Surgery-GI Flashcards
Abd pain after trauma- X-ray, gas-filled loops of both small and large intestines and gastric dilation
Paralytic (dynamic) ileus
Migratory pain, N/V, fever, leukocytosis, McBurney point tenderness, and Rovsing sign. NSIM?
<p>Immediate appendectomy; no imaging needed for classic presentation</p>
Evidence of pancreatitis ( Midepigastric pain, N/V, elevated Amylase & Lipase) with ALT >150; gallstones on US, diagnosis? NSIM?
<p>Gallstone pancreatitis; Laparoscopic Cholecystectomy
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<p>The most common cause of SBO</p>
<p>Adhesions</p>
<p>N/V, abd bloating, high-pitched hyperactive bowel sounds, dilated loops of bowel on x-ray</p>
<p>complete SBO</p>
<p>Easily satiety, Nausea, non bilious vomiting, wt loss, hx of acid ingestion</p>
<p>Gastric outlet obstruction- pyloric stricture </p>
<p>acute-onset severe abd pain, fever, tachycardia, sign of peritonitis (guarding, rigidity, reduced bowel sound, rebound tenderness) is? NSIM?</p>
<p>Perforated viscus, upright x-ray of chest &amp; abd</p>
Recurrent episodes of mild jaundice precipitated by stressors (eg. infection, fasting, vigorous exercise, surgery)
Gilbert syndrome
cholestatsis and gallbladder ischemia leading to secondary infection by enteric organisms and resultant edema and necrosis of the gallbladder is? Tx?
Acalculous cholecystitis; Abx, percutaneous cholecystostomy, followed by cholecystectomy after pt is stable
Left-sided and pain with radiation to the shoulder, fever, and vomiting
spleen infarct
Hypotension, free intraperitoneal fluid, RUQ pain and bruising, and R shoulder pain
Hepatic laceration
treatment for anal fissures
fiber, fluid intake, stool softeners, sitz baths, and topical anesthetics and vasodilators (Nifedipine, nitroglycerin, lidocaine)
what is the differential diagnosis of an inguinal hernia
Lymphadenopathy, psoas abscess, ectopic testis, hydrocele of the cord, saphenous varix, lipoma, varicocele, testicular torsion, femoral artery aneurysm, abscess
Gallstone that has passed through a biliary-enteric fistula is called? caused by?TX?
Gallstone ileum results from small bowel obstruction, Surgical removal of stone and cholecystectomy
The 3 peritoneal signs
- rebound tenderness
- involuntary guarding
- Abdominal rigidity
RLQ pain with extension of right thigh is called? Dx?
Psoas sign, abscess adjacent to posts or retrocecal appendix
RLQ pain with internal rotation of R thigh called? Dx?
Obturator sign, pelvic appendix or abscess
RLQ pain with LLQ palpation and retropulsion of colonic contents is called? Dx?
Rovsing’s sign, acute appendicitis
Right pelvic pain during rectal examination, especially with pressure on right rectal wall
Rectal tenderness, pelvic appendix or abscess
The most likely cause of abd pain, tachycardia, left chest wall and shoulder pain in blunt abd trauma is? NSIM?
Splenic injury; FAST examination
Fever, RUQ pain, N/V, crepitus in abd wall adjacent to gallbladder, air-fluid levels in gallbladder. Dx? Tx?
Empheysematous cholecystitis; emergent cholecystectomy with broad-spectrum antibiotics with clostridium coverage (Amp-Sulbactam)
25M, obese, with sedentary lifestyle, fluctuant mass cephalad to the anus (near the tip of the coccyx) in the intergluteal region with mucoid, purulent or bloody drainage, painful. Dx?
Pilonidal disease
Colicky abd pain, vomiting, no flatus or stool, hyperactive to absent bowel sounds, distended and tympanitic abd. DX? NSIM?
SBO; bowel rest, NG suction, IVF and complicated needs urgent surgical exploration
67M, N/V increasing abd pain over 3hrs. Post MI, DM 2, PUD, HTN & hypercholesterolemia. Dx?
Acute mesenteric ischemia
Tx for complicated diverticulitis with abscess formation is
CT-guided percutaneous drainage. If fails surgical drainage
Tx for Gallstones without symptoms
None
Tx for Gallstones with typical biliary colic symptoms
- elective lap cholecystectomy
- Possible urosodeoxycholic acid in poor surgical candidates
Tx for complicated gallstone disease (Acute cholecystitis, choledocholithiasis, gallstone pancreatitis)
-Cholecystectomy with in 72hrs
Fluid shift from the interavscular space to the small intestine, leading to hypotension, stimulation of autonomic relaxes and release of intestinal vasoactive polypeptides after gastrectomy surgery is
dumping syndrome:
Nausea, diarrhea, abd cramps, palpitation, diaphoresis, light-headless for about 20mins after eating
dumping syndrome:
It occurs commonly in pediatric patients and following blunt abd trauma , with epigastric pain and vomiting after 24hr. Dx?, NSIM?
Duodenal hematomas; gastric decompression and parenteral nutrition
Organs that can be affected from PAT on LUQ
-Spleen, Splenic flexure of the colon, left hemidiaphragm
How do you establish an airway in an apnea patient with a cervical spine injury
Orotracheal intubation with rapid-sequence intubation
Due to risk for carbon dioxide retention, you will not perform this type of intubation on patients with head injury who might require hyperventilation to prevent or treat intracranial hypertension except in children <12 because it is anatomically easier
Needle Criothyroidotomy
Diaphragm can rise as high as what dermatome level on the Right and Left ?
R 4th thoracid dermatome
L 5th thoracic dermatome (level of nipple)
A penetrating wound below the 4th intercostal space (level of nipples) is considered to involve the __ and requires ___ in unstable patient
Abdomen
exploratory laparotomy
