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Emergency Medicine > Unit 3 Lecture 5 > Flashcards

Unit 3 Lecture 5 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

sxs of meckel’s diverticulum

A

asx, abd pain (SBO), GI bleeding

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2
Q

dx of meckel’s diverticulum

A

meckel’s scan

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3
Q

tx of meckel’s diverticulum

A

resection

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4
Q

most common of the rule of 2’s for meckel’s

A

2 yo at presentation

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5
Q

causes of diffuse abd pain

A

gastroenteritis, mesenteric ischemia, metabolic, malaria, bowel obstruction, peritonitis, IBS

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6
Q

what is mesenteric ischemia

A

decreased perfusion to section or/entire colon due to embolic, atherosclerotic, aortic surgery, or hypotension

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7
Q

risk factors for mesenteric ischemia

A

cardiac arrhythmias, advanced age, low CO states, valvular heart ds, MI, malignancy

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8
Q

sxs of mesenteric ischemia

A

severe acute midabdominal pain, post-prandial, possible hematochezia/diarrhea

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9
Q

PE of mesenteric ischemia

A

pain out of proportion to exam

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10
Q

pneumatosis intestinalis

A

air within the wall of the ascending bolon;sx not a dx; a/w ischemic bowel

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11
Q

tx of mesenteric ischemia

A

aggressive fluid resuscitation, NGT, foley cath, abx, anticoag, embolectomy or colon resection

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12
Q

sxs of appendicitis

A

abd pain, anorexia, N/V, dysuria

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13
Q

PE of appendicitis

A

mcburney’s point tender, guarding, rebound tenderness

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14
Q

rebound tenderness

A

done anywhere on the abd; pain when released

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15
Q

rovsing’s sign

A

done on the LLQ and pain when pressing in

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16
Q

pecial tests for appendicitis

A

rovsing’s, psoas, obturator, DRE pain on right side

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17
Q

dx of appendicitis

A

CT with contrast

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18
Q

signs of appendicitis on CT

A

enlargement with wall thickening, fat stranding, and fecalith

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19
Q

tx of appendicitis

A

periop abx, appendectomy

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20
Q

complications of appendicitis

A

perforated (most common), peritonitis, abscess

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21
Q

signs of perf append.

A

more diffuse pain after localized tenderness; pain may be relieved followed by peritonitis

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22
Q

signs of peritonitis from perforated appendix

A

high fever, localized or generalized pain

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23
Q

location of appendix during 5th month of pregnancy

A

level of the umbilicus

24
Q

causes of LLQ pain

A

diverticulitis, salpingitis, ectopic pregnancy, inguinal hernia, nephrolithiasis, IBS, IBD

25
Q

where is diverticulitis most prevalent

A

sigmoid colon

26
Q

sxs of diverticulitis

A

LLQ pain, fever, anorexia, N +/- V

27
Q

PE of diverticulitis

A

tenderness, guarding, distension, hypoactive/absent BS or hyperactive BS, +guaiac

28
Q

labs of divertic.

A

leukocytosis with left shift

29
Q

tx of divertic

A

oral abx->clear liquids->low residue diet->high fiber diet

surgery if repeated attacks, complications, or failure to improve with conserv. tx after 3-4d

30
Q

colostomy

A

colon divided->proximal end brought through the abdominal wall

31
Q

hartmann’s procedure

A

colostomy with distal end oversewn and placed in peritoneal cavity as blind limb

32
Q

stoma

A

portion of the intesting outside the abd

33
Q

loop colostomy

A

both proximal and distal end drain to the abd wall

34
Q

proctocolectomy

A

removal of entire colon and rectum

35
Q

adominoperineal resection

A

removal of lower sigmoid colon, entire rectum, and anus (very low rectal CAs)

36
Q

low anterior resection

A

removal of distal sigmoid colon and 1/2 of rectum (CA of middle of upper sections of rectum)

37
Q

diff between internal or external hemorrhoid

A

internal above dentate line, external below dentate line

38
Q

most common cause of rectal bleeding

A

internal hemorrhoids

39
Q

grade I hemorrhoid

A

palpable, nonprolapsed

40
Q

grade II hemorrhoid

A

prolapse with straining and defecation

41
Q

grade III hemorrhoid

A

protrude spontaneously or with straining, require manual reduction

42
Q

grade IV hemorrhoid

A

chronically prolapsed and cannot be reduced

43
Q

tx of grade II and grade III internal hemorrhoids

A

rubber band ligation

44
Q

acute and chronic complication of infection of the anal glands

A

acute=abscess

chronic=fistula

45
Q

causative organisms or anorectal abscesses

A

E. coli, proteus sp., strep., bacteriodes

46
Q

tx of anorectal tx

A

surgical drainage, abx, wound care

47
Q

presentation of rectal FB

A

anorectal/abd pain, blood per rectum, mucus d/c

48
Q

complications of rectal FB

A

fistulas

49
Q

dx of enteric fistula

A

imaging/endoscopy

50
Q

tx of enteric fistula

A

fluid resus., bowel rest, nutritional support, op. tx

51
Q

what is fistula in ano

A

abnl communication b/t anal canal and the perianal skin

52
Q

dx of fistula in ano

A

goodsall’s rule, cord like tract on DRE, drainage or granulation seen on PE

53
Q

tx of fistula in ano

A

drainage and curretage of fistula tract, placement of seton

54
Q

impact of starvation in Ebb phase

A

immediate, tissue hypoperfusion, decrease metabolism, catecholamin release

55
Q

impact of starvation in flow phase

A

catabolic and anabolic, increase CO, hypermetabolic, hyperglycemia

56
Q

kcal and protein needed in “stressed” patients

A

50 kcal/kg/day and 2.5g protein/kg/day

Emergency Medicine (6 decks)

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