Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med semester 2 > Surgical Abdomen- Beloy > Flashcards

Surgical Abdomen- Beloy Flashcards

1
Q

Who will you be treating?

A

-Lots of cancer patients
-Trauma patients
-People with other comorbidities:
–Cirrhosis (ETOH, fatty liver)
–Chronic constipation, IBS, –Chron’s disease
Infectious diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RLQ?

A

appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

LLQ pain?

A

diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PE: (what do you need?)

A
  • Vitals
  • Cardiac/Pulmonary brief exam
  • Abdomen:
  • -Inspection
  • -Auscultation of all 4 quadrants
  • –Bowel sounds, bruits
  • -Palpation of all 4 quadrants and major organs (liver, spleen)
  • -Percussion
  • Skin, sclera, mucous membrane (check for jaundice or yellow tint to mucosal membranes)
  • **Rectal exam if indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Peritonitis=

A

inflammation of the lining of the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Important General Questions:

A

-Where is the pain?
-Appetite, when was the last time you ate?
-Nausea, Vomiting (what color?)
Constipation, Diarrhea (what color?) (note: c diff will smell horrible)
Are you passing gas?
Any irregular bleeding/easily bruising? (**thinking of liver function and clotting factors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Genral GI pre-operative work up

A
  • EKG (ordered cuz can the Pt tolerate surgery)
  • Chest x-ray (ordered cuz can the Pt tolerate surgery)
  • UA (pregnancy test if indicated)
  • CBC, **CMP (includes liver enzymes), INR/PTT, Type and Screen (order when you want to know the Pt’s blood type). Crossmatch– reserves the blood for you, when you anticipate a large blood loss with future surgery)
  • Appropriate radiology imaging
  • Bowel preps (helps flush the system out)
  • Surgical consent discussion (sit down with the Pt and educate them with the risks/benefits of the procedure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Gastric ulcers:

______ have significantly reduced surgical intervention

A

antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Gastric ulcers:

-which ones require surgery

A

Bleeding, obstruction, perforation or non-healing sometimes require surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

34 yo female with acute onset abdominal pain:

  • can you point to where the pain is?
  • last cycle was 20 days ago
  • describe the pain? stabbing
  • When did it start? 24 hrs ago
  • does it radiate? no
  • when’s the last time you ate? dinner yesterday, no appetitie
  • pain came on suddenly
  • no diarhea, but slight nausea

hx: esophageal spasms 10 yrs ago and she had to undergo an endoscopy
- she’s had 3 c-sections

Labs: order a chest X ray

  • V/S
  • EKG
  • pregnancy test
  • CMP
A
  • all tests were normal
  • Pt still has pinpoint pain in epigastric pain
  • order a GI cocktail : malox and zofran
  • Get a CAT scan–> it came back normal

Next day: she had severe abdominal pain and went back to ER

2nd CT scan: showed an acute gastric perforation (possibly from a non symptomatic ulcer), there was NO air, so the Pt did not need surgery

-she recieved an NG tube and slowly introduced foods back into her diet and gfollowed up with a GI specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Duodenal ulcers are strongly associated with _____

A

H. pylori,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Other pathology ex’s associated with the abdomen

A
  • Zollinger-Ellison syndrome. (outlier, a genetic disorder that calls hypersecretion of acid)
  • Obesity
  • Gastric Cancer: –Adenocarcinoma (high risk factor is smoking), –Gastrointestinal Stromal Tumors (GIST)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ulcer is considered non-healing after failure of ____ weeks of medical therapy (but most providers tx much longer).

A

> 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Gastointestinal tumors (GIST)=

A

space occupying lesions within the GI tract .

-throughout the entire alimentary canal. MC symptom GI bleedingRecurrence rate is high 20-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

GI procedures: (list examples)

A
  • vagotomy
  • Antrectomy
  • Roux-en Y Gastric Bypass vs Laparoscopic Adjustable banding (Lap Band) vs Gastric Sleeve
  • Gastrectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Roux-en Y Gastric Bypass also eliminates _____

A

the fundus of the stomach where some hormones for hunger are produced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Gastric bypass has 2 functions:

A
  • restrictive

- and malabsorptive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Gastrectomy=

A

Removal of all or part of the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Antrectomy=

A

Gastrin (the hormone that stimulates gastric acid secretion is in the antrum of the stomach)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Vagotomy- is used for?

A

peptic ulcer disease, not common

–Resection of a branch of the Vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Gastric sleeve is a _______ surgery

A

restrictive surgery

–staple across the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lap band surgery–>

A

put a lap band around antrum of stomach and you can control how small or large the band is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Gastric bypass: formal roux and Y

A

BOTH malabsorptive and restrictive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Gastric sleeve, Lab band surgery, and gastric bypass is considered in Pts with ..

A

BMI >40 or BMI >35 +weight related health problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Post-op care/complications: describe dumping syndrome

A

-(esp. with gastric bypass surgery)
Sx: Post prandial tachycardia, diaphoresis, abdominal pain, & diarrhea
–Watch for after a vagotomy or any stomach resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Post-op care/complications: others?

A

Nausea, vomiting, diarrhea

-Gastroparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the Post gastrectomy diet

A

Eat small frequent meals, high fiber, avoid simple sugars, do not drink fluids with meals, wait 30-60 mins after meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Gastroparesis- sx?

A

(stomach is not emptying in the way it should)

Sx: Nausea/vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Gastroparesis: tx?

A

NPO status

  • IV fluids
  • May include TPN (Total Parental Nutrition)
  • **Reglan, Erythromycin (these are GI motility drugs, Reglan s/e is tardive dyskinesia)
  • NG tube verse Dobhoff (do a dobhoff if you want to feed the Pt)
  • -Used for stomach decompression
  • -Can use for medications/nutrition
  • -Confirm placement with CXR prior to use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Dobhoff=

A

can be a feeding tube (for ppl with dysphagia)

-do an NG tube if you’re not trying to feed them and you just want to decompress the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Each segment of the liver has a biliary system, portal vein leaves liver

-IF portal vein gets damaged!!!! ??

A

BIG problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Liver: work-up

A
  • Exam
  • Hepatic ultrasound, CT scan
  • -Future Liver remnant, how much function will the remaining liver have?
  • -Child-Pugh classification (<7)
  • -3D CT volume to asses vascular inflow/outflow biliary drainage
  • Bilirubin levels (is it more then twice the upper limit of normal?)
  • Comprehensive metabolic panel, Coags, Ammonia levels

-CBC (Heme-8)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Just know!! for child pugh score

A

<7 , dont need to memorize criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Most important # on CBC involving the liver?

A

**platelet count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

pathology associated with the liver?

A
  • Tumors (Metastatic or primary; Hepatic adenoma; Hepatocellular carcinoma, Intrahepatic Cholangiocarcinoma)
  • Liver cysts
  • Liver abscess
  • Hepatic hemangioma (benign vascular malformation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Do you need to do anything about hemangioma inside the liver?

A

most of the time it’s fine. but have them return in 3 months to get CT scan and evaluate growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Any mass that has “rim enhancing” is indicative of______

A

( KNOW!!!)

INFECTION!!! this is infectious until proven otherwise, get biopsy and WBC count send bx to microbiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Portal vein embolization=

A
  • Typically preformed as pre-operative radiology procedure

- Done several weeks prior to liver resection can help to redirect blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Other procedures:

A
  • Liver resections

- liver transplants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Describe liver transplants (what criteria is needed?)** KNOW

A
  • End-stage liver disease from cirrhosis
  • Model for End Stage Liver disease (MELD) score: Assess the severity of liver and kidney disease to prioritize patients for transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

POST op care issues: often have ________ drain

A

jackson-pratt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Post op: labs to monitor?

A

-Watch Coags, LFTs, bilirubin

  • What could go wrong?
  • -Ileus verse small bowel obstruction?
  • -Nausea/vomiting
  • -Wound infection
  • -Post op hernia?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

If INR goes up?

A

-give them vitamin k

or FFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

56 yo male with RU quadrant pain and a fever?

-chronic cramping for months
- denies vomiting
-not eating helps
-sometimes radiates to left shoulder
-denies weight changes
-he still has his gallbladder
-Alcohol- 1x a week
-

Order:?

A
  • CMP and CBC

- start with RUQ ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

56 yo male with RU quadrant pain and a fever?

-chronic cramping for months
- denies vomiting
-not eating helps
-sometimes radiates to left shoulder
-denies weight changes
-he still has his gallbladder
-Alcohol- 1x a week
-

Order:?

A
  • CMP and CBC
  • start with RUQ ultrasound
  • or order a

DDX:

  • cholecystitis
  • chollithiasis= irritation within gallbladder
46
Q

Tx: usually laparoscopic resectomy (in this surgery you CUT the ______ DUCT!!!!) know!!!

A

CYSTIC

47
Q

Murphy’s sign=

A

pathopneumonic for gallbladder issues ***

48
Q

HIDA scan=

A

Hepatobiliary Iminodiacetic acid scan, inject Pt with CCK and look at the EF of the gallbladder. If you have low EF–> you may have choleli

49
Q

MRCP=

A

Magnetic resonance cholangiopancreatography (gives you a picture)

50
Q

ERCP=

A

better, Endoscopic retrograde cholangiopancreatography (you can do something during this imaging procedure)

51
Q

Non-operative treatment methods tried:

A

Diet adjustment
Weight loss
Smoking sensation

52
Q

During an ERCP:

A
  • tube goes in and you can take pictures and also

- requires sedation during an ERCP

53
Q

Cholelithiasis=

Choledagon..??

A

Gallstones

-stones within a duct!!

54
Q

Cholecystitis=

A

Inflammation of the gallbladder

55
Q

Ascending cholangitis=

  • MC organisms?
  • Sx?
  • Tx?
A
  • Infection of the bile duct (MC gram neg bacilli Escherichia coli, Klebsiella, Enterobacter)
  • Sx: Jaundice, abdominal pain, fever
  • Tx: IV fluid and antibiotics
56
Q

Cholecystectomy

A

Open verse laparoscopic

57
Q

Endoscopic retrograde cholangiopancreatography (ERCP)= allows for..

A

Allows for sphincterotomy, lithotripsy, stent placement

58
Q

Percutaneous Transhepatic Cholangiography= is used when..

A

obstruction is too great you can use ultrasound and percutaneous approach (often done by radiology)

59
Q

Cholecystectomy: during this procedure you cut the ____

A

cystic duct

60
Q

What will you find in the gallbladder?

A
  • stones

- cancer-RARE

61
Q

describe gallstones

A
  • Cholesterol vs mixed (cholesterol, calcium bilirubinate)
  • In the US 80% of all gallstones contain cholesterol
  • Can see calcium bilirubinate in patient with high hemoglobin breakdown, remember bilirubin is a bi-product of hemoglobin breakdown
62
Q

Porcelain gallbladder=

A

=CANCER=calcification of the gallbladder) leads to higher risk
-Can also include lymph node and partial liver resections

-Tx: Chemo/radiation as adjunct (poor prognosis if late stage– high mortality)

63
Q

Post op care/complication: after laparoscopic cholecystectomy

A

-Laparoscopic cholecystectomy usually done as outpatient (ie pt sent home same day)

  • Bile leak
  • Damage to surrounding blood vessels, tissues, nerves
  • Incisional hernias
  • Ileus
  • Diet adjustment
  • –Cut back on dairy and fatty/cholesterol rich foods

-Diarrhea

64
Q

52 yo diabetic female presents with nausea, vomiting, and abdominal pain. She has noticed greasy/pale white stools the past 2 days?

Questions to ask: 
-pain? center of abdomen
-they're a diabetic
-+ for weight changes and sweats
-
A
  • U/S
  • CMP
  • CBC
  • *CT scan!!! and admit the Pt
65
Q

Pancreas: important to note that it shares a blood supply with the ____ at the distal end

A

spleen

66
Q

Work-up for pancreatic issues:

A
  • Complete metabolic panel
  • Physical exam
  • Magnetic resonance cholangiopancreatography (MRCP)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Pancreas protocol CT
67
Q

Pancreatic adenocarcinoma=

A

5%, 5-year survival rate without other intervention

68
Q

Pancreatic cysts can cause..

A

pancreatitis

69
Q

Intraductal Papillary Mucinous Neoplasms= can progress to..

A

into invasive pancreatic cancer

70
Q

Other pancreatic pathology:

A
  • Traumatic pancreatic duct disruption (ie skateboard to the abdomen)
  • Formation of Pseduocyst
71
Q

Pancreatic procedures

A
  • Distal Pancreatectomy +/- splenectomy–> Open verse laparoscopic
  • Transgastric pseudocyst gastrostomy= Draining of pseudocyst through stomach
  • Pancreaticoduodenectomy “Whipple”
72
Q

Describe Pancreaticoduodenectomy “Whipple”

A

-Open verse laparoscopic
(done for tumors on the head of the pancreas)
-Resection of the head of the pancreas, gallbladder (including part of the common bile duct), a portion of the duodenum, sometimes the pyloric sphincter

-Can increase 5-year survival rate to 20%

73
Q

Pancreaticoduodenectomy

A

high risk for leaking, so they put lots of tubes around there to help catch leaks

74
Q

Post op care/complication: post pancreatic surgery

A

-Several JP drains
Have to watch out for amylase; the pancreas is like a sponge and can leak

  • NG tube
  • Diabetes (you took away their insulin maker)
  • Ileus/constipation
  • Gastroparesis
75
Q

80 yo female presents to ED from an outside facility after a fall to a night stand. she has LUQ pain. Systolic BP is 75/50 after 2L of IV fluids

A

-do FAST exam
-emergent splenectomy
OR
-spleen has splenic artery and splenic vein

76
Q

Workup for spleen issues:

A 
Complete metabolic panel
CBC
Complete immunization history
Physical exam
CT scan
-Ultrasound (sometimes a FAST exam in the ED)
77
Q

Pathology of the spleen:

A

-Illnesses that increase the size of the spleen: Idiopathic thrombocytopenic purpura: antibodies target and destroy RBC OR Hereditary spherocytosis
OR Blood cancers: leukemia, lymphoma

  • Splenic artery aneurysm vs splenic infarction
  • Splenic cyst/Abscess
  • Spleen trauma
78
Q

During a splenic artery embolization–> spleen fx is

A

-can be partially preserved! this is debated– if splenic fx be preserved

79
Q

“rim enhancing”

A

infectious abscess

80
Q

Pre op plan for young Pt with ITP getting a laproscopy:

A

-REquires immunizations!!!!
for encapsulated organisms!! KNOW
Immunization prior to discharge if not given pre-operatively (need to give 3 weeks pre-op)
Pneumococcal, H. influenza and meningococcal

-+/- antibiotics prophylaxis

81
Q

Post op care for Exploratory laparotomy with Splenectomy

A

Ileus/constipation

Reactive thrombocytosis and leukocytosis– Aspirin therapy?

Nausea/vomiting

82
Q

Work-up for Small intestine issues:

A

Complete metabolic panel
CBC
KUB or abdominal erect and lateral decubitus views
Physical exam
CT scan
Ultrasound (sometimes a FAST exam in the ED)

83
Q

Pathology of the small intestine

A
  • Trauma
  • Ischemic colitis, Mesenteric ischemia, Cancer, Obstruction
  • Enterocutaneous, Enterovaginal Fistuals
  • Cancer: Carcinoid, Lymphoma, Adenocarcinoma, GIST tumors, metastatic disease
  • Intussusception
  • Meckel’s Diverticula: MC cause of lower GI bleeding in pediatrics
84
Q

Pathopneumonic Sx for intussusception is

A

**Jelly current stool

KNOW

85
Q

Procedures assoc. with the small intestine

A
  • Small bowel perforation repair
  • Small bowel resection
  • Fistula repair

-Manual reduction of intussusception verse resection (+/- appendectomy)

86
Q

Post op small intestine complications:

A

-Ileus= a painful obstruction of the ileum or other part of the intestine.

  • Bowel leakage
  • Small bowel obstruction
  • Adhesions!
  • Malabsorption issues
87
Q

constipation= tx

A

VERY common!
tx:
Senna, Colace, Miralax (stimulant), Go-Lightly Suppository, Enema, De-impaction

88
Q

Ileus (common):

  • suspect with a Pt with which sx?
  • dx?
A

prolonged constipation, Abdomen Distension

-KUB (or Abd supine and erect) to diagnosis–>**dilated bowel loops

89
Q

SBO=

A

=small bowel obstruction
Sx: Distension, Diminished bowel sounds
-NOT passing gas
-NPO, NG tube, Surgical resection

90
Q

abdominal cramping and RLQ pan?

A

-appendix!! she had an abscess in her appendix

91
Q

Appendicitis=MC surgical _____

A

emergency of the abdomen

-Approximately 250,000 appendectomies performed annually

92
Q

Sx: Appendicitis (KNOW)

A

**Usually cramping, periumbilical pain migrating to RLQ +/- fever

  • McBurney’s point
  • Rovsing’s, obturator, and Iliopsoas “psoas” sign
93
Q

appendicitis: imaging?

A
  • in peds order U/S, for adults CT cuz its more sensitive

- On CT looking for a thick wall >2mm, increased size >7mm, phlegmon or abscess, free fluid

94
Q

Rovsing’s=

A

palpation of LLQ ellicts pain in the RLQ

95
Q

Obturator and iliopsoas

A

Obturator: pain with internal rotation of the hip
Iliopsoas: pain with extension of the right hip

96
Q

Mcburneys point=

A

McBurney’s point: 2/3 distance from the umbilicus to the ASIS

97
Q

Tx: appendicitis

A

Antibiotics
Becoming more favorable, but the patient needs to be reliable and have close follow up

  • Laparoscopic verse open Appendectomy
  • -If Appendicolith is noted on CT, surgery is indicated
98
Q

Laparoscopic vs Open

appendectomy

A
  • Hospital stay usually overnight, unless perforated
  • If perforated consider antibiotic 3-7day, may required longer hospital stay

Post op care:
Tolerated well, N/V, diarrhea, decreased appetite
Abscess
Hernia

99
Q

Large intestine Workup:

A

-Complete metabolic panel
CBC
-KUB or abdominal erect and lateral decubitus views

  • Physical exam, *including rectal!
  • CT scan
  • Ultrasound (sometimes a FAST exam in the ED)
100
Q

Large intestine: assoc. pathology

A
  • Cancer: Colon cancer, Colorectal cancer
  • **Diverticulosis/Diverticulitis
  • Colitis -> perforation/toxic megacolon/bleeding. Can be Ulcerative, Chron’s, Ischemic, C-diff
  • Obstruction
  • Rectal prolapse
101
Q

Ogilvie’s syndrome

A

=Also known as colonic pseudo-obstruction.
-When the cecum is >10cm in diameter

  • Dysregulation within the autonomic nervous system
  • Tx= decompression (NG tube or colonoscopy, Neostigmine(S/E: is arrythmia) or surgical resection
102
Q

Colectomy is typically

A

partial

103
Q

Colostomy=

A

=bringing up a section of the colon and connecting it to another part
-Done when you can’t reconnect the colon
Is reversible in some cases

104
Q

Other surgical procedures involving the colon:

A
  • Ileostomy (divert the entire colon and bring a loop of the ilium to the surface– now drain waste through )
  • Hemorrhoidectomy
  • Sphinecterotomy–>Not common, can be done for chronic anal fissure
105
Q

Hemorrhoids=

A

=Engorgement of normal fibrovascular cushions

-Classified into internal (above dentate line) or external (below)

106
Q

Problem with ileostomy?

A
  • dehydration (since colon cant absorb h20 anymore)

- monitor their creatine levels!!

107
Q

Tx options for hemorrhoids

A
  • Always try OTC medical management first! ie Witch Hazel, Phenylephrine supp, Hydrocortisone crm, Sitz Baths
  • Sclerotherpathy (can be done in the office)
  • Hemorrhoidectomy–> Always indicated for incarcerated or gangrenous hemorrhoids
  • Suture ligation
108
Q

Abdominal hernia tx:

A

sew a mesh over the abdominal wall

109
Q

Trauma:

A
  • ATLS (Advance Trauma Life Support)
  • CT scan verse Focused Assessment with Sonography for Trauma
  • FAST exam: US to look at Pericardial, Perihepatic, Perisplenic and Pelvic region (Can also be used to evaluate pleural spaces)
  • Open laparotomy
  • Abdominal packing if all else fails
110
Q

Kidney injuries

A
  • Kidney laceration
  • Kidney hematoma: **Blood in the urine is always a problem
  • Always rule out Foley trauma
  • Call urology!
111
Q

Take home:

A
  • Need a complete history physical and exam
  • Abdominal surgery can have a lot of complications–> When in doubt make the patient NPO
  • Never be afraid to order imaging (if indicated!)

Clin Med semester 2 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions