surgery- pestanos Flashcards
signs of mechanical intestinal obstruction
high pitched bowel sounds
distended loops of small bowel with air fluid levels
signs of strangulation
fever
leukcystosis
constant pain
peritoneal irritation
signs of strangulated hernia
hernia that was once reducible is no longer so
presentation/treatment for R colon cancer
hypochromic Fe deficiency anemia, 4+ occult blood
R hemicolectomy
presentation of L colon cancer
bloody stool, narrow stool caliber
when do you surgically treat crohns
complications such as bleeding/ stricture/ fistula
proper surgical treatment for UC
removal of rectal mucosa –> need stoma or ileoanal anastomosis
medical therapy for anal fissure
diltiazem topical ointment TID for 6 weeks
higher success rate than botulinum toxin
most common causes of GI bleeding
angiodysplasia
polyps
diverticulosis
cancer
origin of GI bleed is always ______ when there is hemoptysis or blood recovered by NG tube
upper
approach to lower GI bleed
1) EXCLUDE HEMORRHOIDS Next: -angiogram --> agnioembolization -wait to stop, --> colonoscopy -tagged red cell study
blood per rectum in a child
meckel divertic –> technetium scan looking for ectopic gastric mucosa
causes of acute abdomen
perf
obstruction
inflammation
ischemia
acute abdomen: perf
sx: diffuse/ generalized pain, guarding, rebound, PT DOESN’T MOVE
dx: free air under diaphragm
ex: perf peptic ulcer
acute abdomen: obstruction
think of a duct
sx: PT MOVES CONSTANTLY SEEKING COMFORT, typlica location of pain and radiation
things to rule out in generalized acute abdomen before doing ex lap
MI
PE
lower lobe PNA
pancreatitis
findings on xray for sigmoid volvulus
“parrot’s beak sign”
giant air filled loop from RUQ to LLQ
hepatic adenoma
complication of birth controls pills?
can rupture and bleed into abdomen
labs associated with obstructive jaundice
elevations of direct and indirect bili, inc AST/ALT,
INC ALP!!!!
courvoisier terrier sign
malignant biliary duct obstruction (large and THIN WALLED with distended galbladder)
MRCP vs ERCP
MR cholangiopancreatogram
Endoscopic retrograde “
MR is noninvase, only imaging
ERCP is functional
cancers that cause obstructive jaundice
adeno of head of panc
adeno of ampulla of Vater
cholangocarcinoma of common duct
surgical managment of acute cholecystitis
NPO, NG suction, IVF, abx –> elective chole
option in non surgical patient needed emergent chole?
percutaneous transhepatic cholecystOSTOMY
ranson’s criteria for acute hemorrhagic pancreatitis
inc WBC, bG
dec serum Ca, HCT
hesselbachs triangle
inguinal lig= inferior
inf epigastric= lateral
rectus abdominus = medial
excessive salivation after birth, or choking after first feeds
esophageal atresia
what should you check for if you note esophageal atresia?
VACTER- vertebral, anal, cardiac, tracheal, esophageal, renal and radial
check for imperforate anus, echo for heart, xray for spine
congenital diaphragmatic hernia
LEFT
- -> hypoplastic lung with fetal type circulation
- req intubation/sedation/low pressure vent/ NG suction
when do you repair congenital diaphragmatic hernia
3-4 days after birth to allow lung maturation
how do you fix large omphaloceles
construction of “silo” to protect bowel –> contents squeezed into belly piece wise over a week –> closure
do babies with gastroschisis require nutrition?
yes, parenteral for ~1 month because bowel will not work
gastroschisis vs omphalocele
gastro –> defect to RIGHT of cord, no covering
omphaloSEAL–> cord goes to defect, thing protective membrane
differential for billious vomiting and “double bouble”
duodenal atresia
annular pancreas
malrotation
how can you distinguish malrotation from duodenal atresia and annular pancreas? how do you dx it?
double bubble with minimal normal gas pattern beyond
surgical emergency!
dx with contrast enema, upper GI
bililous vomiting, multiple air fluid levels, no double bubble
intestinal atresia
“vascular accident” in utero
necrotizing enterocolitis: signs and tx
- feeding intol, abd distention, rapid drop in plt
- stop feeds, IV abx, IV nutrition
meconium ileus
CF
- multiple dilated SB loops + ground glass appearance in low abd
- gastrograffin= dx and tx
nonbilious projectile vomiting after feeds in newborn
pyloric stenosis
- olive mass
- FIRST rehydrate, correct hypochloremic, hypokalemic metabolic alkalosis
tx for pyloric stenosis (after electrolyte correction)
ramstedt pyloromyotomy
balloon dilation
biliary atresia
6-8wk with progressive jaundice
- stimulate with phenobarbital
- liver transplant is definitive
hirschprung (aganglionic megacolon) –> sx
chronic constipation
-explosive expulsion of stool and flatus on DRE –> relief of abdominal distention
hirschprung on xray, dx
distended proximal colon (normal) –> “normal” distal colon (aganglionic)
dx with full thickness biopsy of rectal mucosa
intussussception
colicky abd pain
currant jelly stools
RLQ
barium/air enema= dx and tx
how do you tell appy from intussussception in kids
appy > age 3
pediatric lower GI bleed
meckel’s
radioisotope scan to look for gastric mucosa
three complications of GI fistula when draining freely (stable pt)
- fluidand lyte loss
- nutritional depletion
- erosion/digestion of abdominal wall
**feed past fistula + ostomy
fistula FETID mnemonic (fistula will heal unless these are present)
Foreign body Epithelialization Tumor Infection/Irradiation/IBD Distal obstruction
t/f steroids prevent fistula healing
TRUE
also remember FETID
how to manage traumatic pelvic fracture
External fixation
give blood
look for urethral injury
***if CT shows bleeding only in pelvis. If its expanding to peritoneum –> OR
