General surgery Flashcards
what % of appy are perforated at presentation?
25%
what is the alvarado score for appendicitis?
pre-test probability: migratory right iliac pain N/V anorexia tenderness on exam in right iliac fossa rebound tenderness fever leucocytosis left shift
how do you manage perforated appy?
IV abx until afebrile
who gets pyloric stenosis
2 week to 2 month
male 4;1
first born
Fhx esp in mom
How do we dx pyloric stenosis
must rule out other etiology for emesis
AUS - length > 14 mm, thickness > 4 mm
UGIS - string sign
what is the electrolyte abnormality in pyloric stenosis
hypochloremic metabolic alkalosis
loss of H and Cl in the emesis
kidneys try to balance by excreting Na and HCO3
then kidneys try to reabsorb Na at the expense of H and K = paradoxical aciduria
what type of intussuception can not be reduced radiologically?
jejuno-ileal - too far and can’t get enough pressure
who gets intussuception?
3 mo to 3 yrs
males 3:1
recurrence 3-11%
what is the most common type of intussuception?
ileocolic - 85%
what are absolute contraindications for pneumatic reduction of intussusception?
peritonitis
persistent hypotension
pneumoperitoneum
what are the rules of 2 for Meckel’s diverticulum?
2% of population 2;1 M 2-6% asymptomatic within 2 feet of ileocecal valve 2 inces long 2 types of mucosa - gastric or pancreatic
what are CF of Meckel’s ?
MC - bleeding, painless, episodic
diverticulitis - inflammation, pain, perforation
how do you Dx Meckel’s?
99Tc scan
give ranitidine before helps make it more sensitive
T or F. prenatal Dx of CDH is associated with better outcome than post natal Dx
True
what chromosomal abnormality of most commonly associated with CDH
Trisomy 18
what are important mgnt steps for a CDH?
- intubate on first breath
- NG to decompress
- stabilize
- RO other abnormalities - ECHO and genetics
- wait until stable to operate
if you are suspicious for TEF, what might help Dx? and if found, what other investigations are warranted
insert 8-10F NGT - will block at 10 cm if TEF
Need ECHO for ? VACTERL
need to look for anal atresia
which upper GI abnormality may show up with no air on abdo Xray
esophageal atresia
what is the mc typeof esophageal atresia?
EO with distal TEF
what is the best test for volvulus Dx
upper GI series
US is a screen only - mesenteric vessel orientation
what is the DDx for billious emesis in a neonate?
- Mid gut volvulus
- malrotation
- duodenal atresia
- Hirshsprung
- ileus - NEC
when does malrotation and vulvulus tend to present?
first month - 65%
firts year - 13%
how do we Dx Hirschsprung?
screen- contrast enema looking for transition zone seen in 80-% might not see in early presentation
classic is rectosigmoid
Gold - suction rectal Bx - no ganglion, hypertrophic nerves and incraesed ACh-esterase stain(seen in all constipation
(can do rectal manometry in older)
How do Pt with Hirschsprung present
abdo distension
bilious emesis
failure to pass mec in 24 hrs
enterocolitis - fever, lethargy, HD un stable
how do you manage Hirschsprung?
rectal decompression with saline irrigation
Sx early - definitive pull-through
which of these has associated malrotation - omphalocele and gastroschisis
BOTH!!!
what is the MC cardiac malformation associated with omphaloceles?
TOF
if baby found to have omphalocele, what other investigations are required?
ECHO - TOF
genetics for BWS, T13, T18
multiple and isolated congenital anomalies (musculoskeletal, 24%; urogenital, 20%; cardiovascular, 15%; and central nervous system, 9%)
where is the defect in gastroschisis?
Right of umbilicus
what are the issue with gastroschisis?
atresia
volvulus
prolonged ileus
doe omphaloceles have bowle atresia?
not usually
bowel works well
50% have associated abnormalities
what age group gets inguinal hernias?
most common in < 1 year olds
when should an inguinal hernia be repaired?
if strangulated - right away
otherwise - within 2 weeks bc risk of incarceration is 30-40% and inc if wait
CL exploration only if ex-prem
how do you manage an incarcerated inguinal hernia?
attempts manual reduction with sedation
followed by OR 24-48 hours later
what are complications of inguinal hernia repair?
scrotal swelling scrotal hematoma - resolves 10-14 d iatrogenic undescended testicle recurrence - esp if incarcerated or prem testicular atrophy
why do we do orchidopexies?
- fertility
- malignancy
- risk of torsion/hernia/trauma
how can you tell apart an incarcerated hernia from a acute hydrocele?
incarcerate - patient looks a bit sicker, emesis, abdo pain, no poops
what are CF of UC
tenesmus urgency crampy abdo pain norcturnal BM Bloody stool/diarrhe anorexia/wgt loss
what defines fulminant colitis
fever
> 5 bloody stools X 5 days
severe anemia
hypoalbuminemia
what are extra Gi manifestations of Crohn’s
apthous ulcers arthritis EN clubbing renal stone/gallstones delayed puberty
what are the typical CF of Crohn’s
weight loss - can be the only sign
abdo pain
diarrhea
fatigue
how do we Dx Crohn’s
bc can have small bowel disease
UGI/SBFT
colonoscopy for Dx
