Surgery p426-434 Flashcards
Esophageal Perforation presentation?
Retrosternal chest pain, odynophagia, positive hamman sign, pain that radiates to L shoulder.
What is Boerhaave Syndrome? Causes?
Full thickness tear. #1 cause is iatrogenic (Endoscopy). #2 secondary to retching and vomiting.
Symptoms of Boerhaave Syndrome?
Retrosternal chest pain (acute onset), Radiates to L shoulder, Subcutanous emphysema
Most common location of Boerhaave Syndrome?
left posterolateral -distal esophogus.
Dx of Boerhaave Syndrome?
Gastrofin Esophagogram with leakage.
Tx of Boerhaave Syndrome? Cx? Mortality rate?
Emergent surgery. Cx: Acute mediastinitis (high mortality) 25%
What is Mallory Weiss Syndrome?
Mucosal tear, due to vomiting in alcoholics.
Symptoms of Mallory Weiss Syndrome?
Hematomesis, Odynophagia
Most common location of Mallory Weiss Syndrome?
GE junction
Dx of Mallory Weiss Syndrome?
Gastrofin Esophagogram without leakage.
Tx of Mallory Weiss Syndrome? Cx?
Supportive. cauterization if necessary. Rare
Gastric perforation is most commonly seen secondary to ?
Ulcer disease
Risk factors for Gastric perforation?
Helicobacter Pylori, NSAID abuse, burns, head injury, trauma, cancer
Gastric perforation -> leakage of gastric acid -> peritonitis or pancreatitis. Presentation?
Abdominal pain that radiates to right shoulder (phrenic nerve irritation). Peritonitis - guarding, rebound tenderness, abdominal rigidity
Dx test for gastric perforation? Initial test? Accurate test?
Initial: Upright chest X-ray (free air under diaphragm)
Accurate test: CT scan
Tx of gastric perforation?
- NPO
- NG tube
- Medical management (broad spectrum antibiotics, IV fluids in preparation for surgery)
- Emergent surgery (explorative laparotomy and repair of the perforation)
Most common Cx of Diverticulitis ?
Abscess formation
________ and ______ contraindicated in Diverticulitis due to increased incidence of perforation?
Barium enema and Colonoscopy
Diverticulitis Tx ?
Make NPO, place NG tube. Broad spectrum antibiotics.
Abdominal abscess Dx & Therapy?
CT scan. Incision and drainage. Antibiotics
Appendicitis Dx, Tx & Cx
CT scan, Laparoscopic Surgery, Abscess formation and gangrene perforation
Acute Pancreatitis Dx, Tx, & Cx
Dx: CT scan, amylase is sensitive, and lipase is specific. Tx: Aggressive IV fluids and NPO until symptoms resolve. Cx: Hemorrhage pancreatitis and pseudocyst formation.
Diverticulitis Dx, Tx, & Cx
Dx: Ct scan Tx: antibiotics, surgical resection if it recurs or perforates. Cx: Abscess formation. No endoscopy due to risk of perforation.
Cholecystitis Dx, Tx, & Cx
Dx: Ultrasound (pericholecystic fluid, gallbladder wall thickening, and stones in the gallbladder), Tx: Laparoscopic surgery or open surgery Cx: Perforation of the gallbladder
Signs of Appendicitis
Rovsing Sign: LLQ –> RLQ pain
Psoas Sign: Pain on extension of the hip
Obturator Sign: Pain with internal rotations of the right thigh
Hallmark signs of Small bowel obstruction
Abdominal pain, Nausea, vomiting, fever, hyperactive bowel sounds, high pitched tinkling sounds, hypovolemia
Most common cause of small bowel obstruction
Previous abdominal surgeries
Dx for small bowel obstruction
Dx: elevated WBC, lactate with marked acidosis. Initial test: AXR (multiple air fluid levels with dilated loops of small bowel). Accurate test: CT scan of the abdomen, transformation zone
Tx for small bowel obstruction
NPO, NG tube with suction, Medical: IV fluids to replace volume, Surgical decompression indicated if (complete obstruction - emergent), (lack of improvement with medical management)
What is fecal incontinence ?
Continuous or recurrent passage of fecal material for at least 1 month in age >3
Fecal incontinence Dx
Clinical hx + flexible sigmoidoscopy or anoscopy. Accurate: anorectal manometry. If there is a history of anatomic injury –> best test = endorectal manometry
Fecal incontinence Tx
Medical therapy - bulking agents (fiber)
Biofeedback - control exercises and muscle strengthening exercises
Injection - dextranomer/hyaluronic acid which decreases incontinence by 50%
Surgery - colorectal surgery
RLQ pain in female patient of child bearing, ectopic pregnancy, cysts, and torsion. Dx?
Beta- HCG, pelvic sonogram
If pelvic sonogram, emergent surgery
Never X-ray and CT
