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Gastrointestinal II Exam 2 > GI Trauma and Emergencies > Flashcards

GI Trauma and Emergencies Flashcards

1
Q

What is the H/P for acute appendicitis?

A

visceral periumbilical pain evolving to somatic RLQ pain

fever, n/v

McBurney’s point tenderness

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2
Q

What are the diagnostic tests for acute appendicitis?

A

CBC (elevated WBC), chem panel, UA, pregnancy test

CT abd/pelvis with IV and oral contrast in adults

US and/or CT scan in kids

MRI in pregnant women

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3
Q

Treatment for appendicitis?

A

NPO, IVF, Antiemetic and pain control, pre-op abx

Surgery

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4
Q

What percentage of foreign body ingestions occur in children?

A

80%

<1% need surgical intervention

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5
Q

what percentage of foreign object ingestions pass without the need for intervention?

A

80-90%

<1% require surgery

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6
Q

What FB objects do children tend to ingest?

What FB objects tend to occur in adults?

A

coins, button batteries, toys, magnets, etc.

food bolus (meat, bones, pills)

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7
Q

Where is the most frequent site of obstruction in the GI tract?

A

esophagus (points of pathological or physiological narrowing)

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8
Q

What are some physiologic narrowings of the esophagus?

A

upper esophageal sphincter

level of aortic arch

diaphragmatic hiatus

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9
Q

What esophageal pathologies can increase risk for food bolus impaction?

A

diverticula

webs

rings

strictures

achalasia

tumors

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10
Q

What percentage of individuals with esophageal food impactions have underlying eosinophilic esophagitis?

A

50%

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11
Q

what are the s/s of ingestd foreign body?

A

may be asymptomatic

drooling, unable to swallow (requires emergent endoscopy)

fever, abd pain, vomiting (further work up needed)

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12
Q

If there are s/s of esophageal obstruction (drooling, not handling secretions), what imaging study do you order?

A

Emergent EGD

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13
Q

Treatment for FB ingestion varies based on what?

What indications need emergent care by ENT or GI?

A

presence and severity of sx

type of object ingested

location of object

signs of airway compromise (choking, stridor, etc)

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14
Q

Wha types of esophageal FB injestions need emergent endoscopy (within 6hrs)

A

complete obstruction

disk batteries

sharp-pointed objects

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15
Q

What FB injestions require urgent endoscopy (within 24hrs)

A

all foreign bodies in esophagus

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16
Q

How long does it take for FBs in the stomach or proximal duodenum to pass?

A

4-6 days

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17
Q

urgent endoscopy for FB in stomach or prox. duodenum is indicated for what objects?

A

sharp objects

longer than 5cm

magnets

blunt objects over 2cm in diameter

disk and cylindrical batteries

lead

everything else is expectant management

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18
Q

What is the management of FB objects distal to Lig. of Treitz?

A

expectant mangement

surgery or endoscopy if signs of inflammation or obstruction

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19
Q

What percentage of hernias are inguinal hernias?

of that, how many are indirect?

A

75%

2/3

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20
Q

Where are ventral hernias mostly located?

A

epigastric and umbilical

spigelian, incisional, parastomal

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21
Q

Where are groin hernias typically located?

A

inguinal (direct and indirect)

femoral, obturator

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22
Q

What are the most common ventral hernia locations?

A

epigastric and umbilical hernias

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23
Q

Where do indirect inguinal hernias pass through?

A

pass from the internal to the external inguinal ring through the patent process vaginalis and then scrotum

24
Q

Where do direct inguinal hernias pass through?

A

passes directly through the weakness in the transveralis fascia in the Hesselbach triangle

25
Q

What is a reducible hernia?

A

hernia sac itself is soft and easy to repalce back through the hernia neck defect

26
Q

What is an incarcerated hernia?

A

hernia sac is ferm, often painful, nonreducible by direct manual pressure

no signs of systemic illness

27
Q

What is a strangulated hernia?

A

hernia sac is firm and very painful

systemic illness present

implies impaired blood flow

28
Q

Which type of hernia is an acute surgical emergency?

A

strangulated hernia

29
Q

What is the protocol for a strangulated hernia?

A

exquisite tenderness with toxic s/s

consult gen surg

IV abx (broad spectrum)

IVF and narcotics

pre-op labs

30
Q

At what size is a AAA diagnosed?

A

AAA is diagnsoed when the aortic diameter exceeds 3.0cm

31
Q

Most AAAs are asymptomatic, but symptoms of unruptured AAA can include:

A

Abd pain, flank pain, limb ischemia, fever, malaise

32
Q

What is the classic triad for ruptured AAA?

A

Abd and/or flank pain

hypotension

shock

33
Q

What are the risks of AAA?

A

Old, white, smoker male with fmhx and hx of vascular disease

MOSTLY ASYMPTOMATIC

34
Q

AAA is misdiagnosed how often?

What is it often mistaken for?

A

30%

renal colic, perforated viscus, diverticulitis, GI hemorrhage, ischemic bowel

35
Q

For a symptomatic AAA that is stable, what is the testing?

For unstable symptomatic AAA, what is the testing?

A

CT abd/pelvis with IV contrast

If known hx, go to OR without imaging

if unknown or suspected hx, CT abd/pelvis with IV contrast

36
Q

Screen for AAA when?

Monitor AAA how?

A

one time for risky patients over 65 with US

if known AAA, monitor every 6 months or annually with US or CT abd/pelvis

37
Q

What is blunt trauma?

A

direct blow causing rupture of hallow organs and bleeding

can be from deceleration causing sheering injuries

38
Q

What is penetrating trauma?

A

GSW, stab, lac, etc

GSW can cause kinetic energy transfer to viscera, worsening damage

39
Q

What is explosive trauma?

A

blunt/penetrating/lung and hollow viscus injury

inhalation injury

40
Q

What are the most commonly injured abdominal organs from blunt trauma?

A

spleen and liver

41
Q

What sort of hx do you need for MVC?

A

restrained?

intoxicated?

location in vehicle?

airbags?

LOC?

ejection?

roll over?

fatality at scene?

42
Q

What hx do you want for penetrating injury?

A

time?

type of injury?

number of penetrations

43
Q

What hx do you want for an explosive trauma?

A

enclosed space?

distance from detonation?

combo of injury types?

inhalation?

44
Q

What are the ABCDEs for trauma care?

A

A-airway maintance by C spine control

B-breathing and ventilation

C-circulation with hemorrhage control

D-disability and neuro status

E-Exposure/environmental control

45
Q

Besides normal IAPP for the abdomen during PE for trauma, what else should be assessed?

A

pelvic stability

urethral meatus, perinala, rectal and vaginal vaults

46
Q

When to suspect diaphragm injuries?

A

after MVC or blunt trauma to thoracoabdominal region

most often on left

47
Q

When to suspect duodenal injuries?

A

unrestrained driver in MVC

bicycle handlebar injury

order CT abd/pelvis with IV and oral contrast

48
Q

When to suspect pancreatic injuries?

A

direct blow to pancreas that compresses it to vertebral column

watch amylase/lipase trends

CT abd/pelvis with IV and oral contrast

49
Q

When to suspect GU injuries?

What is a clue that there might be anterior pelvic injuries present?

A

direct blow to back or flank

gross or microscopic hematuria

CT abd/pelvis with IV contrast

urethral dusruption

50
Q

When to suspect hollow viscus injuries?

A

sudden decel. injury from MVC

Chance fractures

early US and CT may not ID these injuries

51
Q

If liver/spleen lac and pt is hemodynamically stable, what is management?

if unstable, what is management?

A

close observation by gen surg in hospital

if unstable, surgery

52
Q

When to suspect pelvic fracture and assx injury?

A

MVC, auto v. pedestrian, fall from heights

Hypotension and pelvic fx have high mortality rate

can have venous plexus damage or internal iliac artery damage

53
Q

What is the main diagnostic studies for trauma in general?

A

CBC, chem, UA, pregnancy test, Pt/PTT/INR, type and screen

C spine, CXR, AP pelvis Xrays

FAST scan

CT abd/pelvis wiht IV contrast

DO NOT DELAY TRANSFER in order to obtain labs/images, if they need to be transfered, just send them.

54
Q

Blunt abdominal trauma with hypotension with a positive fast scan or clinical evicence of intraperitoneal bleeding gets sent where?

A

to surgery for a laparotomy

55
Q

What is the purpose of a FAST scan?

A

detect free intraperitoneal fluid, pericardial fluid, pleural fluid, hemothorax, pneumothorax in trauma patients

can check heart with subxiphoid view

Morrison’s pouch for kidney/liver

perisplenic view

retrovesicular view (pelvis)

Gastrointestinal II Exam 2 (10 decks)

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