Surgical Abdomen Flashcards
In management of surgical abdomen how hesitant or aggressive should you be with each of these treatments?
- Antibiotics
- pain management
- NG tube
- Antibiotics –> DO IT
- pain management –> DO IT
- NG tube –> Hesitate to do it
Can you differentiate between direct and indirect hernias on exams?
NO
What is a richter hernia?
when a portion of the hernia, rather than the entire circumference, is trapped
What is the difference between an incarcerated and strangulated hernia?
incarcerated: trapped despite gentle firm pressure
Strangulated: vascular compromise and surgical emergency
What is the most common cause of pneumoperitoneum?
Perforated duodenal ulcer
What is the most common form of gallstone?
cholesterol stone
What is charcot’s triad of ascending cholangitis?
- fever
- abdominal pain
- jaundice
What is reynold’s pentad of ascending cholangitis
- fever
- abdominal pain
- jaundice
- confusion
- shock
What is functional gallbladder disorder?
- dyskinesia and dysmotility
- diagnosed with HIDA scan (eF < 40%)
- diagnosed with ROME III critera
- When high degree of suspicion of gallbladder disease but negative US consider sending for HIDA
what is the most common cause of surgical abdomen?
appendicitis
What is Carnett sign?
Ask pt to perform crunch. Positive if pain persists or worsens
indicated abdominal wall pathology
What is dunphy sign?
also called cough sign
cough elicits pain
suggests peritoneal inflammation
Most common cause of small bowel obstruction?
Adhesions from previous surgery
Most common cause of large bowel obstruction?
neoplasm
What are the early signs and symptoms of small bowel obstruction?
sxs:
- colicky abdominal pain
- n/v
- diarrhea (early finding)
signs:
- distention
- tympany, high pitched BS
What are the late findings of small bowel obstruction?
- lack of flatus
- constipation
- fever/tachycardia (strangulation)
- abdominal tenderness and peritoneal signs (strangulation)
What is the imaging strategy for suspected small bowel obstruction?
Upright abdominal XR
If negative but still have high suspicion then get CT
What are XR findings of small bowel obstruction?
Dilated loops of bowel
Lack of air in colon
air fluid levels
What are the signs and symptoms of large bowel obstruction?
sx:
- crampy abdominal pain
- nausea, vomiting
- distention
Signs:
- hypertympanic to percussion
- bowel sounds normal early then become quiet
- fever/tenderness/rigidity are serious signs
Who are most likely to develop sigmoid volvulus?
- Average age: 8th decade of life
- result of chronic constipation
- also think about neurological disorders: MS, spinal cord injury, parkinsons
Who are most likely to develop cecal volvulus?
- average age: 6th decade of life
- hereditary condition
Treatment of sigmoid volvulus
endoscopic decompression?
Treatment of cecal volvulus
Right hemicolectomy
