Gastrointestinal & Nutrition Flashcards
Treatment:
Acute variceal bleeding
establish vascular access with two large bore intravenous needles OR a central line
Treatment:
Acute gastrointestinal perforation
emergent laparotomy
How is the treatment of acute gastrointestinal perforation altered when patient is on warfarin?
Fresh frozen plasma must be infused pre-operatively to achieve rapid reversal of anti-coagulation.
Why should patients with blunt abdominal trauma be evaluated by focused assessment with sonography for trauma (FAST)?
You perform the FAST exam to evaluate for intraperitoneal hemorrhage.
How does a positive FAST scan change the management of a patient with blunt abdominal trauma?
A positive FAST abdominal scan requires emergent exploratory laparotomy.
Clinical Manifestation:
acute-onset mid-abdominal pain out of proportion to physical exam
This is most likely acute mesenteric ischemia.
What is the most common cause of acute mesenteric ischemia?
The most common cause of acute mesenteric ischemia is an embolus from the heart.
How does the diagnosis change when a patient with acute mesenteric ischemia develops (1) peritoneal signs and (2) begins to pass bloody stool?
This patient has progressed to bowel infarction.
What complication is common in older patients after vascular surgery?
Ischemic colitis is very common in older patients after vascular surgery, typically due to extensive underlying atherosclerosis.
Diagnosis:
CT findings in a patient with ischemic colitis
thickening of the bowel wall
Diagnosis:
Colonoscopy findings in a patient with ischemic colitis
- cyanotic mucosa
2. hemorrhagic ulcerations
What are the qualifying criteria (3) for surgery in patients with intestinal obstruction?
- clinical or hemodynamic instability
- failure to improve after initial conservative measures (i.e bowel rest, IV rehydration, nasogastric tube)
- development of symptoms/signs of strangulation (i.e. fever and tachycardia)
Clinical Manifestation:
early psoas abscess
subacute presentation of psoas abscess:
- fever
- lower abdominal or flank pain that radiates to the groin
Describe the “psoas sign” often detected upon clinical examination of a patient with a psoas abscess.
abdominal pain with hip extension
What imaging modality is required to diagnose a psoas abscess?
CT scan is necessary for official diagnosis.
Treatment:
Psoas abscess
- Drainage
2. Antibiotics
Clinical Manifestation:
- acute pain
- swelling of the midline sacrococcygeal skin and subcutaneous tissues
Pilonidal disease
These patients often present with acute infection of a dermal sinus tract over the coccyx.
Treatment:
Umbilical hernia in an infant
Umbilical hernias are generally reducible and close spontaneously before the age of 5. Surgery is not required initially.
- Umbilical hernias are especially common in African-American infants.
Clinical Manifestation:
- acute abdominal pain out of proportion to examination findings
- metabolic acidosis
- atrial fibrilation
Bowel ischemia
Patient may also have peripheral vascular disease (PVD) or other known risk factors of thromboembolic disease in addition to abdominal pain and metabolic acidosis. Atrial fibrillation is a common finding because cardiac embolus is the most common cause of acute mesenteric ischemia.
What is the most common etiology for a complete small-bowel obstruction?
Post-operative adhesions
Clinical Manifestation:
- nausea
- vomiting
- abdominal bloating
- XRay indicating: dilated loops of bowel
small bowel obstruction
Treatment:
Complicated diverticulitis with abscess formation
CT-guided percutaneous drainage. Surgery is recommended if percutaneous drainage fails.
Clinical Manifestation:
Acute cholecystitis
- RUQ pain
- Fever
- Leukocytosis
Patients may or may not have leukocytosis.
Diagnosis:
- RUQ pain x 7 days
- fever x 7 days
- Leukocytosis
Perforated appendicitis with abscess formation.
Symptoms of appendicitis >5 days puts patients at risk for perforation and abscess formation.
