Gallbladder Disease, Diverticular Disease and Hernias - Ritesma Flashcards

1
Q

Strangulated Hernia

A

not reducible

vascular supply compromised

surgical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Hernia Causes

A
  • congenital defect
  • obesity
  • pregnancy
  • chronic cough
  • constipation
  • heavy lifting
  • family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Reynolds Pentad

A
  1. Pain
  2. Fever/chills
  3. Jaundice
  4. Altered Mental Status
  5. Hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ventral and Umbilical Hernia

A

frontal wall of abdomen

secondary to tears or seperation of muscle

  • pregnancy
  • surgical incisions
  • congential weakness

TX:

  • attempt to reduce & assess for danger signs
  • surgical referral
  • hernia belt or binder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diverticulitis

A

microperforation of the diverticula: inflammation & infection

SYMPTOMS:

  • lower abdominal pain
  • constipation or loose stools are common
  • nausea and vomiting
  • can be mild (microperforation) to severe (macroperforation - abscess)

PHYSICAL EXAM

  • low grade fever
  • LLQ tenderness and palpable mass
  • rectal exam - + occult blood
  • Lekocytosis
  • perforation would have more dramatic peritonal signs (Obturator, Psoas, Markle)

IMAGING TREATMENT

  • Abdominal CT - more severe symptoms or not responsive to antibiotics

TREATMENT

  • MILD: liquid diet & oral antibiotics
  • MODERATE: admit to hospital, NPO, IV fluids, IV ABX
  • SEVERE: surgery

COMPLICATIONS

  • fistula formation
  • bowel obstruction
  • abscess
  • perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hernia

A

protrusion of intra-abdominal contents through a weakness or abnormal fascia opening in abdominal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diverticulosis

A

presence of diverticula (pockets/puches) of intestinal mucosa and submucosa

PATHOPHYSIOLOGY:

  • sigmoid and descending colon
  • lack of fiber in the diet
  • patients with connective tissue disorders are predisposed

PHYSICAL EXAM:

  • often an incidental finding
  • LLQ discomfort on exam, thickened palpable sigmoid and descending colon

IMAGING: None

TREATMENT: high fiber diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Epididymitis

A

STD: men

UTI and Prostatitis: older men; gram negative rods

pain in FLANK or ABDOMEN

urinary retention, urgency

nausea/vomiting, fever

EXAM: tender and swollen epididymis, scrotum inflamed, warm, and red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cholecystitis

A

INFLAMMATION & DISTENSION of the GALLBLADDER

CAUSES:

  • obstruction
  • acalculus cholecystitis - due to biliary stasis from fasting, TPN, trauma
  • infection: CMV, cryptosporidosis, vsculitis

PATHOGENESIS

  • gallbladder inflammed, lysolecithin is released due to trauma to gallbladder wall

SYMPTOMS

  • RUQ pain may radiate to back or R shoulder
  • pain is constant and severe
  • nausea
  • vomiting
  • anorexia
  • fever

PHYSICAL

  • RUQ + guarding
    • Murphy’s sign
  • fever
  • tachycardia

LABS

  • complete blood count
  • metabolic panel
  • amylase (may be elevated), lipase

DIAGNOSTIC

  • ultrasound - can detect stones, thinckened wall and sonographic murphy’s sign

TREATMENT

  • GI rest - NPO
  • IV pain medications, anti-emetics, hydration,
  • surgery?
  • IV antibiotics - 2nd or 3 rd generation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Reducible Hernia

A

can be manually of spontaneously repositioned into abdominal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Charcot Triad

A
  1. Pain
  2. Fever/chills
  3. Jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Testicular Torsion

A

MEDICAL EMERGENCY

acute, severe unilateral testicular pain

pain on palpation

most common 12-18 yo; left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Indirect Hernia

A

passes THROUGH inguinal ring

LATERAL TO EPIGASTRIC A.

occurs in younger males and females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Testicular Tumor

A

painless enlargment of testis

negative urinalysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cholelithiasis

A

GALLSTONES

classified according to chemical composition

RUQ episodic pain due to stones moving, no infection, inflammation or blockage; often eating fatty or fried foods

no fever, no elevated WBC/liver enzymes

EXAM

  • RUQ tneder to palpation
    • Murphy’s sign

LAB

  • CBC, LFT, chemisty, amylase, lipase - usually normal

IMAGING

  • ULTRASOUND gold standard
  • HIDA scan

TREATMENT

  • Pain medication
  • IV hydration
  • Elective laprascopic cholecystectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Direct Hernia

A

passes through abdominal wall

MEDIAL TO EPIGASTRIC A.

more common in older men; uncommon in females

16
Q

Gallbladder Disease Prevalence

A
  • 9x greater prevalence in Native American women
  • 5.5% in men
  • 8.6% in women

Special Populations

  • family hx of gallbladder
  • cystic fibrosis patients
  • pancreatic disease
  • patients on TPN
  • male/female > 60
18
Q

Risk for Gallbladder Disease (5 F’s)

A
  • Female
  • Fat
  • Fair
  • Fertile
  • Forty

other risks:

  • estrogen/progesterone replacement tx
  • rapid weight loss
  • dyslipidemia
  • DM2/glucose intolerance/insulin resistance
  • medications
19
Q

Incarcerated Hernia

A

cannot be reduced

can lead to bowel obstruction but no vascular compromise

20
Q

Choledocholithiasis

A

Bile Duct Stones

Features:

  • hx of recurrent RUQ pain
  • chills and fever w/ pain episode
  • jaundice w/ pain episode

Charcot Triad

  1. Pain
  2. Fever/Chills
  3. Juandice

Reynolds Pentad - acute cholangitis - EMERGENCY

  1. Pain
  2. Fever/Chills
  3. Jaundice
  4. Altered Mental Status
  5. Hypotension

EXAM

  • hepatomegaly
  • tenderness of RUQ or epigastrium
  • charcot triad or tirad + lab evidence of inflamation, elevated liver enzymes or biliary dilation on imaging

TREATMENT:

  • surgery
21
Q

Hydrocele

A

painless accumulation of fluid in the tunica vaginalis or along spermatic cord (bag of worms)

tx: aspiration (temporary), surgery

22
Q

Murphy’s Sign

A

when palpating at the edge of the gallbladder fossa just beneath the liver edge, ask patient to inspire deeply

+ patient stops inspiration or has increased pain