contribute to normal anal pressures and ensure a water-tight closure of the anal canal

A

Hemorrhoidal Venous Cushions

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66
Q

Rich vascular supply, highly sensitive location, and tendency to engorge and prolapse, common causes of anal pathology

A

Hemorroidal Venous Cushions

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67
Q

Subepithelial vascular cushions consisting of connective tissue, smooth muscle fibers, and arteriovenous communications between terminal branches of the superior rectal artery and rectal veins

A

Internal Hemorrhoids

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68
Q

Three primary locations of internal hemorrhoids

A

Right anterior

Right posterior

Left lateral

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69
Q

Hemorrhoids may become symptomatic as a result of activities that:

A

Increase venous pressure (result in distention and engorgement)

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70
Q

Can contribute to hemorrhoids

A

Straining, constipation, prolonged sitting, pregnancy, obesity, and low-fiber diets

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71
Q

Thrombosis of the external hemorrhoidal plexus results in:

A

Perianal hematoma

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72
Q

From coughing, heavy lifting, or straining

Exquisitely painful, tense and bluish perianal nodule

Pain is most severe within within the first few hours, gradually eases over 2-3 days

A

Perianal hematoma (thrombosis of external hemorrhoids)

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73
Q

Stage of Internal Hemorrhoids

Confined to the anal canal

A

Stage I

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74
Q

Stage of Internal Hemorrhoids

Gradually enlarge and protrude from the anal opening

A

Stage II

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75
Q

Stage of Internal Hemorrhoids

Manual reduction after bowel movements

A

Stage III

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76
Q

Stage of Internal Hemorrhoids

Chronically protruding and unresponsive to manual reduction

A

Stage IV

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77
Q

Protuberant purple nodules covered by mucosa

A

Prolapsed Hemorrhoids (internal)

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78
Q

Readily visible on perianal inspection

Tense bluish perianal nodule

Extremely tender to palpation

A

External hemorrhoids

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79
Q

RADs

Colonoscopy should be performed in all patients with:

A

Hematochezia

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80
Q

Treatment for thrombosed external hemorrhoids

A

Warm sitz baths

Analgesics and ointments

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81
Q

What time frame can you remove a hemorrhoid clot?

A

First 24-48 hours

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82
Q

Surgical excision (hemorrhoidectomy) is reserve for __% of patients with chronic severe bleeding from stage III or stage IV hemorrhoids or patients with acute thrombosed stage IV hemorrhoids

A

5-10%

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83
Q

Linear or rocket shaped ulcers that are usually <5mm in length

A

Anal Fissures

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84
Q

Anal Fissures occur most commonly in the:

A

Posterior Midline

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85
Q

Fissures that occur off midline raise suspicion of:

A

Serious diseases or Sexual assault

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86
Q

Fissures occur most from

A

Trauma to the anal canal during defecation

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87
Q

Symptoms:

  • Severe, tearing pain
  • Bright red blood
  • Visual Inspection: Cracks in the epithelium
A

Anal Fissures

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88
Q

Treatment for Anal Fissures

A

Promote effortless painless bowel movements

  • Fiber, sitz baths
  • Topical anesthetics
  • Oral Analgesics (Tylenol/NSAIDS)
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89
Q

Anal Fissures

Healing occurs within 2 months in up to __% of patients with conservative management

A

45%

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90
Q

Chronic fissures should be referred and treated with:

A

Topical Nitroglycerin

Diltiazem

Botulinum toxin injection

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91
Q

Obstruction of an anal gland that opens in the base of an anal crypt which normally drains into the anal canal

A

Anorectal abscess

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92
Q

Abscesses are frequently encountered in:

A

Perianal and Perirectal region

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93
Q

Almost all abscesses begin with involvement of an:

A

Anal crypt and its Gland

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94
Q

Infections from abscesses usually involve ____ tissue, where there is little resistance to the progression of infection.

A

Fatty

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95
Q

Spaces which can become infected alone or in combination with each other are:

A

Perianal

Intersphincteric

Ischiorectal

Deep postanal

Supralevator or pelvirectal

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96
Q

Most common and least common locations for anorectal abscesses

A

Most Common: Perianal Abscess

Least Common: Supralevator Abscess

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97
Q

What can occur from persistent anorectal abscesses?

A

Fistula formation

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98
Q

Anorectal abscesses are more common in:

A

Young middle-aged males

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99
Q

Symptoms:

Dull, aching, or throbbing pain that becomes worse immediately before defecation, lessened after defecation, but persists between bowel movements

A

Anorectal Abscess

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100
Q

RADs for Anorectal Abscess

A

Ultrasound for deep abscesses

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101
Q

Treatment for Anorectal Abscesses

A

Surgical and should be performed as soon as the diagnosis is made

Drainage - early and extensive

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102
Q

All perirectal abscesses should be drained in the:

A

Operating room

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103
Q

Isolated, simple, fluctuant perianal abscesses can be drained in:

A

Emergency Department

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104
Q

Simple, linear drainage incision is made, the abscess is more likely to occur because of:

A

Premature closure of skin edges

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105
Q

Anorectal abscesses with a linear drainage incision must be packed with gauze stops for at least:

A

24 hours

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106
Q

Abscesses with a cruciate/elliptical incision can be made over the fluctuate part. Trimming the flaps prevents closures and allows drainage. No packing is required but if done should be removed in:

A

24 hours

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107
Q

Abscesses with fever, leukocytosis, valvular heart disease, or cellulitis should be given:

A

Broad-Spectrum antibiotics

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108
Q

Initial Care of:

Anorectal Abscesses

A

Incision and Drainage

Complicated Cases: Refer to General Surgery

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109
Q

The chronic manifestation of the acute perirectal process that forms an anal abscess. When the abscess ruptures or drains, an epithelialized track can form that connects the abscess in the anus or rectum with the rectal skin.

A

Anorectal Fistula

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110
Q

“Non Healing” anorectal abscess following draining

Chronic purulent discharge

Intermittent rectal pain

A

Anorectal Fistula

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111
Q

Treatment plan for Anorectal Fistula

A

Require higher level of care.

MEDEVAC if unstable.

Consider MEDEVAC if in pain for appropriate treatment/medications.

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112
Q

A malformation in the sacrococcygeal region; ranging from asymptomatic hair-containing cysts and sinuses to large symptomatic abscesses.

A

Pilonidal Disease

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113
Q

Pilonidal sinuses or cysts occur in the midline in the:

A

Upper part of the natal cleft, over the sacrum and coccyx

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114
Q

Pilonidal sinus is formed by the:

A

Pentation of the skin by an ingrown hair

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115
Q

Pilonidal disease usually occurs before what age?

A

40

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116
Q

Symptoms:

  • Swelling, pain, persistent discharge over the lower sacrum and coccyx
  • Pt complains of a Tender mass
  • Exam reveals inflammation midline with one or more sinus openings
A

Pilonidal disease

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117
Q

The most common finding of pilonidal disease

A

Single opening from which hair is protruding

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118
Q

Spontaneous and ongoing drainage is the common indicator and if an abscess is present it is usually:

A

Small

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119
Q

Considered diagnostic for pilonidal disease

A

Patient gives a history of recurrent infection at the base of spine

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120
Q

Labs for pilonidal disease

A

CBC if patient has systemic symptoms (fever, chills, etc)

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121
Q

Treatment for pilonidal disease

A

Surgical treatment

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122
Q

Definitive treatment for pilonidal disease

A

Surgical excision

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123
Q

Surgical excisions are typically performed __ weeks after initial infection

A

6 weeks

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124
Q

Pilonidal disease

Simple I&D’s recure because of:

A

Hair follicles within the sinus tracts were not debrided

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125
Q

Initial care of pilonidal disease

A

I&D with suction. In more complicated cases refer to general surgery.

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126
Q

Inflammatory bowel disease includes what conditions?

A

Ulcerative Colitis

Crohn’s diease

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127
Q

What influences inflammatory bowel disease?

A

Genetic factors

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128
Q

Inflammatory bowel disease

What disrupts the intestinal mucosa and leads to a chronic inflammatory process?

A

Immune response

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129
Q

Inflammation that is limited to colonic mucosa

Can have pseudo-polyps

A

Ulcerative Colitis

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130
Q

Can affect any segment of the GI tract

“Skip lesions”

Transmural inflammation

A

Crohn’s Disease

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131
Q

Crohn’s disease and ulcerative colitis may be associated in __% of patients with a number of extra-intestinal manifestations

A

50%

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132
Q

Most common portion affected by the GI tract from Crohn’s

A

Terminal ilium

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133
Q

When Crohn’s affects the ilium, what is affected?

A

Malabsorption of digested foods

Vitamin B12 deficiency

Malabsorption of bile salts and calcium

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134
Q

Crohn’s

The clinician should take particular note of:

A

Fevers

General sense of well-being

Weight loss

Abdominal pain

Number of liquid bowel movements per day

Surgical/hospitalization history

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135
Q

Crohn’s

___ of patients with large or small bowel involvement develop perianal disease

A

1/3

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136
Q

Symptoms:

Intermittent bouts of low-grade fever, diarrhea, RLQ pain

Diffuse abd pain/discomfort, RLQ mass/tenderness

Perianal diease

A

Crohn’s

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137
Q

Crohn’s

__ of cases involve the small bowel only

A

1/3

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138
Q

Crohn’s

___ of all cases involve the small bowel and colon, usually ileocolitis

A

Half

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139
Q

Strongly associated with the development of Crohn’s disease, resistance to medical therapy, and early disease relapse

A

Cigarette Smoking

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140
Q

Lab for Crohn’s disease that should be obtained in all patients to assess immune response and nutritional status

A

CBC and serum albumin

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141
Q

RADs for Crohn’s

A

Endoscopy

Colonoscopy

ACUTE Exacerbations: CT

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142
Q

Available therapies for Crohn’s

A

5-aminosalicylic acid derivatives (5-ASA)

Corticosteroids

Immuno-modulating and biologic agents

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143
Q

Crohn’s:

Tender abdominal mass with fever and leukocytosis

Diagnosis: Emergent CT

Treatment: Broad-spectrum antibiotics

A

Intra-abdominal abscess formation

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144
Q

Crohn’s:

Develop secondary to active inflammation

Precipitated by dietary indiscretion or untreated flare

Diagnosis: Up-right abdominal X-ray

Treatment: NG tube to decompress GI tract

A

Small bowel obstruction

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145
Q

Symptom that is unusual in patients with Crohn’s

A

Bleed/severe hemorrhage

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146
Q

Screening colonoscopy for patients with Crohn’s to detect cancer should be done every:

A

8 or more years after initial flare/diagnosis

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147
Q

Patients with Crohn’s are __x likely to develop colon cancer than the general population

A

20x

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148
Q

Ulcerative Colitis is limited to:

A

Colonic mucosa

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149
Q

Ulcerative Colitis is caused by:

A

Abnormal activation of the immune system

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150
Q

Ulcerative Colitis causes:

A

Ulceration

Edema

Bleeding (Common)

Fluid and electrolyte loss

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151
Q

UC that extends to the splenic flexure

A

Left-sided colitis

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152
Q

UC that extends more proximally

A

Extensive colitis

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153
Q

UC is more common in what type of patients?

A

Non-smokers and former smokers

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154
Q

Ulcerative Colitis is less severe in:

A

Active Smokers

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155
Q

Associated with reduced risk of developing ulcerative colitis

A

Appendectomy before the age of 20

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156
Q

What can mimic the symptoms of Ulcerative Colitis?

A

Infectious colitis (Diverticulitis)

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157
Q

Pertinent patient history for Ulcerative Colitis

A

Stool frequency and character

Presence and amount of rectal bleeding

Diffuse crampy abdominal pain

Fecal urgency

Tenesmus

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158
Q

Hallmark of Ulcerative Colitis

A

Bloody diarrhea

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159
Q

Symptoms:

Bloody diarrhea

Lower abdominal cramps and fecal urgency

Anemia and low serum albumin

Negative Stool cultures

A

Ulcerative Colitis

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160
Q

Ulcerative Colitis:

  • Gradual onset of infrequent diarrhea (<5 a day)
  • Stool is formed or loose
  • Fecal urgency and tenesmus
  • Cramps relieved by defecation
  • No abdominal tenderness
A

Mild UC

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161
Q

Ulcerative Colitis:

-Severe diarrhea with frequent bleeding

Abdominal pain and tenderness (not severe)

Mild fever, anemia, hypoalbuminemia

A

Moderate UC

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162
Q

Ulcerative Colitis:

  • More than 6 blood bowel movements per day resulting in severe anemia, hypovolemia, and impaired nutrition with hypoalbuminemia
  • Abdominal pain and tenderness
A

Severe UC

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163
Q

Initial assessment of UC patient with a flair should focus on:

A

Volume status (BP, HR, Urine output, mental status)

Nutritional status

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164
Q

Labs for Ulcerative Colitis

A

CBC

ESR & CRP (Inflammatory studies)

Stool Bacterial culture

C Diff

Ova and Parasites

Serum Albumin

Electrolytes

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165
Q

What lab values reflect Ulcerative Colitis disease severity?

A

Hct

Sedimentation rate

Serum Albumin

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166
Q

RADs for Ulcerative Colitis

A

CT

Colonoscopy to screen for cancer (8 years post initial diagnosis)

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167
Q

Two main treatment objectives when treating patients with ulcerative colitis

A

Terminate the attack

Prevent recurrence of attacks

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168
Q

Medication options for UC

A

Mesalamine

Corticosteroid

5-ASA, Immunomodulating & biologic agents

Antidiarrheal agents (NEGATIVE for C Diff)

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169
Q

Curative treatment for Ulcerative Colitis

A

Total proctocolectomy

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170
Q

Treatment for mild/moderate colitis:

A

Treatment recommended by GI

Limit intake of caffeine and gas-producing vegetables

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171
Q

Treatment for severe UC

A

Hospitalization

Discontinue all oral intake for 24-48 hours

Restore volume with fluids

Serial abdominal exams

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172
Q

The physiology of sensation in the gut is:

A

Multifaceted

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173
Q

What is involved in the perception autonomic response to visceral stimulation?

A

5-HT (Serotonin)

Substance P

Norepinephrine

Nitric Oxide

174
Q

Characterized by abdominal pain of discomfort that occurs in association with altered bowel habits

A

Irritable bowel syndrome (IBS)

175
Q

__ months of symptoms are required to diagnose IBS

A

3 months

176
Q

IBS is thought to occur from a combination of:

A

Psychosocial abnormalities

Intestinal permeability

Immune system

Nervous system

177
Q

What plays a big role in the pathophysiology of IBS?

A

Mental Health

178
Q

Symptoms:

  • Being in late teens/twenties
  • Abnormal stool frequency, stool form, passage
  • HALLMARK: Abdominal discomfort that is relieved immediately after defecation with a otherwise normal physical exam
A

Irritable Bowel Syndrome

179
Q

Diagnosis of IBS is abdominal discomfort or pain that has at least TWO of the THREE:

A

Relief with defecation

Change in stool frequency

Change in stool form

180
Q

IBS-C

A

IBS with constipation

181
Q

IBS-D

A

IBS with diarrhea

182
Q

IBS-U

A

Infrequent bowel movements

183
Q

IBS-M

A

IBS with constipation & diarrhea

184
Q

Alarm symptoms of IBS

A

Starts at the age of >40

Nocturnal diarrhea

Severe constipation

Hematochezia

Weight loss

Fever

Family history of cancer, IBS, or Celiac disease

185
Q

IBS is a diagnosis of:

A

Exclusion

186
Q

RADs for IBS:

All patients over >50 should get:

A

Colonoscopy to exclude cancer

187
Q

Does IBS increase risk of cancer?

A

No

188
Q

IBS:

What is closely associating with bettering and worsening of symptoms?

A

Diet

189
Q

IBS:

Avoid foods with:

A

Fat or caffeine

fiber has little value

190
Q

IBS patients may benefit from a diet low in:

A

Fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs)

Lactose

Gluten

191
Q

Drugs that can benefit IBS

A

Antidiarrheal/Anticonstipation

Antispasmodic (anticholinergics)

Psychotropic agents (antidepressants)

192
Q

IBS

Patients with underlying psychological abnormalities should be evaluated by:

A

Mental Health

193
Q

Patients with severe disability should be referred to:

A

Pain treatment center

194
Q

What type of reflux episodes typically occur postprandially, short-lived, asymptomatic, and rarely occur during sleep?

A

Physiologic

195
Q

What type of reflux is associated with symptoms or mucosal injury and often occurs nocturnally

A

Pathologic

196
Q

GERD:

Endoscopy demonstrates abnormalities in ___ of patients

A

1/3

197
Q

Plays a vital role in the frequency and severity of GERD

A

Lower Esophageal Sphincter

198
Q

GERD:

Secondary to the stimulation and activation of mucosal chemoreceptors by acid

A

Pain

199
Q

Exacerbate the symptoms of GERD

A

Spicy, Acidic, Salty foods

Alcohol

200
Q

Heartburn occurs ___ minutes after meals and upon laying down

A

30-60 minutes

201
Q

Atypical or extraesophageal manifestations of GERD:

A

Asthma

Chronic cough

Chronic Laryngitis

Sore throat

Non-Cardiac Chest pain

202
Q

Condition in which the squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium containing goblet and columnar cells

A

Barrett Esophagus

203
Q

The most serious complication of Barrett esophagus is:

A

Esophageal Adenocarcinoma

204
Q

Manifested by the gradual development of solid food dysphagia progressive over months to years

A

Peptic Stricture

205
Q

Most peptic strictures are located at the ______ junction

A

Gastroesophageal

206
Q

RADs for complicated GERD patients

A

Endoscopy

207
Q

Treatment for mild/intermittent symptoms

A

Lifestyle modifications

  • Eat smaller meals
  • Eliminate acidic foods
  • Eliminate foods that precipitate reflux

Weight loss

208
Q

Foods that precipitate reflux

A

Fatty foods

Chocolate

Peppermint

Alcohol

Cigarettes

209
Q

Patients with nocturnal GERD should avoid lying down within __ hours after meals

A

3 hours

210
Q

GERD Medications:

Role is limited, only used as relief of mild GERD symptoms

A

Antacids (-tidines)

211
Q

Medications of troublesome GERD

A

PPI (-prazoles)

212
Q

PPIs have an onset of delay of 30 minutes but relief heartburn for up to __ hours.

A

8 hours

213
Q

When would you refer a GERD patient?

A

Does not resolve with maximum management of twice-daily PPI’s for 3 months

214
Q

Initial Care of GERD

A

Eliminate the causative factor

Lifestyle modifications

215
Q

Esophagitis could range from:

A

Pill induced

Reflux

Eosinophilic infections

216
Q

Medications that cause direct esophageal mucosal injury

A

Antibiotics - Tetracycline, Doxycycline, Clindamycin

Anti-inflammatory medications - Aspirin

Bisphosphonates

217
Q

Patients with GERD who have endoscopic evidence of esophageal inflammation

A

Reflux esophagitis

218
Q

Infectious Esophagitis (thrush) occurs in ______ patients

A

Immunocompromised

219
Q

Symptoms:

  • Retrosternal pain/Heartburn
  • Odynophagia
  • Dysphagia
  • Often have a history of swallowing a pill without water
A

Esophagitis

220
Q

Pill induced esophagitis onset of symptoms occur:

A

Few hours to one month

221
Q

Hallmark of Candida esophagitis is:

A

Odynophagia (pain when swallowing)

Discrete retrosternal pain

222
Q

Labs for Esophagitis

A

CBC

Specimen culture

Swab for Candida

223
Q

RADs for Esophagitis

A

Consider Endoscopy

224
Q

Treatment for Candida esophagitis

A

Evaluate for: HIV, Cancer, Diabetes

225
Q

Treatment for Esophagitis with fever and elevated WBC

A

Broad spectrum antibiotic

226
Q

Most infectious esophagitis requires what to diagnose?

A

Endoscopy and biopsy

227
Q

Promotes motility, via peristalsis, of introduced food to the stomach

A

Esophagus

228
Q

Esophageal strictures are likely caused as a result of:

A

GERD

229
Q

Why does stricture formation happen in patients with GERD?

A

To lower the volume of reflux

Reduce Symptoms

230
Q

What percentage of patients with esophageal stricture is unrelated to GERD?

Examples include: Radiation, Sclerotherapy, or Caustic ingestions

A

25%

231
Q

More commonly recognized cause of esophageal strictures, particularly in young men

A

Eosinophilic Esophagitis

232
Q

Symptoms:

  • Localized substernal chest pain
  • Heartburn
  • DYSPHAGIA (Hallmark)
A

Esophageal stricture

233
Q

RADs for esophageal stricture

A

Endoscopy

Barium study

234
Q

Treatment for mild esophageal stricture

A

Treat for GERD

235
Q

Treatment for severe esophageal stricture

A

MEDEVAC for potential surgery

236
Q

Esophageal stricture

Refer all patients to Gastroenterology for:

A

Dilation and Evaluation

237
Q

Severe symptoms of Esophageal stricture

A
  • Dysphagia
  • Food impactions
  • Asphyxiation
238
Q

Complications of esophageal stricture

A

Mallory-Weiss Tear

Asphyxiation

Esophageal Paresis

239
Q

Idiopathic motility disorder which causes loss of peristalsis in the distal two thirds of the esophagus and impaired relaxation of LES

Impaired inhibitory innervation, leading to premature and rapidly propagated contractions in the distal esophagus

A

Esophageal Spasm

240
Q

Symptoms:

  • Gradual onset of dysphagia
  • Can be present for months
  • Substernal discomfort/fullness
  • Lifting neck or throwing shoulders back to enhance gastric emptying
A

Esophageal Spasm

241
Q

RADs for Esophageal Spasm

A

CXR

Barium Esophagography

Endoscopy

242
Q

Treatment for Esophageal Spasm

A

PPI if GERD is present

Eat smaller bites of food

Invasive procedures (Botox injection)

243
Q

Complications of Esophageal Spasm

A

Asphyxiation

Dysphagia

Esophageal Dysmotility

Mallory-Weiss Tear

Peptic Stricture

244
Q

Occurs when the balance between the aggressive factors and the defensive mechanisms is disrupted

A

Peptic ulcer

245
Q

What can lead to peptic ulcers?

A

NSAIDs

H. pylori infection

Bile salts, acid, & pepsin

246
Q

Diagnostic procedure of choice for H. pylori infection

A

Upper endoscopy with gastric biopsy

247
Q

Break in the gastric or duodenal mucosa that arises when the normal mucosal defensive factors are impaired

A

Peptic Ulcer

248
Q

Peptic ulcers that extend through the muscularis mucosae are over ___ in diameter

A

5mm

249
Q

Lifetime prevalence of ulcer in the adult population is:

A

10%

250
Q

Ulcers occur most commonly in the:

A

Duodenum (Five times more common)

251
Q

Duodenal ulcers occur at the ages of:

A

30-55

252
Q

Gastric ulcers occur at the age of:

A

55-70

253
Q

Ulcers are more common in patients who:

A

Smoke

Chronic NSAID use

254
Q

Gastric ulcers are increasing as a result of:

A

NSAIDs

Low-dose aspirin

255
Q

Three major causes of peptic ulcer disease:

A

NSAIDs

Chronic H pylori infection

Acid Hypersecretory states

256
Q

What should be sought in all patients with peptic ulcers?

A

H pylori infection

NSAID ingestion

257
Q

Cofactor for the majority of duodenal and gastric ulcers not associated with NSAIDs

A

H pylori

258
Q

Approximately __%/year of long-term NSAID users will have an ulcer that causes clinically significant dyspepsia or a serious complication

A

2-5%

259
Q

Peptic Ulcer:

The risk of NSAID complications is greater in:

A

First 3 months of therapy

Prior History of ulcers

Combination with aspirin, corticosteroids, or anticoagulants

260
Q

Hall mark of peptic ulcer disease

A 
Epigastric pain (dyspepsia)
-Gnawing, dull, aching, or "Hunger-like"

NOT BURNING

261
Q

Peptic Ulcer:

A change from a patient’s typical rhythmic discomfort to constant or radiating pain may reflect:

A

Ulcer penetration or perforation

262
Q

Nausea and anorexia may occur in:

A

Gastric Ulcers

263
Q

Peptic Ulcer:

Physical exam is often:

A

Normal

264
Q

Labs for peptic ulcer with severe pain that suggests penetration into the pancreas

A

Elevated serum amylase

265
Q

Labs for a patient with a history of peptic ulcer or when an ulcer is diagnosed by upper GI series

A

H pylori with fecal antigen assay

Urea breath testing

266
Q

RADs for peptic ulcers

A

Upper Endoscopy

267
Q

Retards the rate of ulcer healing

A

Smoking

268
Q

Treatment for Peptic Ulcers

A

Eat balanced meals at regular intervals

Stop taking NSAIDs
-4 to 6 week PPI Therapy

269
Q

Treatment for H pylori infection Peptic Ulcers

A

Anti-H pylori regimen for 10-14 days

-PPI with a combination of Antibiotics

270
Q

Confirm successful eradication of H pylori ulcers with urea breath test, fecal antigen test, or endoscopy with biopsy __ weeks after completion of antibiotic treatment and __ weeks after PPI treatment

A

4 weeks

1-2 weeks

271
Q

Disposition of Peptic Ulcers

A

Stay on ship unless not responsive to PPI therapy

272
Q

Initial care of Peptic Ulcer Disease

A

D/c the causative agent

Eradicate H pylori

273
Q

Anatomical landmark that defines the border between the upper and lower GI track

A

Ligament of Treitz

274
Q

Proximal to the Ligament of Treitz

A

Upper GI tract

275
Q

Distal to the Ligament of Treitz

A

Lower GI tract

276
Q

Most common source of lower GI Bleeding, often occult

A

Colon Carcinoma

277
Q

Visible Blood loss

A

Overt

278
Q

Coffee-ground hematemesis is from hemoglobin interacting with:

A

Gastric acid

279
Q

Bright red hematemesis means the bleed is proximal to the:

A

Lower esophageal sphincter

280
Q

Melana “tar like” stool indicates

A

Upper GI bleed

281
Q

Hematochezia, bright red blood in stool indicates

A

Lower GI bleed

282
Q

Two most common presentations of upper GI bleed

A

Hematemesis

Melana

283
Q

Melena develops after as little as __mL of blood

A

50mL

284
Q

Upper GI bleeds can present with hematochezia if:

A

The bleed is massive (>1000mL)

285
Q

RADs, gold standard for Upper GI bleed

A

Upper endoscopy

286
Q

Hematocrit takes ___ hours to equilibrate

A

24-72 hours

287
Q

Labs for Upper/Lower GI Bleed

A

CBC

PT/PTT

INR

288
Q

Upper GI Bleed:

  • Diagnostic and therapeutic
  • Should be done on all patients with active upper GI bleed
A

NG tube

289
Q

Confirms upper GI source of bleeding

A

Aspiration of red blood or “coffee grounds”

290
Q

GI Bleed:

<100 SBP

A

Severe blood loss (30-40%)

291
Q

GI bleed:

HR >100

SBP >100

A

Moderate blood loss (15-29%)

292
Q

The gold standard medication of choice for severe bleeds

A

PPIs

293
Q

Upper GI bleeding is self-limited in __% of patients

A

80%

294
Q

Common causes of lower GI Bleeding

A

Diverticulitis

Inflammatory bowel disease (UC > Crohn’s)

Anorectal Disease

Hemorrhoids

Fissures

295
Q

Large volumes of bright red blood sugggest:

A

Colonic source

296
Q

Marron stools imply a lesion in the:

A

Right colon or small intestine

297
Q

Black tarry stools predict a source ______ to the ligament of Treitz

A

Proximal

298
Q

Management of lower GI Bleed

A

Initial stabilization, blood replacement, and triage

Colonoscopy

299
Q

Two conditions that may result in an upper GI Bleed

A

Mallory-Weiss

Boerhaave Syndrome

300
Q

Characterized by a non-penetrating vertical mucosal tear/laceration at the gastroesophageal junction

A

Mallory-Weiss

301
Q

Severe laceration of the anterior esophagus associated with a full perforation of the esophagus into the mediastinum

A

Boerhaave’s syndrome

302
Q

Mallory-Weiss and Boerhaave’s Syndrome:

Patient will typically be a:

A

Heavy alcohol user

303
Q

Boerhaave’s syndrome

Crunching sound heard on auscultation of the mediastinum

A

Hartman’s sign

304
Q

Boerhaave’s chest X-ray findings

A

Mediastinal air

305
Q

Treatment for Mallory-Weiss

A

NPO

IV PPI

IV/IM Antiemetic

306
Q

Treatment for Boerhaave’s Syndrome:

A

NPO

IV PPI

IV/IM Antiemetic

ANTIBIOTICS (IV)

307
Q

Disposition for Mallory-Wiess and Boerhaave Syndrome

A

MEDEVAC

Surgical evaluation

308
Q

Sac-like protrusion of the colonic wall

A

Diverticula (-lum)

309
Q

Diverticulosis is defined by the presence of:

A

Diverticula (sacs)

310
Q

Diverticular bleeding is characterized by painless hematochezia due to:

A

Weakness of the vasa recta

311
Q

Inflammation of a diverticulum is caused by:

A

Small pockets fill with stagnant fecal material and become inflammed

312
Q

Diverticulitis can lead to disease which can then lead to:

A

Perforation (micro is the most common)

313
Q

Symptoms:

  • Low grade fever
  • LLQ tenderness and a possible palpable mass
  • Leukocytosis is mild to moderate
A

Diverticulitis

314
Q

Labs for Diverticulitis

A

CBC w/ Diff

Occult blood

315
Q

Diverticulitis:

Treatment for patients with mild symptoms and no peritoneal signs

A

Clear liquid diet

Dual Therapy Antibiotics

316
Q

Diverticulitis:

Symptomatic improvement occurs __ days from starting antibiotics

A

3

317
Q

Diverticulitis recurs in __% if patients treated with medical management

A

10-30%

318
Q

Disposition:

Diverticulitis

A

MEDEVAC

319
Q

Most common abdominal surgical emergency

A

Appendicitis

320
Q

Appendicitis is most common between what ages?

A

20-35

321
Q

Appendix is found at the:

A

Base of the cecum

322
Q

Located one third of the distance from the right anterior superior iliac spine to the umbilicus

A

McBurney’s Point

323
Q

Believed to be involved with the development of intestinal bacterial flora

A

Appendix

324
Q

Appendicitis typically manifest from:

A

Blockage of the lumen

325
Q

Most common appendix luminal blockage

A

Fecalith

326
Q

Obturator sign is a positive test for:

A

Inflamed appendix deep in the pelvis

327
Q

Psoas sign is positive for

A

Retro-cecal appendix

328
Q

Atypical symptoms of appendicitis

A

Pain in the flank

Lower back pain

Groin pain (very thin females)

Tenesmus

Non-specific lower abdominal pain

329
Q

Gold standard for diagnosis of appendicitis is:

A

CT scan of the abdomen

330
Q

Labs for appendicitis

A

CBC

Fecal occult blood

UA

331
Q

Bile is made in the:

A

Liver

332
Q

Bile is stored in the:

A

Gallbladder

333
Q

In response to fat entering the proximal small intestine, bile is ejected from the gallbladder into the:

A

Cystic duct

334
Q

Bile flows from the cystic duct into the:

A

Common bile duct

335
Q

Bile flows from the common bile duct into the:

A

Duodenum

336
Q

Bile works in the duodenum to:

A

Emulsify fats

337
Q

Bile is reabsorbed into circulation in the:

A

Terminal ilium (distal small intestine)

338
Q

Without bile, fats would aggregate to form large:

A

Hydrophobic micelles

339
Q

Bile is composed of:

A

Bile salts

Cholesterol & Bilirubin

340
Q

Most common form of Gallstones

A

Cholesterol gallstones

341
Q

Situations that raise cholesterol (gallstones)

A

Increased estrogen (pregnancy)

Increased circulating cholesterol

  • Diet
  • Rapid weight loss
342
Q

Pigmented gallstones are formed by:

A

Precipitation of bilirubin

343
Q

What will happen if the amount of cholesterol or bilirubin present in the gallbladder exceeds the amount of bile salts needed to dissolve it?

A

Precipitates (stones) form

344
Q

Disease processes that can occur from stones occluding ducts within the biliary tract

A

Asymptomatic Cholelithiasis

Biliary Colic

Cholecystitis

Choledocholithiasis

Cholangitis

345
Q

Gallstones are present but patient does not have any symptoms

A

Asymptomatic cholelithiasis

346
Q

__% of individuals with gallstones will be asymptomatic their entire life

A

80%

347
Q

Gallstones are present and intermittently obstruct the lumen of the cystic duct

Symptoms last less than 6 hours

A

Biliary Colic

348
Q

Inflammation of the gallbladder

Usually from a gallstone permanently lodged in the cystic duct

Symptoms last longer than 6 hours

A

Cholecystitis

349
Q

Inflammation of the gallbladder caused by obstruction of the common bile duct

Patients may show jaundice

A

Choledocholithiasis

350
Q

Bacterial infection of the biliary tract

RUQ pain

Fever

Jaundice

A

Cholangitis

351
Q

Charcot’s Triad

A

RUQ Pain

Fever

Jaundice

352
Q

Management of biliary colic

A

Recommend a change in diet

353
Q

Cholecystitis

Associated with gallstones in over __% of the cases

A

90%

354
Q

Cholecystitis

10% is caused by:

A

Acalculous cholecystitis and infectious agent

355
Q

No radiologic evidence of gallstones

Had a major surgery within the past 2-4 weeks

NPO due to critical condition

A

Acalculous Cholecystitis

356
Q

6 F’s of cholecystitis/choledocholithiasis

A

Fat, fertile, 40, Female

Flatulence, Fever

357
Q

Sudden onset of RUQ pain after eating a meal high in fat

Murphy’s sign

Palpable gallbladder (15% of cases)

A

Cholecystitis

358
Q

Labs for cholecystitis

A

CBC

LFTs

Lipase (rule out pancreatitis)

Bilirubin (elevated, dx with choledocholithiasis)

359
Q

Gold standard imaging for cholecystitis

A

RUQ Ultrasound

360
Q

Why is a CT not indicated for cholecystitis?

A

Cholesterol gallstones are radiolucent and tend to not be visible

361
Q

Cholecystitis

Continuous symptoms for >24 hours suggests possible:

A

Necrosis of the gallbladder

362
Q

Necrosis of the gallbladder may develop without definite signs in:

A

Obese, Diabetic, Elderly, Immunosuppressed

363
Q

Mainstay treatment for cholecystitis

A

Cholecystectomy

IV Antibiotics

364
Q

Patients treated with conservative management will require cholecystectomy __ days after initial presentation

A

2-4

365
Q

Gallstone obstructing the common bile duct (CBD) causing inflammation of the gallbladder

Backed of bilirubin caused jaundice

A

Choledocholithiasis

366
Q

Bacterial infection of the common bile duct

A

Cholangitis

367
Q

Typical infectious organism that causes cholangitis

A

E. Coli

368
Q

Cholangitis patients will present with:

A

Charcot’s Triad

  • Fever
  • RUQ Px
  • Jaundice
369
Q

Disposition for Cholangitis

A

IV antibiotics

MEDEVAC

370
Q

Produces enzymes that are released into the duodenum via the common bile duct

Produces hormones that are secreted into the vascular system

A

Pancreas

371
Q

Most common causes of pancreatitis

A

Alcohol

Gallstones

Other

372
Q

Causes auto-activation of pancreatic enzymes while still in the pancreas resulting in enzymatic destruction of pancreas

A

Alcohol

373
Q

Can obstruct the ampulla of Vater, causing impaired extrusion of enzymes into the duodenum. Leads to auto-digestion of pancreas tissue

A

Gallstones

374
Q

Patient presentation:

History of cholelithiasis and/or cholecystitis treated without surgery

History of alcoholism

Similar episodes of pain

A

Pancreatitis

375
Q

Symptoms:

  • Abrupt onset
  • Steady, boring, severe abdominal pain - worse when walking and laying down
  • Relief when sitting upright and leaning forward
  • Mild jaundice
  • Nausea and vomiting
  • Weakness, fever, anxiety
  • Grey-Turner and Cullen’s sign in severe disease
  • Possible upper abdominal mass
A

Pancreatitis

376
Q

Labs for pancreatitis:

A

CBC (Leukocytosis)

Gold standard: Elevated serum Lipase is diagnostic

  • UA
  • Glucometer: Hyperglycemia
  • Elevated Serum lactate
  • Elevated aspartate
377
Q

Gold standard imaging for pancreatitis

A

CT

378
Q

Gold standard treatment for uncomplicated pancreatitis

A

NPO & Aggressive fluid resuscitation

379
Q

Disposition of pancreatitis

A

Fluids

Pain control

MEDEVAC

380
Q

What makes up the inguinal canal

A

Inguinal ligament

External inguinal ring

Internal inguinal ring

381
Q

Hasselbach’s triangle (Inguinal triangle)

A

Inferior epigastric vessels

Lateral aspect of the Rectus Abdominis

Inguinal Ligament

382
Q

Protrusion of any body part through a cavity

A

Hernia

383
Q

Most common type of hernias (75-80%)

A

Inguinal Hernias

384
Q

Two main types of Inguinal hernias

A

Direct (Directly through Hasselbach’s triangle)

Indirect (inguinal canal)

385
Q

What side is more common in indirect inguinal hernias?

A

Right

386
Q

All hernias have the ability to present with signs and symptoms of:

A

Small Bowel Obstruction

387
Q

Lower anterior abdominal mass

A

Direct hernia

388
Q

Scrotal mass

A

Indirect hernia

389
Q

Out-y belly button

A

Umbilical hernia

390
Q

“Turn your head and cough” checks for:

A

Inguinal canal hernias

391
Q

Labs for Hernia

A

CBC (incarceration/strangulation)

CMP (hydration and toxicity levels)

UA

392
Q

Hernia Imaging

A

CT and US may benefit before surgery

393
Q

What kind of hernias require immediate attention?

A

Incarcerated

394
Q

Hernia treatment if strangulation is suspected or shock is present

A

Broad-spectrum IV antibiotics and fluid resuscitation

395
Q

Hernia:

Place patient in supine Trendelenburg

Administer Narcotic for analgesia

Administer Diazepam for muscle relaxation

Allow for passive reduction

A

Closed Passive Reduction technique

396
Q

Disposition for irreducible incarcerated hernia - all ages

A

MEDEVAC for immediate surgical eval/repair

397
Q

Disposition for reducible hernias

A

Refer to general surgery

Avoid heavy lifting

398
Q

Two main subcategories of intestinal obstruction

A

Mechanical

Paralytic ileus

399
Q

A physical blockage of the intestinal tract

A

Mechanical obstruction

400
Q

Dysfunction of the intestinal tracts ability to move bowel contents through its lumen

A

Paralytic ileus

401
Q

Two most common causes of small bowel obstruciton

A

Adhesions (most common)

Hernias

402
Q

Symptoms:

  • Crampy, intermittent abdominal pain
  • Urge to move
  • Distention
  • Vomiting
  • Constipation, bloating
  • Tympany on percussion
  • High-pitched bowel sounds (rushes)
A

Mechanical Bowel obstruction

403
Q

Bowel Obstruction Symptoms:

  • Less intense pain that is more constant
  • Constipated
  • Diminished bowel sounds
A

Paralytic ileus or Large Bowel (colon)

404
Q

Labs for Bowel obstruction

A

CBC

CMP

405
Q

Gold standard imaging for bowel obstruction

A

Upright abdominal X-Ray

406
Q

Management and treatment for bowel obstruction

A

NPO

NG Tube

Two IV sites with aggressive fluid resuscitation

MECHANICAL: IV Antibiotics

407
Q

__% of completely obstructed SBO patients will fail conservative therapy

A

60%

408
Q

Almost all Large bowel obstructions are caused intrinsically from:

A

Adenocarcinoma

409
Q

Inflammation of the localized or generalized peritoneum

A

Peritonitis

410
Q

Inflammation of the peritoneal surface without another intra-abdominal process

Also known as Spontaneous Bacterial Peritonitis (SBP)

A

Primary Peritonitis

411
Q

Lines the outer portions of all intra-abdominal organs

A

Visceral peritoneam

412
Q

Lines the interior portion of the abdominal wall

A

Parietal Peritoneum

413
Q

Posterior to the posterior parietal peritoneal membrane

A

Retroperitoneal Space

414
Q

“Acute abdomen” or “Surgical abdomen”

Indicates severe intra-abdominal infection

A

Peritonitis of the entire peritoneum

415
Q

Most common causes of acute peritonitis

A

Perforated Appendicitis

Perforated Diverticulitis

Pancreatitis

416
Q

Patient Presents:

  • Fetal positions or supine with legs bent (or on pillow)
  • DO NOT want to move (unlike obstructive bowel)
  • Board like abdomen
  • Absent bowel sounds in all 4 quadrants
A

Peritonitis

417
Q

Labs for peritonitis

A

CBC w/ Diff

UA

Blood Culture

Female: HCG

418
Q

RADs for peritonitis

A

Upright Abdominal X-ray

Abdominal CT

419
Q

All patients with suspected peritonitis need:

A

Antibiotics

420
Q

Disposition for Peritonitis

A

IV Antibiotics

IV fluids and NPO

Pain control (Morphine)

MEDEVAC

421
Q

Three regions of the abdomen

A

Intrathoracic

True abdomen

Retropertioneal

422
Q

What organs are in the intrathoracic abdomen?

A

Liver, Gallbladder, Spleen, Stomach, Transverse Colon

423
Q

Any penetrating injury at or below the __th intercostal space is suspected to be in the abdomen

A

4th

424
Q

Organs in the True Abdomen

A

Large and small intestine

Portion of the liver and the bladder

(females: uterus, fallopian tubes, ovaries)

425
Q

Organs in the retroperitoneal

A

SADPUCKER

Suprarenal (adrenal) gland
Aorta
Duodenum
Pancreas
Ureters
Colon
Kidneys
Esophagus
Rectum
426
Q

Common injuries with a direct blow (blunt)

A

Splenic rupture and liver fractures

427
Q

Common injuries in deceleration injury from MVA’s or falls (Blunt)

A

Duodenal and aortic rupture

428
Q

The sum of the number of bullet wounds and actual bullets seen on diagnostic imaging should always be an even number

A

“Bullet Rule”

429
Q

Momentum transmitted to neighboring organ due to changing bullet velocities caused by tissue density variation

A

Blast effect

430
Q

Abdominal trauma:

All patients should get:

A

DRE for blood and rectal tone

431
Q

Labs for abdominal trauma

A

CBC/Diff

UA

Fecal Occult Blood

Type and screen

Females: HCG

Gastrointestinal (3 decks)

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