Surgical Abdomen Flashcards
main reasons for emergent/urgent surgery
Obstruction, necrosis, perforation, and exsanguinating hemorrhage
“when I was riding to the hospital, going over the bumps in the car hurt a lot” sign of..
peritonitis
types of blockage in GI tract
GOO (gastric outlet obstruction), small bowel obstruction, and colonic obstruction
proximal obstruction hallmarks
frequent vomitting, non-feculent, less colicky, late obstipation
distal obstruction hallmark
late vomitting that smells feculent, MORE colicky, early obstipation
what is GOO caused by
pyloric/duodenal pathology- such as foreign body, tumor of antrum/pylorus/duodenum, or pyloric channel ulcer
GOO treatment
EGD with dilation or surgery, resection/bypass around tumor, or removal of FB
most common cause of small bowel obstruction
adhesion (mechanical cause)
most common cause of colonic obstruction
carcinoma (mechanical cause)
workup for SBO includes
AXR, SBFT, CT with oral contrast
tx for small bowel obstruction
IVF, NG tube for decompression, pain control, abx if indicated, and NPO
when is surgery indicated for SBO
if hernia, pain severe, or conservative management failed
preop surgery for SBO
NG tube for decompression, correct electrolytes (IVF), abx within 30 min of decompression, NPO, DVT prophylaxis, consent
types of surgery for SBO
adhesiolysis, small bowel resection, exploratory laparotomy
functional cause of obstruction
SBO- paralytic ileus. LBO- colonic pseudo obstruction or ogilve’s
tx of colonic obstruction
preoperative decompression (stent for stricture or tumor), resection of obstructed segment, or end colostomy/loop ileostomy
right sided vs left sided colon cancer
right sided- presents with anemia and liquid stood. left sided- presents with obstruction and solid stool
what can diverticulitis look exactly like on radiographic study and grossly?
tumor
types of volvulus
sigmoid, cecal, transverse, and cecal bascule
tx of volvulus
decompression colonoscopy or resection
segmental colon resection
diverticulitis, colon cancer, perforation, volvulus
hartman’s procedure
surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy.
subtotal colectomy indications (main)
pseudomembranous colitis with toxic megacolon, UC, ischemia of colon
total colectomy indications
UC
2 finishes of total colectomy
end ileostomy and ileoanal anastomosis with j-pouch plus a temporary diverting ileostomy
LAR indications
high rectal tumor
LAR removes…
sigmoid colon and most of the rectum
abdominoperineal resection
removal of rectum and anus + end colostomy
abdominoperineal resection indication
low rectal tumor
tx of volvulus
decompression with colonoscopy, definitive surgery with sigmoidectomy with end colostomy
“dilated bird beak toward LLQ”
sigmoid volvulus
patient presents with noticeable bulge and severe pain in abdomen. Has N/V. Upon palpation, very tender. Bluish discoloration present on skin. Non-reducible bulge. Dx?
hernia
When is hernia repair emergent?
when there is strangulation of bowel within the hernia sac, otherwise its elective
what type of hernias are at low risk of strangulation?
very large hernias
If patient has hernia that causes strangulation of bowel resulting in death of bowel, what is next course of action?
emergent surgery- necessitates small bowel resection
landmark for differentiating direct vs indirect hernias?
inferior epigastric vessels
borders of hesselbach’s triangle
epigastric vessels, rectus sheath, and inguinal ligament
graham patch used in tx of…
duodenal perforation