MTB 2 Flashcards
MC procedure that causes esophageal perforation?
Endoscopy
Most accurate test for esophageal perforation?
Esophogram w/diatrizoate meglumine and diatrizoate sodium sol’n (Gastrografin)
Do we use barium in esophageal perforation?
No. Can be caustic.
Complication w esophageal perforation w high mortality rate?
Mediastinitis
How do hemorrhagic ulcers present?
Hematemesis - coffee ground emesis
Acute, progressive worsening abdominal pain that radiates to right shoulder?
Gastric perforation
- acid irritation of phrenic nerve
Guarding, rebound tenderness, abdominal rigidity?
Gastric perforation
Treatment gastric perforation?
- NPO
- NG tube to suction 4L gastric juices
- IV normal saline and broad spectrum Abx
- Surgically repair perforation
Best initial test for Gastric perforation?
Upright CXR - free air under diaphragm
Most accurate test for Gastric perforation?
CT scan
Risk factors for gastric perforation
Ulcer Dz NSAIDs H.Pylori Burns Head injury Trauma
What can occur with a posterior stomach ulcer?
Pancreatitis - acid leaks out the back of stomach, damaging pancreas
Most accurate test for appendicitis?
CT
Tx for appendicitis?
Laparascopic surgery
Complications with appendicitis?
Abscess formation
Gangrenous perforation
Best test for acute pancreatitis
CT
Tx for acute pancreatitis
IVF
NPO until sx’s resolve
Complications with acute pancreatitis
Hemorrhagic pancreatitis
Pseudocyst
Best initial test for diverticulitis?
CT
Most accurate test for diverticulitis?
CT
Complications with diverticulitis?
Abscess formation
What tests do we avoid in diverticulitis?
Barium enema (Endoscopy)
colonoscopy
Risk of perforation
Most accurate test for cholecystitis?
HIDA scan
Complications with cholecystitis?
Perforation of GB
Treatment for cholecystitis?
Laparascopic surgery
Open surgery if perforation
What does US show for cholecystitis?
Pericholecystsic fluid, GB wall thickening, stones in GB
Two emergent conditions ass’d with abdominal pain radiating to back?
Pancreatitis
Aortic Dissection
What is seen on HIDA with cholecystitis?
Delayed emptying of GB in acute cholecystitis by failure to visualize GB from isotope accumulation
What is seen with Small Bowel Obstruction?
Failure to pass stool, flatus, complete absence of bowel sounds
N/V, abdominal pain w/hyperactive bowel sounds?
SBO
What is the most common causes of SBO?
Previous abdominal surgery
What are the two types of obstruction?
Partial - small amt of GI contents pass
Complete - no GI contents pass
High pitched “tinkling” in abdomen?
Intestinal fluid and air are under high pressure in the bowel
Bowel obstruction si/sx’s?
Severe waves of intermittent crampy abdominal pain N/V Fever Hyperactive bowel sounds "tinkling" Hypovolemia - third spacing
What are causes of bowel obstruction?
Adhesions - previous surgery Hernias Crohn Dz Neoplasms Intussusception Volvulus Foreign bodies Intestinal atresia Carcinoid
Hallmark sign for bowel obstruction?
Elevated lactate w/marked acidosis
Best initial test for Bowel obstruction?
Abdominal Xray
Multiple air-fluid levels w/dilated loops of small bowel?
SBO
Most accurate test for bowel obstruction?
CT scan of abdomen
CT shows transition zone from dilated loops of bowel w/contrast to area of bowel with no contrast?
SBO
Treatment for SBO?
- NPO
- NG tube to help decompress bowel
- IVF
- OR for emergent surgical resection
When is a closed reduction done?
Mild fractures w/out displacement
When is an open reduction and internal fixation done?
Severe fractures w/displacement or misalignment of bone pieces
What is tx for open fractures?
Skin must be closed and bone set in OR w/debridement
What is a comminuted fracture?
Fx where bone is broken into multiple pieces
MCC - crush injury
What causes a stress Fx?
Repetitive insults to bone
Athlete w/persistent pain
When is CT or MRI needed in Fx?
Stress Fx
What is the Tx for stress Fx?
Rehab
Reduced physical activity
Casting
When do we see a compression Fx?
Specific fx of vertebra in osteoporosis
What is a pathologic Fx?
Fx from minimal trauma to bone
weakened by dz
Older person fractures a rib from a cough - what type of Fx?
Pathologic Fx
Tx for pathologic fx?
Surgical Realignment of bone
What is an open Fx?
Broken bone pierces the skin
High rates of bacterial infxn to local skin
What is tx for open Fx?
Surgery
Pt presents w/fall on outstretched hand, tenderness in anatomic snuffbox?
Scaphoid Fx
What is Tx of Scaphoid Fx?
Wrist immobilization for 6-10 weeks if non displaced
Thumb spica cast
When does Penile Fx occur?
Crush injury of erect penis
MC during sex w/woman on top
Tunica albunigea tears
Rapid hematoma formation
What is the Tx for Penile Fx?
Emergent retrograde urethrogram to asses urethral injury and emergent surgery to evacuate hematoma, mend torn tunica albunigea
MC shoulder dislocation?
Anterior
Cause of anterior shoulder dislocation?
Injury that strains glenohumoral ligament
Pt presents with arm held to the side w/externally rotated forearm w/severe pain?
Anterior shoulder dislocation
Best initial test for shoulder dislocation?
Xray
Most accurate test shoulder dislocation?
MRI
Tx for anterior shoulder dislocation?
Shoulder relocation and immobilization
Cause of posterior shoulder dislocation?
Seizure
Electrical burns
Pt presents with arm medially rotated and held to the side?
posterior shoulder dislocation
Tx for posterior shoulder dislocation?
Traction and surgery if pulses or sensation and diminished during PE
Cause and Tx for clavicular fx?
Trauma
Simple arm sling
What is trigger finger?
Stenosis of tendon sheath
Acutely flexed and painful finger
Tx for trigger finger?
Steroid injections
If persistent - surgery to cut sheath
What is Dupuytren contracture?
Men
> 40 yoa
Palmer fascia is constricted and hand cannot be extended
Tx for Dupuytren contracture?
Surgery
