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Clin Med III Exam I > Hurley Misc Lecture > Flashcards

Hurley Misc Lecture Flashcards

1
Q

Where is the appendix located

A

where tenia join at the cecum

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2
Q

At what point in life is appendicitis most common

A

second and third decade of life

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3
Q

What are some risk factors for appendicitis

A
  • sex (males)
  • age
  • family hx
  • low fiber diet
  • hx of trauma
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4
Q

What is the pathogenesis of appendicitis

A

inflammation–>ischemia–>perforation–> peritonitis/abscess

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5
Q

How does the inflammation typically occur in appendicitis

A

obstructed process at the lumen of the appendix

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6
Q

What types of things can cause an obstruction of the appendix

A
  • fecolith, stricture, foreign body
  • dietary factors
  • bacterial proliferation
  • tumor
  • lymphoid hyperplasia
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7
Q

What are some common organisms that can cause gangrenous and perforated appendicitis

A
  • e coli
  • peptostrep
  • bacteriodes
  • pseudomonas
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8
Q

Common presentation of appendicitis

A

colicky periumbilical pain that progresses to dull constant right iliac fossa pain

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9
Q

What physical exam signs will a patient with appendicitis have

A
  • McBurney’s point tenderness
  • Rocsing’s sign
  • Psoas sign
  • Obturator sign
  • Pointing Sign
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10
Q

What labs are done in a patient with appendicitis

A
  • CBC w/ diff
  • electrolytes
  • LFTs
  • urinalysis
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11
Q

What is the treatment plan for a patient with appendicitis?

A 
-surgery eventually
But first
   -NPO
   -IVF
   -IV abx
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12
Q

What abx are given for a patient with appendicitis

A

3rd gen ceph or gentamycin + flagyl

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13
Q

When do you not operate if a patient has appendicitis

A
  • peritonitis
  • presence of appendicular mass
  • if appendicitis has resolved (can do elective surg later)
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14
Q

What are some complications of an appendectomy

A
  • perforation
  • intra abdominal abscess
  • fecal fistula
  • DVT
  • hernia
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15
Q

Where does most of the midgut get its blood supply

A

superior mesenteric artery

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16
Q

What are the signs of small bowel obstruction

A
  • distension

- tinkering bowel signs (high pitched)

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17
Q

What are some causes of a SBO

A
  • abdominal mass
  • hernia
  • abdominal scar
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18
Q

What is evidence of a small bowel strangulation/ischemia or perforation

A
  • peritonism (pain, vomiting, tenderness, shock)

- fever

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19
Q

What would an xray show if a patient had a small bowel obstruction

A
  • multiple loops of small bowel
  • prominent vasculature
  • rectum is not visible
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20
Q

What is the most common cause of a SBO

A

postoperative adhesions

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21
Q

What is the most common cause of SBO in the developing world

A

hernias

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22
Q

What are other less common causes of SBO

A
  • malignant tumors
  • intussusception
  • volvulus
  • Crohn’s
  • gall stones
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23
Q

What are the different types of SBO? (location)

A

intraluminal, intramural, extramural

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24
Q

What are examples of intraluminal obstructions

A
  • foreign bodies
  • bezoars
  • gallstones
  • parasites
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25
Q

What are example of intramural obstructions

A
  • stricture
  • Crohn’s
  • intussusception
  • voluvulus
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26
Q

What are examples of extramural obstructions

A
  • bands/adhesions

- hernia

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27
Q

What are types of SBO?

A
  • simple
  • closed loop
  • strangulated
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28
Q

What happens above the obstruction in a simple obstruction?

A

persistalsis increases–>intestine dilates–>reduction in perstaltic strength–>flaccidity and paralysis

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29
Q

What happens below the obstruction in a simple obstruction

A

normal peristalsis and absorption until it empties then it contracts and becomes immobile

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30
Q

What does a strangulated obstruction cause

A

impaired venous return and increased congestion, impaired arterial blood supply

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31
Q

What causes distention

A

accumulation of gas and fluid

32
Q

What is the gas from in abdominal distention from

A

swallowed air, bacterial overgrowth, diffusion from blood

33
Q

What are the fluids from in abdominal distention

A

ingested fluids, saliva, gastric and intestinal juices, bile and pancreatic secretions

34
Q

What labs are done in a patient with SBO

A
  • CBC with diff
  • Chem 7
  • abdominal x ray
  • ABG
35
Q

What would elevated WBCs indicate in a SBO

36
Q

What would a low Hgb and MCV in a SBO suggest

37
Q

What type of contrast should be used for a CT if a SBO is suspected

A

water soluble

38
Q

When is urgent surgery indicated in SBO

A
  • evidence of strangulation
  • perforation
  • irreducible hernia
39
Q

What is the treatment for SBO

A
  • NPO
  • IVF
  • ? abx
  • NGT
  • surgery
40
Q

How do you manage a SBO cause by a hernia

41
Q

How do you manage a SBO caused by adhesion

A

conservative measures

42
Q

How do you manage a SBO casued by a volvulus

A

derotate and operate

43
Q

How do you manage a SBO caused by an abscess or peritonitis

A

drain and treat

44
Q

How do you mange an SBO caused by mesenteric ischemia

45
Q

How do you manage an SBO caused by intussusception

A

pneumatic or barium reduction then to the OR

46
Q

What is postoperative paralytic ileus

A

obstipation and intolerance of oral intake resulting from a non mechanical insult that disrupts the normal coordinated propulsive motor activity of the GI tract

47
Q

How do you treat an ileus

A
  • treat the underlying medical condition
  • NGT for decompression
  • contrast study to r/o mechanical obstruction
  • NSAIDs
48
Q

Mesenteric ischemia

A

ischemia of the small bowel

49
Q

What is mesenteric ischemia typically secondary to

A

an acute cause involving the SMA or SMV

50
Q

Ischemic colitis

A

ischemia of the colon

51
Q

Causes of mesenteric ischemia

A
  • SMA occlusion (most common)
  • nonocclusive mesenteric ischemia
  • mesenteric venous thrombosis
52
Q

What can cause an SMA occlusion

A

MI, afib, endocarditis, valve disorder, atherosclerosis

53
Q

What causes mesenteric venous thrombosis

A

primary clotting disorder

54
Q

What is the classic presentation of ischemic bowel disease

A
  • rapid onset of severe, unrelenting periumbilical pain
  • pain out of proportion to findings of physical examination
  • N/V
  • forceful/urgent bowel evacuation
55
Q

Labs for ischemic bowel disease

A

CBC and chem 12

56
Q

What imaging is done for ischemia bowel disease? What do they show?

A

plain films: thumbprinting, thickened bowel

CT: thickened/dilated bowel, intramural hematoma, pneumatosis

Mesenteric angiography: can identify the type of ischemia (test of choice)

57
Q

How do you treat ischemic bowel disease

A
  • fluids and blood products
  • anticoagulation
  • infusion of a vasodilator
58
Q

How do you treat ischemic bowel disease when it becomes infarction

A

-emergent laporatomy

59
Q

When do you know ischemic bowel disease turns to infarction

A

peritoneal signs and fever

60
Q

What is the most frequent form of mesenteric ischemia

A

colonic ischemia

61
Q

What portion of the colon is most commonly affected by colonic ischemia

A

left colon

62
Q

Etiology of colonic ischemia

A
  • hypotension
  • a fib
  • post MI
  • post AAA surg
  • closed loop construction
  • mesenteric vein thrombosis
63
Q

Toxic megacolon

A

total or segmental non obstructive colonic dilation plus systemic toxicity

64
Q

Etiology of toxic megacolon

A
  • IBD
  • bacterial: C diff, salmonella, shigella, campylobacter, yersinia
  • parasitic: E histolytica, cryptosporidium
  • viral: CMV
65
Q

What is the pathogenesis of toxic megacolon

A

mucosal inflammation–>release of inflammatoryo mediators and bacterial products–> generation of excessive nitric oxide–> colonic dilation

66
Q

How does toxic megacolon present

A

-abdominal distension and acute/chronic diarrhea
-radiographic evidence of colonic distension
PLUS three of the following
-fever >38
-HR >120
-WBC >10,500
-anemia
PLUS at least one of the following
-dehydration
-altered sensorium
-electrolyte distrubances
-hypotension

67
Q

What is the first line treatment for toxic megacolon

A

medical therapy

  • IVF
  • correction of lab abnormalities
  • broad spectrum abx and steriods for pts w/ IBD
  • NPO
  • NGT for decompression
68
Q

What is the second line treatment for toxic megacolon

A

surgery- subtotal colectomy with en ileostomy

69
Q

What are risk factors for pancreatic cancer

A
  • chronic pancreatitis
  • smoking
  • diabetes mellitus
  • family hx
70
Q

What will a history show in a patient that has pancreatic cancer

A
  • jaundice
  • weight loss
  • pain
  • recent onset of atypical DM
71
Q

What would a physical exam show if a patient had pancreatic cancer

A
  • palpable mass/acites late in the disease

- Courvoisier sign (non tender palpable gallbladder with jaundice)

72
Q

What is the treatment for pancreatic cancer

A

-surgery

whipple, distal pancreatomy

73
Q

What is the most common cause of pancreatic cancer

A

ductal adenocarcinoma

74
Q

Where do most of the tumors arise in pancreatic cancer

A

head, neck or uncinate process

75
Q

Where has pancreatic cancer metastasized to by the time it is discovered

A

peripancreatic lymph nodes

76
Q

What are premalignant lesions for pancreatic cancer

A
  • intraductal papillary mucinous neoplasms

- mucinous cystadenoma

Clin Med III Exam I (9 decks)

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