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GI II > Clinical Approach to Abdominal Trauma > Flashcards

Clinical Approach to Abdominal Trauma Flashcards

1
Q

describe the visceral history of appendicitis

A

vague, nonspecific, aching/cramping abdominal pain

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2
Q

describe the typical presentation of appendicitis

A

RLQ abdominal pain
anorexia
nausea/vomiting
+/- fever

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3
Q

describe the treatment for appendicitis

A 
NPO
IVF
antiemetic
pain medication
possible preoperative antibiotics

surgery

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4
Q

what can mimic gastroenteritis or viral illness?

A

early appendicitis

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5
Q

can a patient with a normal CBC have appendicitis?

A

yes

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6
Q

can a patient with an abnormal UA still have appendicitis?

A

yes

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7
Q

what is the most frequent site of obstruction in the GI tract?

A

esophagus

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8
Q

name three spaces in which esophageal foreign bodies are often impacted

A
  1. UES
  2. at the level of the aortic arch
  3. diaphragmatic hiatus/LES
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9
Q

approximately half of the individuals with esophageal food impacts have underlying…

A

eosinophilic esophagitis

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10
Q

drooling and inability to swallow liquids is indicative of…

A

an esophageal obstruction, and requires emergent endoscopic evaluation

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11
Q

fever, abdominal pain, and repetitive vomiting after foreign body ingestion are concerning and warrant…

A

further workup

make sure history includes type of foreign body, time of ingestion, and presence and type of ongoing symptoms

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12
Q

imaging is only performed in patients […] signs of symptoms suggestive of…

A

[without] – it is so important not to delay EGD imaging

an esophageal obstruction

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13
Q

for what patients do you order CT scans?

A
  1. suspected perforation
  2. sharp or pointed foreign body ingestion
  3. ingested packets of narcotics or other drugs
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14
Q

describe the expectant “watch and wait” management for foreign body ingestion

A

watch and wait applies when the object is beyond the ligament of treitz; XR every week

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15
Q

name the three situations for emergent endoscopy (within 6 hours)

A
  1. complete esophageal obstruction (drooling)
  2. disk batteries in the esophagus
  3. sharp-pointed objects in the esophagus
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16
Q

all foreign bodies in the esophagus require removal within…

A

24 hours; perform urgent endoscopy

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17
Q

most foreign bodies that enter the stomach pass within…

A

4-6 days

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18
Q

when is urgent endoscopy indicated? there are six situations

A
  1. sharp-pointed objects in the stomach or duodenum
  2. objects >5cm in length at or above the proximal duodenum
  3. high powered magnets within endoscopic reach
  4. blunt objects in the stomach that are >2cm in diameter
  5. disk batteries and cylindicral batteries
  6. objects containing lead
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19
Q

with foreign body ingestion, when is endoscopic or surgical intervention indicated?

A

signs or symptoms suggesting inflammation or intestinal obstruction (fever, abdominal pain, vomiting)

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20
Q

75% of all hernias are…

A

inguinal hernias

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21
Q

2/3 of all inguinal hernias are…

A

indirect

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22
Q

constant or intermittent mass in the groin gradually increasing in size, +/- other symptoms

A

hernia

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23
Q

describe hernia classification

A
  1. anatomic location (ventral, groin)
  2. hernia contents (bowel, fat)
  3. status of those contents (reducible, incarcerated, strangulated)
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24
Q

name the two most common ventral hernias

A
  1. epigastric

2. umbilical

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25
name the three kinds of groin hernias
1. inguinal (indirect, direct) 2. femoral 3. obturator
26
where are incisional hernias most commonly located?
midlines; spigelian and parastomal hernias occur off the midline
27
hernia which passes directly through a weakness in the transversalis fascia in the Hesselbach triangle
direct inguinal hernia
28
hernia which passes from the internal to the external inguinal ring through the patent process vaginalis, and then the scrotum
indirect inguinal hernia
29
hernia sack is soft and easy to replace back through the hernia neck defect
reducible
30
hernia sack is firm, often painful, and nonreducible by direct manual pressure; no signs of systemic illness
incarcerated
31
hernia sack is firm and very painful, usually with signs of systemic illness (NVF) which implies impairment of blood flow
strangulated can be arterial, venous, or both
32
which hernia is an acute surgical emergency?
strangulated
33
describe the steps taken when strangulated hernia is suspected...
- consult general surgery, immediately - broad-spectrum IV antibiotics - fluid resuscitation and adequate narcotic analgesia - obtain preoperative laboratory studies
34
describe the steps taken when strangulated hernia is suspected...
- consult general surgery, immediately - broad-spectrum IV antibiotics - fluid resuscitation and adequate narcotic analgesia - obtain preoperative laboratory studies
35
how do you care for an incarcerated hernia?
attempt to reduce, if unsuccessful consult surgery
36
how do you care for reducible hernia?
outpatient surgery follow up
37
what size is sufficient to diagnose AAA?
diameter exceeding 3.0 cm
38
what is the most common site of AAA?
inferior to the renal arteries
39
what is the most important factor for risk of AAA rupture?
smoking
40
small and medium sized AAAs (<5.5 cm) expand at an average rate of...
2-3 mm/year
41
larger AAAs (>5.5 cm) expand at approximately...
3-4 mm/year
42
AAAs that exhibit rapid diameter expansion are at an increased risk for rupture, what counts as rapid expansion?
>5 mm over six months or >10 mm over 12 months
43
describe a symptomatic but not ruptured AAA
abdominal pain, flank pain, limb ischemia, fever, malaise - AAA rapidly expanding; large enough to compress surrounding structures, inflammatory or infectious
44
describe the triad of ruptured and symptomatic AAA
- severe acute abdominal and/or flank pain - hypotension, shock - pulsatile abdominal mass
45
describe the risk factors for AAA
``` advanced age male gender caucasian positive family history smoking presence of other large vessel aneurysms atherosclerosis ```
46
what are the symptoms, if any, present with AAA?
- abdominal, back, or flank pain - syncope - thromboembolism and/or limb ischemia - aneurysms that produce symptoms are at an increased risk for rupture
47
what is ruptured AAA commonly mistaken for?
- renal colic - perforated viscus - diverticulitis - gastrointestinal hemorrhage - ischemic bowel
48
describe the screening for AAA
one time US for at risk patients over 65
49
describe the monitoring for asymptomatic AAA
6 month or annual US or CT Abd/pelvis
50
describe the testing for symptomatic AAA
stable: CT Abd/pelvis w/ IV cont. unstable: if known hx of AAA --> OR! if unknown hx but suspected AAA --> CT Abd/pelvis w/ IV cont. if possible
51
what size AAA indicates conservative management?
asymptomatic infrarenal AAA <5.5 cm
52
describe the circumstances for elective AAA repair (open or endovascular)
- asymptomatic AAA >5.5 cm - rapidly expanding infrarenal AAA; doesn't cross renal a. - associated arterial disease (coexisting iliac, femoral or popliteal a. aneurysms; symptomatic artery disease undergoing revascularization)
53
what is a leading cause of mortality globally?
trauma - road traffic injuries 18-29 years of age - 30% of ICU admissions
54
direct blow causing rupture of hollow organs and bleeding
blunt trauma deceleration causes shearing injuries
55
stab wounds and low velocity GSWs causing tissue damage by lacerating and cutting high velocity GSWs transfer more kinetic energy to the abdomen viscera, cause increased damage by cavitation
penetrating trauma
56
blunt and penetrating blast injury to lung and hollow viscus from blast overpressure inhalation injury
explosives
57
what mechanism of injury accounts for the majority if abdominal injuries seen in the ED?
blunt abdominal trauma (BAT)
58
what are the most commonly injured solid organs in BAT?
spleen and liver kidneys also possible
59
name important MVC historical questoins
- restrained - intoxicated - location within vehicle - vehicle type and velocity - air bags
60
what four aspects increase risk of serious injury in MVC?
- unrestrained - ejected - rolled over by vehicle - fatality of another at scene
61
describe ABCDE for critically ill patients
``` Airway - maintenance w/ C-spine control Breathing and ventilation Circulation - w/ hemorrhagic control Disability/neurologic status Exposure/Environmental control - completely undress pt, prevent hypothermia ```
62
in addition to normal abdominal exam (inspect, auscultate, palpate) what other components are important?
- asses pelvic stability | - asses urethral meatus, perineal, rectal, vaginal
63
where is the diaphragm most commonly injured?
left side d/t blunt high impact (MVC); suspect w/ thoraco-abdominal trauma DO NOT USE TROCHAR when inserting chest tube, may puncture stomach
64
describe situations where you should be concerned about duodenal injuries
- unrestrained drivers - bicycle handlebar injury get CT abd/pelvis w/ IV and oral contrast
65
how do pancreatic injuries occur?
direct blow to the pancreas, compressing it against vertebral column check and trend amylase and lipase; CT abd/pelvis w/ IV and oral contrast
66
describe how one can sustain GU injuries
SUSPECT URETHRAL DISRUPTION W/ ANTERIOR PELVIC INJURIES direct blows to the back or flank - suspect w/ gross or microscopic hematuria get CT abd/pelvis w/ IV contrast
67
when should you suspect urethral disruption?
anterior pelvic injuries
68
describe how one can sustain hollow viscus injuries
sudden deceleration injuries (MVC) or Chance fracture (think duodenal injury) early CT and US not diagnostic
69
when do patients w/ pelvic fracture have high mortality?
if they are hypotensive - 1/6 die w/ all types of pelvic fractures - 1/4 die w/ closed pelvic fracture and hypotension - 1/2 die w/ open pelvic fracture common: MVC, fall from heights, auto-vs-pedestrian MOA: disruption pelvic ring tears pelvic venous plexus and occasionally disrupts internal iliac arterial system
70
what will a FAST SCAN reveal?
blood / if + need to send to proper care, do not get CT free intraperitoneal fluid, pericardial fluid, pleural fluid, hemothorax and pneumothorax
71
what imaging is definitive for most intra-abdominal trauma?
CT Abd/Pelvis w/ IV
72
all patients with significant trauma need these three basic imaging studies...
lateral C spine CXR AP pelvis
73
what is the most critical situation which qualifies a patient for a laparotomy?
BAT w/ hypotension w/ +FAST SCAN or clinical evidence of intraperitoneal bleeding
74
if a patient has blunt or penetrating abdominal trauma w/ +DPL do they qualify for laparotomy?
yes DPL = diagnostic peritoneal lavage

GI II (5 decks)

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