Ectopic Pregnancies Flashcards
What is the most common decade for Sigmoid Volvulus occurrence?
8th decade
Predominantly affects older adults.
Are males and females equally affected by Sigmoid Volvulus?
Yes
There is no gender predominance.
In which types of facilities is Sigmoid Volvulus predominantly found?
Long-term nursing facilities and neuropsych facilities
These environments may contribute to its occurrence.
What is the ‘Volvulus belt’ and where is it found?
A region in Africa and the Middle East associated with high fiber diet
This diet increases the risk of Sigmoid Volvulus.
What is the third most common cause of colonic obstruction?
Sigmoid Volvulus
What pathophysiological condition leads to Sigmoid Volvulus?
Redundant sigmoid colon gets twisted on its mesenteric axis
This can lead to obstruction or infarction.
What imaging sign is characteristic of Sigmoid Volvulus on plain film?
Coffee bean sign
What imaging sign is characteristic of Sigmoid Volvulus on CT?
Whirl sign
What imaging sign is characteristic of Sigmoid Volvulus on a barium enema?
Bird beak sign
What are the clinical symptoms of Sigmoid Volvulus?
- Insidious onset
- Constant, severe pain with periods of colicky pain
- Nausea
- Abdominal distention
- Constipation
- Vomiting (later finding)
Symptoms may develop gradually over time.
What is the initial non-operative treatment for Sigmoid Volvulus?
Non-operative decompression via rectal tube placement
This is done using a flexible sigmoidoscope.
How is the placement of the rectal tube confirmed in Sigmoid Volvulus?
Abdominal x-ray
How long should the rectal tube stay in place for Sigmoid Volvulus treatment?
1-2 days
What is the elective treatment for Sigmoid Volvulus?
Elective resection
What indicates the need for emergent resection in Sigmoid Volvulus?
Signs of necrosis
What is the most common location for Ectopic Pregnancy?
Fallopian tubes
This is where most ectopic pregnancies occur.
What are the risk factors for Ectopic Pregnancy?
- Documented tubal pathology (PID)
- Surgery to restore tubal patency
- Tubal sterilization
- Prior ectopic pregnancy (10-16x)
- Smoking (>1ppd) (3-4x)
- Advanced maternal age (35-44 y/o) (3x)
- Intrauterine devices (IUD)
These factors significantly increase the risk of ectopic pregnancies.
What is the classic triad of symptoms for Ectopic Pregnancy?
- Amenorrhea
- Vaginal bleeding
- Ipsilateral abdominal pain
What additional symptoms may present in Ectopic Pregnancy?
- Breast tenderness
- Nausea
- Urinary symptoms
- Shoulder pain (referred)
- Vertigo
- Syncope (hemorrhagic hypovolemia)
What is the gold standard for diagnosing Ectopic Pregnancy?
Diagnostic laparoscopy
Which laboratory tests are used in the workup for Ectopic Pregnancy?
- Serum beta-hCG level
- Urine beta-hCG level
- Transvaginal ultrasound
- Transabdominal ultrasound
- Culdocentesis
What is the medical management for a stable Ectopic Pregnancy?
Methotrexate
It is a folic acid antagonist that inhibits dihydrofolate reductase.
What does Methotrexate lead to in the treatment of Ectopic Pregnancy?
Arrest of DNA, RNA, and protein synthesis due to reduction of purines and thymidylate
In which cases is laparoscopy preferred over laparotomy for Ectopic Pregnancy?
When the patient is clinically stable and compliant with surveillance