GI Emergencies and Abd Trauma Flashcards
what age group is most likely to get appendicitis
10-19 year olds
What labs would be ordered for suspected acute apendicits
CBC CMP UA Pregnancy Imaging
What imaging would be ordered for suspected appendicitis
Adults: Ct abdomen and pelvis w/ contrast
Kids: US; if neg then CT
Pregnant: MRI
What is the initial treatment of appendicitis?
NPO IVF antiemetic pain meds preop abx
Cut that shit out
what is the best way to not miss acute appendicitis acting like a gastroenteritis or viral illness?
treat the patient
if normal CBC and abnormal UA keep appendicitis on ddx
what percent of all foreign body ingestions occur in children
80%
80-90 percent pass w/o need for intervention
What is the reason that the esophagus is the primary point of impaction
physiological areas of narrowing at UES, aortic arch, and diaphragmatic hiatus
there are also pathologies that narrow the esophagus
What are the hallmark symptoms of esophageal obstruction?
- drooling and inability to swallow saliva
- Fever abd pain, vomiting
What is the reason you would use imaging on a suspected esophageal impaction
if they were asymptomatic!!! don’t delay EGD
In what instance is a plain radiograph appropriate for foreign body ingestion
without suspicion of esophageal obstruction and history of ingestion of radio opaque object ie coin
When is a CT appropriate for foreign body ingestion
suspected perf
sharp/pointy object
suspected ingestion of narcotics in a condom or such
what factors inform the course of treatment for foreign object ingestion?
presence and severity of sx
type of object
location of object
When is an emergent <6hrs endoscopy indicated in foreign object ingestion
complete obstruction
disk batteries
sharp pointed objects
When is an urgent <24 hrs endoscopy indicated in foreign object ingestion indicated
all foreign objects in esophagus
What percent of hernias are inguinal hernias?
75%
what fraction of inguinal hernias are indirect?
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
what are the three statuses of hernias
Reducible
incarcerated
strangulated
what type of hernia is the most common ventral hernia
epigastric
umbilical
1/4 of people will be born with or develop this kind of hernia
what is a direct inguinal hernia
passes DIRECTLY through a weakness in the transversalis fascia in the hesselbach triangle
What is an indirect inguinal hernia
passes through the femoral ring through a patent processus vaginalis
Which of the three hernia statuses is a surgical emergency
strangulated hernia
What is the treatment for a strangulated hernia
consult gen surge
broad spectrum IV abx
fluid resuscitation
pre op lab studies
when is an AAA diagnoses?
when diameter of AA exceeds 3.0 cm
where do AAA most commonly occur
in abdomen below renal arteries
what are the three categories of AAA
asymptomatic - most
symptomatic but not ruptured
symptomatic and ruptured - consult surgery and the morgue
what is the triad of symptomatic and ruptured AAA
abdominal/flank pain, hypotension, shock
who and how should be screened for AAA
at risk population over 65
- advanced age
- male
- caucasian
- smoking
when would surgery for AAA repair be indicated
asymptomatic >5.5 cm
rapidly expanding >.5 cm/6mo
patients with associated arterial disease
how does blunt force trauma cause injury
direct blow ruptures hollow organs
deceleration (MVC) causes shearing
How do penetrating trauma cause injury
low velocity cause tissue damage by laceration
high velocity is kinetic transfer of energy
Why are blast injuries so damaging
it combines blunt force trauma with penetrating trauma as well as potential inhalation injuries
what are the most commonly injured organs in abdominal blunt force trauma
Liver and spleen
75% related to MVC
What are the ABCDEs of ATLS
A- Airway w/ c-spine B - Breathing C - Circulation D - disability neuro E - exposure/environmental control
Where do most diaphragmatic injuries occur
on the left side in MVC
-can occur when using trocar with chest tube placement
what tests are useful for tracking suspected pancreatic injury
amylase and lipase
CT abd/pelvis w/ contrast IV and PO
Is surgery always necessary for liver and spleen injury?
no. if hemodynamically stable, no surgery needed
why are pelvic fractures so deadly?
many vascular structures and no way to ligate them if they rupture and contract.
manage with pelvic binding
If you are waiting on a test that will confirm your diagnosis, should you wait before transferring them to definitive care?
NO, yeet them on
who would go to surgery for a laparotomy
Blunt trauma with hypotension and + FAST scan or clinical evidence of intraperitoneal bleeding
