GI Emergencies and Abd Trauma

Question 1

what age group is most likely to get appendicitis

Answer 1

10-19 year olds

Question 2

What labs would be ordered for suspected acute apendicits

Answer 2

CBC
CMP 
UA 
Pregnancy 
Imaging

Question 3

What imaging would be ordered for suspected appendicitis

Answer 3

Adults: Ct abdomen and pelvis w/ contrast

Kids: US; if neg then CT

Pregnant: MRI

Question 4

What is the initial treatment of appendicitis?

Answer 4

NPO
IVF
antiemetic 
pain meds
preop abx 

Cut that shit out

Question 5

what is the best way to not miss acute appendicitis acting like a gastroenteritis or viral illness?

Answer 5

treat the patient

if normal CBC and abnormal UA keep appendicitis on ddx

Question 6

what percent of all foreign body ingestions occur in children

Answer 6

80%

80-90 percent pass w/o need for intervention

Question 7

What is the reason that the esophagus is the primary point of impaction

Answer 7

physiological areas of narrowing at UES, aortic arch, and diaphragmatic hiatus

there are also pathologies that narrow the esophagus

Question 8

What are the hallmark symptoms of esophageal obstruction?

Answer 8

• drooling and inability to swallow saliva

- Fever abd pain, vomiting

Question 9

What is the reason you would use imaging on a suspected esophageal impaction

Answer 9

if they were asymptomatic!!! don’t delay EGD

Question 10

In what instance is a plain radiograph appropriate for foreign body ingestion

Answer 10

without suspicion of esophageal obstruction and history of ingestion of radio opaque object ie coin

Question 11

When is a CT appropriate for foreign body ingestion

Answer 11

suspected perf
sharp/pointy object
suspected ingestion of narcotics in a condom or such

Question 12

what factors inform the course of treatment for foreign object ingestion?

Answer 12

presence and severity of sx
type of object
location of object

Question 13

When is an emergent <6hrs endoscopy indicated in foreign object ingestion

Answer 13

complete obstruction
disk batteries
sharp pointed objects

Question 14

When is an urgent <24 hrs endoscopy indicated in foreign object ingestion indicated

Answer 14

all foreign objects in esophagus

Question 15

What percent of hernias are inguinal hernias?

Answer 15

75%

Question 16

what fraction of inguinal hernias are indirect?

Answer 16

2/3 — so if 75% of hernias are indirect and of those 2/3 are indirect, that is your majority choice if you like me and dumb

Question 17

what are the three statuses of hernias

Answer 17

Reducible
incarcerated
strangulated

Question 18

what type of hernia is the most common ventral hernia

Answer 18

epigastric
umbilical

1/4 of people will be born with or develop this kind of hernia

Question 19

what is a direct inguinal hernia

Answer 19

passes DIRECTLY through a weakness in the transversalis fascia in the hesselbach triangle

Question 20

What is an indirect inguinal hernia

Answer 20

passes through the femoral ring through a patent processus vaginalis

Question 21

Which of the three hernia statuses is a surgical emergency

Answer 21

strangulated hernia

Question 22

What is the treatment for a strangulated hernia

Answer 22

consult gen surge
broad spectrum IV abx
fluid resuscitation
pre op lab studies

Question 23

when is an AAA diagnoses?

Answer 23

when diameter of AA exceeds 3.0 cm

Question 24

where do AAA most commonly occur

Answer 24

in abdomen below renal arteries

Question 25

what are the three categories of AAA

Answer 25

asymptomatic - most
symptomatic but not ruptured
symptomatic and ruptured - consult surgery and the morgue

Question 26

what is the triad of symptomatic and ruptured AAA

Answer 26

abdominal/flank pain, hypotension, shock

Question 27

who and how should be screened for AAA

Answer 27

at risk population over 65

• advanced age
• male
• caucasian
• smoking

Question 28

when would surgery for AAA repair be indicated

Answer 28

asymptomatic >5.5 cm
rapidly expanding >.5 cm/6mo
patients with associated arterial disease

Question 29

how does blunt force trauma cause injury

Answer 29

direct blow ruptures hollow organs

deceleration (MVC) causes shearing

Question 30

How do penetrating trauma cause injury

Answer 30

low velocity cause tissue damage by laceration

high velocity is kinetic transfer of energy

Question 31

Why are blast injuries so damaging

Answer 31

it combines blunt force trauma with penetrating trauma as well as potential inhalation injuries

Question 32

what are the most commonly injured organs in abdominal blunt force trauma

Answer 32

Liver and spleen

75% related to MVC

Question 33

What are the ABCDEs of ATLS

Answer 33

A- Airway w/ c-spine
B - Breathing 
C - Circulation 
D - disability neuro 
E - exposure/environmental control

Question 34

Where do most diaphragmatic injuries occur

Answer 34

on the left side in MVC

-can occur when using trocar with chest tube placement

Question 35

what tests are useful for tracking suspected pancreatic injury

Answer 35

amylase and lipase

CT abd/pelvis w/ contrast IV and PO

Question 36

Is surgery always necessary for liver and spleen injury?

Answer 36

no. if hemodynamically stable, no surgery needed

Question 37

why are pelvic fractures so deadly?

Answer 37

many vascular structures and no way to ligate them if they rupture and contract.

manage with pelvic binding

Question 38

If you are waiting on a test that will confirm your diagnosis, should you wait before transferring them to definitive care?

Answer 38

NO, yeet them on

Question 39

who would go to surgery for a laparotomy

Answer 39

Blunt trauma with hypotension and + FAST scan or clinical evidence of intraperitoneal bleeding