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53 Cards in this Set
- Front
- Back
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most common Surgical Disorder of SI
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SBO = small bowel obstruction
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what is SBO's incidence post laparotomy
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10% incidence post laparotomy
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mc cause of SBO
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adhesive process in the abdominal cavity
(from pelvic gynecologic procedure) |
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very common, commonly overlooked, cause of SBO
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Hernia
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cause of intussusception in adults?
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2ndary to pathologic process
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big causes of intraluminal SBO
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gallstone , FB
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big causes of intramural SBO
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Crohn’s , Tumor
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big causes of Extrinsic SBO (mc cause of SBO)
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Adhesions , hernia
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Laundry list of SBO clinical symptoms
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Colicky abdominal pain
N/V Obstipation Volume depletion Hyperactive BS Leukocytosis,hypokalemia common Diffuse abdominal pain,tachycardia,marked leukocytosis,acidosis,hyperamylasemia c/w ischemia 15% with frank infarction no signs |
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Why does SBO pt have hypokalemia
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vomiting
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Percent of pts with SBO who have frank infarction of the bowel with no signs
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15%
very old and very young |
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When diagnosing SBO, what are the details you must figure out in order to treat
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Mechanical vs ileus
Partial vs complete Simple vs Strangulated |
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Laundry list of pertinent history points for SBO pt
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Prior surgery
IBD / Carcinoma Hernias Prior radiation Melanoma Trauma Gallstones |
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List of pertinent exam points for a SBO pt
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Careful Palpation abdomen -s/s peritonitis
Auscultation : typical mechanical sounds vs quiet abdomen Meticulous search for hernias Guiac stools Search for signs of malignancy or extra intestinal signs of disease |
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In the end how do you definitively diagnose SBO?
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Radiology: PF, CT, SBFT
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Which radiological modality will give the following info:
Often will visualize transition point and dgnx etiology , dgnx closed loop , helpful with signs of strangulation |
CT
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Which radiological modality will give the following info:
excellent in Diff partial Vs complete and can be therapeutic |
SBFT
small bowel follow-through |
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#1 SBO treatment
(in fact all surgical diagnoses) |
volume resuscitation
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how do you know that you've given enough hydration?
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pt makes urine, duh.
1cc / kg / hr |
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Next step of treating SBO
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Electrolyte repletion
until alkalosis resolves |
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After Volume resuscitation
Electrolyte repletion, what are the next steps of treatment of SBO |
Nasogastric Decompression
Reduction incarcerated hernia Urgent surgery : Complete obstruction,peritonitis , nonreducible incarcerated hernia |
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Exceptions to Emergent Surgery
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Partial SBO
Early post op without peritonis Crohn’s Carcinomatosis |
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what is carcinomatosis
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carcinoma in the abdominal cavity
end results are not good |
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Is Crohn's disease treated medically or surgically usually
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medically
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*********** (hint of test question)
most common site of crohn's -75% |
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Distal ileum |
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Which president had Crohn's
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Ike
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What will differentiate appendicitis from Crohn's disease?
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CT
(what about the "do not pass go" straight to surgery stuff about appendicitis?) |
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Most common result of Crohn's
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Bowel obstruction
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75% of Crohn's pts have some extra intestinal manifestation. Like what?
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-erythema nodosum,uveitis,cholangitis ,cholelithiasis , nephrolithisis
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How do you diagnose Crohn's
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Presentation acute/chronic pain often RLQ with evidence of chronic inflammation , fistula ,stricture , or obstruction on radiologic eval
Initial presentation can mimic appendicitis with diagnosis made at surgery Initial presentation perinal abscess or fistula |
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Treatment for Crohn's
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No cure , goal is palliation
Medical therapy mainstay : induce and maintain remission |
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When does Crohn's pt have surgery?
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: complications
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What % of Crohn's pts will require surgery at some point
Indications : non responsive to medical therapy / complications |
75-80%
1/3 due to intestinal obstruction |
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MC Small Bowel Neoplasms
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adenomas most common
mainly adenomas fibromas,lipomas,neurofibromas less common |
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MC site of SB Neopasms
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duodenum
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Malignant GI malignancies
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Adenocarcinoma 35-50%
Carcinoid 20-40% Lymphoma 10% |
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-most common mesenchymal tumor -15%
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GIST
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Metastases- most common type in GI?
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melanoma
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Where is the GI cancer that causes jaundice
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periampullary
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Where does adenocarcinoma happen?
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Most commonly arise in duodenum
Crohn’s patient arise in ileum |
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What cancer of the GI tend to be aggressive 25-50% presenting with liver mets and carcinoid syndrome
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SI carcinoids
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Where are lymphomas in the GI
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Primary SI lesions most common in ileum
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most common presentation of lymphoma
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SBO
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What neoplasm:
SI 2nd most common site 25-30% |
GIST
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What is the result of Failure of obliteration of omphalomesenteric duct
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Meckel’s Diverticulum
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Most common congenital abnormality of GI tract
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Meckel’s Diverticulum
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most common complications of Meckel's
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Bleeding , SBO , diverticulitis
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Most common complication overall
Most common complication in children Meckel's |
Bleeding
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Most common complication in adults
Meckel's |
Obstruction
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Intussusception in adults caused by what?
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Meckel's
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Incarcerated hernia B/c of Meckel's
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( Littre’s)
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most common cancer of Meckel's
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Carcinoid
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Treatment for meckel's
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Diverticulectomy simple adhesive obstruction
Segmental resection for bleeding , inflammation , tumor Asymptomatic lesion -treatment controversial |
