GI Trauma/Emergencies Flashcards
Between what ages is appendicitis the most common?
10-19
Describe the history of the pain with Appendicitis
- Visceral (vague and aching) abdominal pain
- Localizes to the RLQ
- Somatic (localized and sharp)
Early Appendicitis can mimic?
Gastroenteritis or viral illness
Early Appendicitis can mimic gastroenteritis or viral illness. Why should you treat the patient and not the CBC/UA lab results?
CBC and UA can come back normal OR abnormal in patients with appendicitis
In kids, instead of a CT, what test should you get first to check for appendicitis?
US
– if (-) then get a CT
Ingested foreign bodies are most common in?
Children
Ingested foreign bodies most common treatment?
Watch and wait == usually pass without intervention
What is an example of a common foreign body ingested in children?
Coin, button batteries
In adults, what is the most common ingestion that causes obstruction?
Food(meat) ==> food bolus
Most frequent site of obstruction for foreign bodies?
Esophagus
What are the signs of an esophageal obstruction?
Drooling and inability to swallow liquids
If a patient is drooling and cannot swallow liquids, what should you do?
Emergent Endoscopy
What symptoms with foreign body ingestion would require a further workup?
Fever, abdominal pain and vomiting after ingestion
When should you get imaging after a foreign body ingestion?
When the patient does NOT have signs of an esophageal obstruction
2 options for imaging and what they can be good for with ingestion of foreign bodies?
Plain radiograph - not all things show up
CT - narcotics, sharps, perforation
What 3 things does treatment of a foreign body ingestion depend on?
Symptoms
Type of object
Location of object
What 3 things does treatment of a foreign body ingestion depend on?
Symptoms
Type of object
Location of object
What treatment does the majority of foreign body ingestion cases require?
Watch and wait
- can get weekly x-ray until found in stool
Majority of foreign objects will pass in?
4-6 days
What treatment does esophageal obstruction require?
Endoscopy within 6-24 hours
Protrusion of an organ through the body wall that normally contains it
Hernia
What 3 ways can hernias be classified?
Location
Contents
Status of contents
Most common ventral hernias?
Epigastric
Umbilical
Most common groin hernias?
Inguinal – direct and indirect
Femoral
Obturator
What is the most common hernia type?
Indirect Inguinal hernia
Indirect Inguinal Hernia
Passes through internal and external inguinal ring, through the patent process vaginalis and into the scrotum
Where do Indirect Inguinal Hernias protrude?
Scrotum
Direct Inguinal Hernia
Passes through a weakness in transversalis fascia in Hesselbach triangle
Contents of hernias are usually?
Fat or bowel
3 status of content types for hernias?
- Reducible
- Incarcerated
- Strangulated
3 status of content types for hernias?
- Reducible
- Incarcerated
- Strangulated
Hernia sac is soft and easy to replace
Reducible
Hernia sac is firm and non-reducible
Incarcerated
Hernia sac is firm, PAINFUL, and signs of systemic illness
Strangulated
Reducible hernias treatment?
Outpatient surgery follow up
Incarcerated hernias treatment?
Surgery consult
Strangulated hernias treatment?
Straight to general surgery – emergency!
Strangulated hernias have signs of systemic illness/obstruction/sepsis. Why?
Impaired blood flow usually
