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Clin Specialties Surgery Exam > Lecture 7: Abdominal Topics > Flashcards

Lecture 7: Abdominal Topics Flashcards

1
Q

What disease presents with the following Sxs: peri-umbilical pain–> RLQ, N/V, and anorexia

A

Appendicitis

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2
Q

What PE & Lab findings are present in appendicitis?

A

Low grade fever, TTP to McBurny’s pt, + Psoas, Rovsing, Dunphy, & Obturator signs

Lab: Leukocytosis w/L shift

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3
Q

What is the Dx test of choice for appendicitis & what confirms the Dx?

A

Abd & pelvic CT w/contrast

- enlarged appendix w/wall thickening

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4
Q

What type of surgical treatment is used for appendicitis?

A

Appendectomy

- laparoscopic or open

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5
Q

What are the common sxs of acute cholecystitis?

A

Prolonged, STEADY, severe RUQ pain, fever, Hx of biliary colic

+/- N/V and R side back pain

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6
Q

What PE & lab findings are consistent w/acute cholecystitis?

A

Febrile, appear ill, RUQ/epigastric tenderness, guarding, Murphy’s sign

Lab: Leukocytosis w/bands

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7
Q

What tests are used to Dx acute cholecystitis?

A
  1. US
    (gallbladder wall thickened/edema, fluid around gallbladder w/+ Murphy’s sign)
  2. HIDA scan - measures EF of bladder
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8
Q

What causes Chronic cholecystitis?

A

Gallstones or gallbladder polyps

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9
Q

What is characteristically seen in chronic cholecystitis?

A

Fibrosis & thickening of gallbladder wall

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10
Q

What is the name of the triad seen in Cholangitis & what does it include?

A

Charcot’s Triad

  1. Fever
  2. RUQ pain
  3. Jaundice
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11
Q

To make a definitive Dx of cholangitis what must be seen on US?

A

Biliary dilatation, stricture or obstruction on US

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12
Q

What Lab findings are associated with cholangitis?

A

Leukocytosis, elevated LFTs and bilirubin

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13
Q

What do you Tx cholangitis like since it can progress quickly?

A

Sepsis

- give fluids & ABX, get blood cultures

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14
Q

What are the two types of surgical interventions for cholangitis?

A

ERCP - for CBD clearance

PTC - if cant access CBD

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15
Q

Common Sx for esophageal perforated viscus?

A

SUDDEN ONSET of ATYPICAL CP or abd pain

PE: SubQ emphysema, Tachypnea/cardia, diminished breath sounds

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16
Q

What tests are used to Dx esophageal perforated viscus?

A
  1. XR (pneumomediastinum & subQ emphysema)
  2. CT w/contrast
  3. Gastrografin esophagram
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17
Q

What is the surgical Tx for esophageal perforated viscus?

A

IR drainage, chest tubes, stenting (so tear can heal)

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18
Q

Common Sx/PE findings for Stomach/SI perforated viscus?

A

Generalized abd pain & diffuse TTP

tenderness, rigidity, N/V/anorexia, tachycardia, peritoneal signs

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19
Q

What tests are used to Dx stomach/SI perforated viscus?

A

CXR (free air)

CT w/contrast via NG tube

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20
Q

What does an apple core lesion suggest?

A

colon cancer

21
Q

Presentation of SBO?

A

Bloating, N/V, crampy pain, obstipation

May include: distention, dehydration, fever, abnormal sounds, tympani, peritoneal signs, hernias, masses

22
Q

Tests for Dx SBO?

A

XR: upright and supine abd
CXR (best to see free air)

Abd & pelvic CT with IV contrast (PO not helpful)

CBC, CMP, lactate, ABG

23
Q

Tx for SBO?

A

IV fluids, NG decompression, bowel rest, +/- abx

If no improvement: then surgery

24
Q

What is the biggest indicator of small bowel function?

A

passing gas

25
Q

What is seen on XR and CT when an ileus is present that differentiates it from a SBO?

A

XR: Air in the colon and rectum

CT: NO transition zone (diffuse dilated bowel)

26
Q

After what type of procedure is an ileus common?

A

open abd surgery

27
Q

What are the positive signs seen in appendicitis?

A

McBurney’s, Psoas, Obturator, Rovsing, Dunphy’s

“DR. MOP will tx your appendicitis”

28
Q

A DM patient present to the ED w/ very painful gallstones, does this patient require surgery?

A

YES - surg is indicated in DM and immunocompromised pts

Note: Gallstones w/no Sxs - NO SURGERY

29
Q

What is the ABX prophylaxis for appendicitis?

A

Either cefazolin, cefoxitin, or cefotetan PLUS metronidazole

30
Q

What is the ABX prophylaxis for acute cholecystitis?

A

None or IV cefazolin

31
Q

What is typically the main surgical Tx for acute cholecystitis? Others?

A

Cholecystectomy

Others: IOC, percutaneous cholecystectomy

32
Q

Why is gallstones in the presence of gallbladder polyps an indication for surgery?

A

Its a RF for gallbladder cancer

33
Q

What are the ABX treatments for someone with cholangitis?

A

Zosyn or Meropenem

give broad spectrum b/c can progress to sepsis quickly

34
Q

What are the ABX treatments for any perforated viscus?

A

Zosyn or Cefepime + Metronidazole

35
Q

What is the common finding indicating a tumor in the small bowel?

A

Target sign/intussessception (one loop of bowel inside another)

36
Q

What is the MC cause of SBO?

A

Adhesions

37
Q

What are the 3 common causes of colon obstruction?

A

tumors, diverticulitis, volvulus

38
Q

What is the advantage of CT for SBO?

A

It can identify complications - closed loop, ischemia, perforation & pneumoperitoneum

39
Q

What is the difference b/t diverticulosis and diverticulitis?

A

Diverticulosis - normal out-pouching (sac like protrusion) of the abd wall
Diverticulitis - inflam/infection of diverticulosis

40
Q

What are the 2 common presentations with diverticulosis?

A

MC = Asx

Painless hematochezia

41
Q

What is the Dx test and Tx for diverticulosis?

A

Colonoscopy

Tx: fluids, endoscopic therapy (dont usu operate)

42
Q

What triad of S/S is highly suggestive of diverticulitis?

A

LUQ TTP + fever + leukocytosis

43
Q

What is the Dx test for for diverticulitis?

A

CT (abd/pelvic) w/IV & PO contrast

Note: NOT confirmatory

44
Q

Why is it necessary to get a colonoscopy after an acute episode of diverticulitis?

A

CT findings are similar to colon CA - must r/o w/colonoscopy

45
Q

What is the ABX treatment for diverticulitis in the outpatient setting?

A

ORAL ABX!!

- PO fluoroquinolone + metronidazole

46
Q

What is the ABX treatment for diverticulitis in the inpatient setting

A

IV ABX!!

  • IV fluoroquinolone + metronidazole or…
  • IV ceftriaxone + metronidazole
47
Q

What is the ABX treatment for diverticulitis in the inpatient setting

A

IV ABX!!

  • IV fluoroquinolone + metronidazole or…
  • IV ceftriaxone + metronidazole
48
Q

What are the elective surgical options for diverticulitis?

A

percutaneous drainage

- if cant do that then –> laparoscopic lavage

49
Q

What are the emergent surgical options for diverticulitis?

When do you consider these options?

A

Resection or Hartmann procedure

Considered if peritonitis, massive free air or failed non-operative Tx

Clin Specialties Surgery Exam (13 decks)

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