GI Flashcards
What pressure is defined as increased intraabdominal pressure due to abdominal compartment syndrome?
> 25mmHg
What are the risk factors for abdominal compartment syndrome? (5)
- packing remaining in the abdomen after initial laparotomy
- bowel edema caused by massive crystalloid resuscitation
- reperfusion injury,
- ongoing intraabdominal bleeding
- primary fascial closure
What is Borchsrdts triad
Enesis followed byretching
Epigastric fistension
Failure to pass an NGT
Boerhaaves Syndrome
Esophageal perforation
Budd chiari syndrome
Thrombosis of hepatic veins
What is Mirizzi syndrome
Extrinsic obstruction of the common hepatic bile duct from a gallstone in the gallbladder or cystic duct
Referring syndrome
Hypo kalemia
Hypomagnasemia
Hypophosphatemia
Short gut syndrome
<200cm of viable small bowel
What are the causes of post-operative pancreatitis? (6)
Manipulation of the pancreas during surgery
Low blood flow (i.e. CPB)
Gallstones
Hypercalcemia
Medications
Idiopathic
What is the initial treatment of post-operative pancreatitis?
NPO
Aggressive fluid resuscitation
NGT PRN
What causes short bowel syndrome?
Malabsorption and diarrhea resulting from extensive bowel resection (<200cm)
What is the initial treatment for short bowel syndrome?
TPN early
Small meals chronically
What is blind loop syndrome?
Bacterial overgrowth in the small intestine
What are the surgical causes of B12 deficiency?
Blind loop syndrome
Gastrectomy (due to decreased secretion of intrinsic factor)
Excision of the terminal ileum
What is dumping syndrome?
Deliver of hyperosmotic chyme to the small intestine causing massive fluid shifts in the bowel
What causes abdominal compartment syndrome (2)?
Increased intra-abdominal pressure after laparatomy
Massive IVF resuscitation
How do you measure the intra-abdominal pressure?
Read the intrabladder pressure (a foley catheter hooked up to the manometry after instillation of 50-100cc water)
What is the intra abdominal pressure that requires treatment?
> /= 25mmHg if there are signs of compromise
What is the treatment for abdominal compartment syndrome?
Decompressive laparatomy
What are the signs and symptoms of pseudomembranous colitis?
Diarrhea
Fever
Hypotension/tachycardia
What is the treatment for pseudomembranous colitis?
Flagyl
PO vancomycin refractory to flagyl
What is an acute abdomen?
Acute abdominal pain so severe the patient seeks medical attention?
34-year-old in the ICU s/p laparotomy with fascia closed,
decreased urine output, increased peak airway pressure,
decreased CVP, normal chest x-ray, normal EKG
Abdominal comparment syndrome
What is the parrot’s beak or bird’s beak sign?
Sigmoid volvulus on barium enema
What is the best way to visualize the biliary and gallbladder?
U/S
What conditions can mask abdominal pain?
Steroids
Diabetes
Paraplegia
How is the free air ruled out if the patient cannot stand?
Left lateral decubitus
What is the differential diagnosis for the patient with AIDS and abdominal pain?
CMV
Kaposi’s sarcoma
Lymphoma
TB
Mycobacterium Avium Intracellulare
What endocrine problems cause abdominal pain?
Addisonian Crisis
DKA
What are the 4 complications of hernias
Pain
SBO
Bowel necrosis
Incarceration/strangulation
What is the difference between incarcerated and strangulated hernia?
Incarcerated: Swollen or fixed within the hernia sac (incarcerated = imprisoned); may cause
intestinal obstruction (i.e., an irreducible hernia)
Strangualted:Incarcerated hernia with resulting ischemia; will result in signs and symptoms
of ischemia and intestinal obstruction or bowel necrosis (Think: strangulated
= choked)
What are the boundaries of the hesselback’s triangle?
Inferior epigastric vessels
Inguinal ligament
Lateral border of the rectus sheath
Hernia here is called the inguinal hernia
What is the difference between direct vs indirect inguinal hernia?
Direct inguinal hernia: within the floor of the hesselbach’s triangle (does not traverse the internal ring).
Indirect inguinal hernia: hernia through the internal ring of the inguinal canal then travelling donwards to the external ring
IS the risk of strangulation higher
