Clinical Apporach to the Patient Presenting with Abdominal Trauma and GI Emergencies Flashcards
What age group is the highest incidence for acute appendicitis seen?
10-to-19-year-old age group
What type of pain does an appendicitis usually start with before migrating to the RLQ?
Vague visceral pain
What are some specialty tests for acute appendicitis in order of specificity and sensitivity?
1) McBurney’s Point
2) Rovsing’s sign
3) Obturator sign
4) Psoas Sign
What is the gold standard for diagnosing appendicitis in adults?
What should be performed first in kids before moving on to the gold standard?
What should be used for pregnant patients?
1) Ct Abdomen and Pelvis with IV and Oral Contrast
2) Ultrasound of RLQ
3) MRI
What can early appendicitis mimic?
Gastroenteritis or viral illness
80 percent of all foreign body ingestions occur in?
How do most (80 to 90 percent) of these cases progress?
Only 10 to 20 percent require?
Less than 1 percent require?
1) Children
2) Pass without the need for intervention
3) Endoscopic removal
4) Surgical intervention
What is a common ingested FB seen in kids?
What about in adults (more frequently in elderly)?
1) Coins
2) Food bolus
Where is the most frequent site of obstruction in the gastrointestinal tract?
The esophagus
Esophageal foreign bodies are often impacted at sites of?
It is estimated that approximately half the individuals with esophageal food impactions have underlying?
1) Physiologic or pathologic luminal narrowing
2) Eosinophilic esophagitis
What is indicative of an esophageal obstruction and requires emergent endoscopic evaluation?
What symptoms after FB ingestion are concerning and warrant further workup?
1) Drooling and inability to swallow liquids
2) Fever, abdominal pain, repetitive vomiting
What should be done for a patient that presents with signs and symptoms of esophageal obstruction?
Emergent EGD (within 6 hrs)
The approach to management of esophageal obstruction is guided by the initial evaluation and depends upon?
1) Presence and severity of symptoms
2) Type of object ingested (size, shape, content)
3) Location of the object
All foreign bodies in the esophagus require removal within?
24 hours
Most foreign bodies that enter the stomach will pass in?
Four to six days
75% of all hernias are?
Inguinal hernias
2/3 of all inguinal hernias are?
Indirect
What are the most common ventral (abdominal wall) hernias?
What are the most common groin hernias?
1) Epigastric and Umbilical
2) Inguinal
Direct inguinal hernias pass directly through a weakness in?
Indirect inguinal hernias passes through?
1) Transversalis fascia in the Hesselbach triangle
2) The internal and external inguinal ring
How is the hernia described if the hernia sac itself is soft and easy to replace back through the hernia neck defect?
What if the hernia sac is firm, often painful, and nonreducible by direct manual pressure with no signs of systemic illness?
What if the hernia sac is firm, very painful, and usually with signs of systemic illness (fever, nausea, vomiting) due to an impairment of blood flow (arterial, venous,
or both)?
1) Reducible
2) Incarcerated
3) Strangulated
How is a strangulated hernia treated?
Acute surgical emergency
What is one of the top 15 causes of mortality in the United States, for those between 85 and 89 years?
Abdominal Aortic Aneurysm
An AAA is diagnosed when the aortic diameter exceeds?
Where does it most commonly occur in the abdomnen?
1) 3.0 cm
2) Below renal arteries
What is the classic triad for a ruptured AAA?
1) Abdominal and/or flank pain
2) Hypotension
3) Shock
Why is a ruptured AAA misdiagnosed 30% of the time?
Mistaken for other conditions because its symptoms (if they are even present) are vague
What should the general screening for AAA be for an at risk patient over 65?
What should be done for an asymptomatic AAA patient?
What should be done for a stable symptomatic patient?
What should be done for an unstable symptomatic patient?
1) US
2) Monitor every 6 months or annual US or CT Abd/pelvis
3) CT Abd/pelvis with IV contrast
4) Emergency surgery
What are the most commonly injured solid organs?
Spleen and liver
What process adopted by ACLS and PALS is used for taking care of critically ill patients?
Which is most important in terms of abdominal trauma assessment?
1) Airway maintenance with C-spine control
2) Breathing and ventilation
3) Circulation with hemorrhage control (Important for abdominal trauma)
4) Disability/neuro status
5) Exposure/Environmental control
Where are diaphragm injuries most common?
What are they a common result of?
What should not be used when putting in a chest tube?
1) On the left
2) Blunt high impact (MVC)
3) Trochar
Patients that have trauma due to being in an unrestrained MVC with frontal impact or from a bicycle handlebar result in what injuries?
What imaging should be done?
1) Duodenal injuries
2) Ct abd/pelvis with iv and Oral contrast
Pancreatic injuries result from direct blow to the pancreas that compresses it against?
What lab values should you check?
What imaging should be done?
1) The vertebral column
2) Amylase and lipase
3) Ct abd/pelvis with iv and Oral contrast
What type of injury can direct blows to the back or flank cause?
Urethral disruption with anterior pelvic injury
What injuries are seen with sudden deceleration injuries from MVC and Chance fractures?
Hollow viscus injuries
Why must patients with pelvic fractures be attended to emergently?
They have high mortality rates due to massive hemorrhage
What should be done on all patients with significant trauma?
1) Lateral C spine
2) CXR
3) AP pelvis
Why should you delay transfer of a trauma patient to definitive care in order to obtain diagnostic studies?
You should NOT do this
When should laparotomy be performed?
Patient presents with blunt abdominal trauma with hypotension with a positive fast scan or clinical evidence of intraperitoneal bleeding
What does a Focused Assessment with Sonography for Trauma (FAST) Scan detect?
1) Free intraperitoneal fluid
2) Pericardial fluid
3) Pleural fluid
4) Hemothorax and pneumothorax
A FAST scan on the right flank is used to view?
On the left flank?
On the pelvis?
1) Hepatorenal space (Morrison’s Pouch)
2) Perisplenic
3) Bladder and retrovesical structures
