GI Surg Condition Flashcards
Diverticular disease- Eti
DiverticuliItis- acute illness due to points of weakness in near blood supply
Free perforation- infection into peritoneal cavity, may abscess
95% in sigmoid colon sue to increased pressure
Diverticular disease- Sx
- LLQ pain
- Constipation
- Bloating
- Subjective fever
- Tachy, abd tenderness, leukocytosis
- Maroon or bright red hematochezia in > 50
Diverticular disease- Dx
CT scan
Diverticular disease- Tx
- Mild- abx
- Elective colonoscopy after 4-6 weeks
- Operation- Free perforation (sigmoid resection) or abscess (percutaneous drainage)
Appendicitis- Eti
- Blockage in lining of appendix leading to infection
Appendicitis- Sx
- RLQ tenderness with guarding
- Malaise followed by periumbilical pain, localizes to RLQ followed by fever
- McBurney point
- Anorexia, nausea, vomiting
Appendicitis- Dx
- US or CT scan
Appendicitis- Tx
- Operation to remove
- Abx- Cephalosporin
Cholecystitis/ cholelithiasis- Eti
- cholithiasis- having a gall stone
- Cholecystitis- stuck, bile can’t get out
Cholecystitis/ cholelithiasis- Sx
- Epigastric pain to RUQ radiating to back and shoulder
- Exacerbated by fatty foods
- Abrupt onset of pain, cessation over mins to hrs
- Bloating and flatulence
- Murphy sign
Cholecystitis/ cholelithiasis- Dx
Ultrasound
Cholecystitis/ cholelithiasis-Tx
- Laparoscopic cholecystectomy if symptomatic
- Abx
Choledocholitiasis- ERCP
Hernia- Eti
- Abnormal protrusion of an organ through abd cavity
- Can be reducible, incarcerated or strangulated (loss of blood supply)
- Higher risk in men
- Right side more common
- Femoral more common in women
Hernia- Sx
- Bulge, pain of ache
- Protrusion in canal on exam
Hernia-Tx
- Reduce the sac and repair the defect
- Can watch and wait but doesn’t get better on own
Hernia- Dx
- Diagnostic tests unnecessary
- Clinical exam
Ruptured spleen- Eti
- Direct blow or trauma to abd
- Mono, AIDS, malaria, leukemia, sickle cell
Ruptured spleen- Sx
- Pain and tenderness radiating to left neck or shoulder (Kehr’s sign)
- LUQ at 9th-10th rib
- Shock, falling hematocrit
Ruptured spleen- Dx
- Ultrasound- multi view
- CT in stable pts
Ruptured spleen- Tx
Emergent splenectomy
Perforated bowel- Eti
Appedicitis, diverticulits
- Blunt trauma
- ASA or NSAID OD
Perforated bowel- Sx
- Sudden explosive onset of severe mid to lower abd pain
- Shock
- Rigid, tender abd
Perforated bowel- Dx
- Abd XR
Perforated bowel- Tx
- Crystalloid fluids
- Abx
- Remove infected material
- Repair
Peritonitis- Eti
Perforation of abd wall
- D/t trauma, diverticulits, pancreatitis
Peritonitis- Sx
- Abrupt pain, distension, fever
- Diminished bowel sounds
- Rebound tenderness
Peritonitis- Dx
Examine fluid- bacteria, lactic acid
Peritonitis- Tx
- Exploration, debridement and drainage
- Abx x 14 days
Bowel obstruction- Sx
- Constipation or obstipation
- Distention and tenderness
- Abd pain
- N/V
Bowel obstruction- Dx
- CT with contrast
Bowel obstruction- Tx
- Resection and decompression
Colon CA- Eti
- Screen at age 50 q 10 yrs
- Yearly fecal occult
- Adenocarcinoma most common
Colon CA- Sx
- Blood in feces
- Weakness and anemia
- Change in bowel habits
- Dyspepsia
Colon CA- Dx
- Colonoscopy and biopsy of polyps
Colon CA- Tx
- Resection of lesion and lymph
- CEA levels pre and post op
- Colonoscopy at 6 mo, 12 mo, 3 yrs, 5 yrs
Volvulus- Eti
- Rotation of bowel loops around fixed point
- Ischemia, gangrene
- Sigmoid most common
Volvulus- Sx
- Colicky abd pain
- Spasms
- Distension, tympany
- High pitched bowel sounds
Volvulus- Dx
- XR: loss of haustra, kidney bean appearance
- Bird beak sign, loop distension
Volvulus- Tx
- Decompression with sigmoidoscopy
- Fluid resuscitation
Umbilical hernia- Eti
- W>M
Umbilical hernia- Sx
- Increased size
- Sharp pain with coughing or sneezing
Umbilical hernia- Dx
Clinical
Umbilical hernia- Tx
- Repair to avoid incarceration
- Mesh
Inguinal hernia- Eti
- M>W
- Indirect > direct
Inguinal hernia- Sx
- Bulge and pain in inguinal canal
- Aching
Femoral hernia- Eti
- Prone to incarceration/ strangulation
- W>M
- Descend through femoral canal beneath inguinal ligament
- Difficult to reduce
Femoral hernia- Sx
- Asymptomatic until incarcerated
- Small bulge in medial thigh
- Colicky abd pain
Femoral hernia- Tx
- Open laparoscopy
Incisional hernia- Eti
- Complication of laparotomy
- COPD, steroids, wt, smoking
Incisional hernia- Sx
- Bulging, pain, ache at incision site
- Protrusion and obstruction at surgical site
Incisional hernia- Tx
- Recurrence is common
- Mesh repair
