Lecture 7: Abdominal Topics Flashcards
What disease presents with the following Sxs: peri-umbilical pain–> RLQ, N/V, and anorexia
Appendicitis
What PE & Lab findings are present in appendicitis?
Low grade fever, TTP to McBurny’s pt, + Psoas, Rovsing, Dunphy, & Obturator signs
Lab: Leukocytosis w/L shift
What is the Dx test of choice for appendicitis & what confirms the Dx?
Abd & pelvic CT w/contrast
- enlarged appendix w/wall thickening
What type of surgical treatment is used for appendicitis?
Appendectomy
- laparoscopic or open
What are the common sxs of acute cholecystitis?
Prolonged, STEADY, severe RUQ pain, fever, Hx of biliary colic
+/- N/V and R side back pain
What PE & lab findings are consistent w/acute cholecystitis?
Febrile, appear ill, RUQ/epigastric tenderness, guarding, Murphy’s sign
Lab: Leukocytosis w/bands
What tests are used to Dx acute cholecystitis?
- US
(gallbladder wall thickened/edema, fluid around gallbladder w/+ Murphy’s sign) - HIDA scan - measures EF of bladder
What causes Chronic cholecystitis?
Gallstones or gallbladder polyps
What is characteristically seen in chronic cholecystitis?
Fibrosis & thickening of gallbladder wall
What is the name of the triad seen in Cholangitis & what does it include?
Charcot’s Triad
- Fever
- RUQ pain
- Jaundice
To make a definitive Dx of cholangitis what must be seen on US?
Biliary dilatation, stricture or obstruction on US
What Lab findings are associated with cholangitis?
Leukocytosis, elevated LFTs and bilirubin
What do you Tx cholangitis like since it can progress quickly?
Sepsis
- give fluids & ABX, get blood cultures
What are the two types of surgical interventions for cholangitis?
ERCP - for CBD clearance
PTC - if cant access CBD
Common Sx for esophageal perforated viscus?
SUDDEN ONSET of ATYPICAL CP or abd pain
PE: SubQ emphysema, Tachypnea/cardia, diminished breath sounds
What tests are used to Dx esophageal perforated viscus?
- XR (pneumomediastinum & subQ emphysema)
- CT w/contrast
- Gastrografin esophagram
What is the surgical Tx for esophageal perforated viscus?
IR drainage, chest tubes, stenting (so tear can heal)
Common Sx/PE findings for Stomach/SI perforated viscus?
Generalized abd pain & diffuse TTP
tenderness, rigidity, N/V/anorexia, tachycardia, peritoneal signs
What tests are used to Dx stomach/SI perforated viscus?
CXR (free air)
CT w/contrast via NG tube
What does an apple core lesion suggest?
colon cancer
Presentation of SBO?
Bloating, N/V, crampy pain, obstipation
May include: distention, dehydration, fever, abnormal sounds, tympani, peritoneal signs, hernias, masses
Tests for Dx SBO?
XR: upright and supine abd
CXR (best to see free air)
Abd & pelvic CT with IV contrast (PO not helpful)
CBC, CMP, lactate, ABG
Tx for SBO?
IV fluids, NG decompression, bowel rest, +/- abx
If no improvement: then surgery
What is the biggest indicator of small bowel function?
passing gas
What is seen on XR and CT when an ileus is present that differentiates it from a SBO?
XR: Air in the colon and rectum
CT: NO transition zone (diffuse dilated bowel)
After what type of procedure is an ileus common?
open abd surgery
What are the positive signs seen in appendicitis?
McBurney’s, Psoas, Obturator, Rovsing, Dunphy’s
“DR. MOP will tx your appendicitis”
A DM patient present to the ED w/ very painful gallstones, does this patient require surgery?
YES - surg is indicated in DM and immunocompromised pts
Note: Gallstones w/no Sxs - NO SURGERY
What is the ABX prophylaxis for appendicitis?
Either cefazolin, cefoxitin, or cefotetan PLUS metronidazole
What is the ABX prophylaxis for acute cholecystitis?
None or IV cefazolin
What is typically the main surgical Tx for acute cholecystitis? Others?
Cholecystectomy
Others: IOC, percutaneous cholecystectomy
Why is gallstones in the presence of gallbladder polyps an indication for surgery?
Its a RF for gallbladder cancer
What are the ABX treatments for someone with cholangitis?
Zosyn or Meropenem
give broad spectrum b/c can progress to sepsis quickly
What are the ABX treatments for any perforated viscus?
Zosyn or Cefepime + Metronidazole
What is the common finding indicating a tumor in the small bowel?
Target sign/intussessception (one loop of bowel inside another)
What is the MC cause of SBO?
Adhesions
What are the 3 common causes of colon obstruction?
tumors, diverticulitis, volvulus
What is the advantage of CT for SBO?
It can identify complications - closed loop, ischemia, perforation & pneumoperitoneum
What is the difference b/t diverticulosis and diverticulitis?
Diverticulosis - normal out-pouching (sac like protrusion) of the abd wall
Diverticulitis - inflam/infection of diverticulosis
What are the 2 common presentations with diverticulosis?
MC = Asx
Painless hematochezia
What is the Dx test and Tx for diverticulosis?
Colonoscopy
Tx: fluids, endoscopic therapy (dont usu operate)
What triad of S/S is highly suggestive of diverticulitis?
LUQ TTP + fever + leukocytosis
What is the Dx test for for diverticulitis?
CT (abd/pelvic) w/IV & PO contrast
Note: NOT confirmatory
Why is it necessary to get a colonoscopy after an acute episode of diverticulitis?
CT findings are similar to colon CA - must r/o w/colonoscopy
What is the ABX treatment for diverticulitis in the outpatient setting?
ORAL ABX!!
- PO fluoroquinolone + metronidazole
What is the ABX treatment for diverticulitis in the inpatient setting
IV ABX!!
- IV fluoroquinolone + metronidazole or…
- IV ceftriaxone + metronidazole
What is the ABX treatment for diverticulitis in the inpatient setting
IV ABX!!
- IV fluoroquinolone + metronidazole or…
- IV ceftriaxone + metronidazole
What are the elective surgical options for diverticulitis?
percutaneous drainage
- if cant do that then –> laparoscopic lavage
What are the emergent surgical options for diverticulitis?
When do you consider these options?
Resection or Hartmann procedure
Considered if peritonitis, massive free air or failed non-operative Tx
