Surgical Abdomen

Question 1

In management of surgical abdomen how hesitant or aggressive should you be with each of these treatments?

• Antibiotics
• pain management
• NG tube

Answer 1

• Antibiotics –> DO IT
• pain management –> DO IT
• NG tube –> Hesitate to do it

Question 2

Can you differentiate between direct and indirect hernias on exams?

Answer 2

NO

Question 3

What is a richter hernia?

Answer 3

when a portion of the hernia, rather than the entire circumference, is trapped

Question 4

What is the difference between an incarcerated and strangulated hernia?

Answer 4

incarcerated: trapped despite gentle firm pressure

Strangulated: vascular compromise and surgical emergency

Question 5

What is the most common cause of pneumoperitoneum?

Answer 5

Perforated duodenal ulcer

Question 6

What is the most common form of gallstone?

Answer 6

cholesterol stone

Question 7

What is charcot’s triad of ascending cholangitis?

Answer 7

• fever
• abdominal pain
• jaundice

Question 8

What is reynold’s pentad of ascending cholangitis

Answer 8

• fever
• abdominal pain
• jaundice
• confusion
• shock

Question 9

What is functional gallbladder disorder?

Answer 9

• 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

Question 10

what is the most common cause of surgical abdomen?

Answer 10

appendicitis

Question 11

What is Carnett sign?

Answer 11

Ask pt to perform crunch. Positive if pain persists or worsens

indicated abdominal wall pathology

Question 12

What is dunphy sign?

Answer 12

also called cough sign

cough elicits pain

suggests peritoneal inflammation

Question 13

Most common cause of small bowel obstruction?

Answer 13

Adhesions from previous surgery

Question 14

Most common cause of large bowel obstruction?

Answer 14

neoplasm

Question 15

What are the early signs and symptoms of small bowel obstruction?

Answer 15

sxs:

• colicky abdominal pain
• n/v
• diarrhea (early finding)

signs:
- distention
- tympany, high pitched BS

Question 16

What are the late findings of small bowel obstruction?

Answer 16

• lack of flatus
• constipation
• fever/tachycardia (strangulation)
• abdominal tenderness and peritoneal signs (strangulation)

Question 17

What is the imaging strategy for suspected small bowel obstruction?

Answer 17

Upright abdominal XR

If negative but still have high suspicion then get CT

Question 18

What are XR findings of small bowel obstruction?

Answer 18

Dilated loops of bowel
Lack of air in colon
air fluid levels

Question 19

What are the signs and symptoms of large bowel obstruction?

Answer 19

sx:
- crampy abdominal pain
- nausea, vomiting
- distention

Signs:

• hypertympanic to percussion
• bowel sounds normal early then become quiet
• fever/tenderness/rigidity are serious signs

Question 20

Who are most likely to develop sigmoid volvulus?

Answer 20

• Average age: 8th decade of life
• result of chronic constipation
• also think about neurological disorders: MS, spinal cord injury, parkinsons

Question 21

Who are most likely to develop cecal volvulus?

Answer 21

• average age: 6th decade of life

- hereditary condition

Question 22

Treatment of sigmoid volvulus

Answer 22

endoscopic decompression?

Question 23

Treatment of cecal volvulus

Answer 23

Right hemicolectomy