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71 Cards in this Set
- Front
- Back
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What is visceral pain? |
pain originating from hollow organs, not well localized |
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What is pleural pain? |
well localized pain with dermatomal distribution, causes guarding, rebound tenderness, rigidity |
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What is the dividing point between the upper and lower GI systems? |
ligament of Treitz |
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What is the most common cause of Upper GI bleed? |
peptic ulcer |
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What tests should be ordered when investigating upper GI pain/bleeding? |
CBC, BUN, cr, lytes, glu, LFT, INR/PT, Hgb, xray, endoscopy, d-dimer, lactase/amylase, angiography, CT |
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How do you treat a patient with acute upper GI bleeding? |
ABCs, large bore IVs, NG tube, PPI drip (for ulcer), octreotide (for varices), endoscopy, sx, stenting, or embolectomy (if needed) |
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List the 9 abdominal regions: |
top down: Right: hypochondrium, lumbar, inguiunal middle: epigastric, umbilical, hypogastric Lest: hypochrondrium, lumbar, inguinal |
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What are the DDx of upper quadrant pain? |
acute pancreatitis, herpes zoster, lower lobe pneumonia, MI |
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What are the DDx of RUQ pain? |
cholecystits, hepatitis, biliary colic, duodenal ulcer, hepatic abcess |
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What are the DDx of LUQ pain? |
gastritis, splentic disorders |
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What are the DDx of RLQ pain? |
appendicitis, cecal diverticulitis, mesenteric adenitis |
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What are the DDx of LLQ pain? |
sigmoid diverticulitis |
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What are the DDx of lower quadrant pain? |
abdominal abscess, abdo hematoma, cystitis, endometriosis, hernia, IBD, PID, renal stones, AAA, ectopic pregnancy, ovarian/teste cyst or torsion |
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What is a hiatus hernia? |
herniation of abdominal content (usually stomach) through the esophageal hiatus of the diaphragm |
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What are the S/S of hiatus hernia? |
nausea, vomiting, retching, GERD, epigastric pain |
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How is a hiatus hernia diagnosed? |
barium enema |
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How do you treat a hiatua hernia? |
PPI or sx |
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What is Boerhaave's syndrome? |
rupture of the esophagus from a sudden increase in pressure due to surgical procedures, forceful vomiting, etc. full thickness tear |
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What is Makler's triad? what is it indicative of? |
triad: vomiting, retrosternal/epigastric pain & subcutaneous emphysema (crackling in the skin) indicative of Boerhaave's syndrome |
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What is Boerhaave's syndrome diagnosed? |
CXR (will see: mediastinal air, pleural effusion, pneumothorax, widened mediastinum) CT scan, gastrograffin upper GI study |
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How is Boerhaave's syndrome treated? |
medically (if cervical perf), surgery for thoracic perf, stabilize the patient |
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What is a Mallory Weiss tear? |
superficial tears in the mucosa at the junction for the stomach and esophagus |
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What are the S/S of Mallory Weiss tears? |
main: hematemesis (after severe vomiting) |
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How are Mallory Weiss tears diagnosed? |
endoscopy |
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What is Kerh's sign? What is it indicative of? |
LUQ pain that radiates to the shoulder indicative of splenic rupture |
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What is choledocholithiasis? What are the S/S? |
stone in the common bile duct SS: jaundice, RUQ pain, pale stools, +Murphys sign, increased amylase, bilirubin and ALP |
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How is choledocholithiasis investigated? how is it treated? |
Ix: blood work (bilirubin, amylase, ALP,), US tx: ERCP to remove stone blockage |
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What is cholangitis? |
infection of the bile duct due to stone obstruction |
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How is cholangitis investigated? treated? |
Ix: blood work: CBC, ALP, LFT, GGT, blood culture, US tx: ERCP, fluids, antibiotics (ampicillin & gentamycin) |
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What are the 4 main risk factors for gall stones? |
fat, forty, female, fertile |
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What are the SS of gall stones? |
RUQ pain, nausea, vomiting, biliary colic, radiating pain to shoulder and back, fever, chills, anorexia |
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How are gall stones investigated? |
CBC, bilirubin, LFT, amylase, ALP, UA, lytes, CXR (EKG to rule out cardiac causes), US (main diagnostic) |
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What are the main causes of pancreatitis? |
ETOH, trauma, perf peptic ulcer, obstruction, drug induced, gall stones |
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What are the SS of pancreatitis? |
epigastric pain radiating to the back, anorexia, fever, nausea, gallstones, tachy, vomiting, abdo distention, Cullen's sign (blue around umbilicus), Grey-Turner's sign (blue on flanks), pain relieved with leaning forward |
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How would you investigate pancreatitis? |
CT (test of choice), blood work: amylase, lipase, WBC, CXR(calcifications), US |
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For what condition is Ranson's Score used? What is it determine? What does it include? |
Condition: pancreatitis determines: mortality includes: age, WBC count, glucose, serum AST & LDH, low Ca & hct & o2 sats, high BUN |
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What Abdo xray finding is indicative of bowel obstruction? |
air fluid levels |
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What are the main causes of small bowel obstruction? |
adhesions following sx, hernia others: bezoar, lymphoma, stricture, intusseception |
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What are the main causes of large bowel obstruction? |
carcinoma, diverticulitis, volvulus, other: stool, IBD, obstruction |
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What are the SS of bowel obstruction? |
abdo pain, distention, decreased bowel movements, obstipation, fecal and bilious vomiting, |
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What is hartmanns procedure? What conditions is it used for? |
proctosigmoidectomy with creating of an end colostomy used for : colon or rectal cancer, large bowel obstruction due to stricture, disease of inflammation (diverticulitis, etc) |
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What causes appendicitis? |
inflammation of the vermiform appendix due to obstruction of appendix lumen with fecal matter |
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What are the SS of appendicitis? |
RLQ pain, fever, anorexia, nausea, vomiting |
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What physicial exam maneuvers would be indicative of appendicitis? |
Rovsing's sign, tender at McBurnery's point, rebound tenderness in LLQ, psoas sign, obturator sign |
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How is a possible appendicitis investigated? |
UA, preg test, CBC, CRP, urea, lytes, amylase US** =main test abdo CT if US indeterminant |
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How do you treat appendicitis? |
initally: fluids, analgesia, anti-emetics appendectomy |
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What is diverticulosis? |
outpouching of the colonic mucosa |
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What is diverticulitis? |
inflammation and infection of the diverticulum that can lead to ischemia and necrosis, and eventual perf. may lead to peritonitis if abscess spills over to peritoneum |
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How is diverticulitis treated? |
complicated: IV fluids, IV antibiotics uncomplicated: sx, liquid diet, antibiotics (quinolones, amoxi-clav, TMP-SMX + metronidazole) |
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what mesenteric arteries might be affect by intestinal ischemia due to total or partial embolus/thrombosis. What structures/organs to each supply? |
1. Celiac artery - liver, stomach, spleen
2. superior mesenteric artery - ileum, jejunum, ascending and transverse colon 3. inferior mesenteric artery - distal transverse colon, sigmoid, and colon |
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What are the risk factors of intestinal ischemia (due to embolus or thrombosis) |
old age, atherosclerosis, shock, valvular disease, cardiac arrhythmias, recent MI, abdo cancer, hypercoagulability, PVD, DVT/PE Any condition where an embolis or thrombosis might occlude an intestinal artery |
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How do you treat intestinal ischemia? |
restore blood flow asap! IV fluids, NG tube, NO vaspressors!! anticoagulation, angioplasty, embolectomy, stenting, thrombolysis, surgery |
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What is a volvolus? What are the SS? How is it diagnosed? How is it treated? |
twisting of the bowel onto itself SS: extreme abdo pain, vomiting, distention, ischemia Diagnosis: CT w/contrast, abdo xray, upper GI series Tx: sigmoidoscopy +rectal tube, laparotomy |
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What is intussesception? What are the SS? How is it investigated? How is it treated? |
parts of the intestine telescope or invaginate into itself (often causes obstruction) SS: nausea, vomiting, relief with legs to chest, intermittent ***abdo pain (cramps), bloody stool (may cause ischemia-necrosis-sepsis) Ix: US or CT w/contrast Tx: air or barium enema, surgery |
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What US or CT finding would be indicative of intussesception? |
target-like mass usually >3cm in diameter |
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What are the 3 MAIN ddx of intussesception? |
1. acute gastroenteritis 2. Henoch-Schonlein purpura 3. rectal prolapse |
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List immediate surgical complications
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basal atelectasis shock low urine output |
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List early surgical complications
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nausea/vomiting fever secondary hemorrhage pneumonia wound dehiscence or infection |
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List late surgical complications |
incisional hernia persistent sinus malignancy recurrence of reason for surgery |
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What might a fever during or immediately following surgery be indicative of?
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tissue damage hematoma atelectasis infection drug reaction |
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What might a fever in the early post-op period indicate? |
sepsis wound infection phlebitis abscess formation DVT |
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What might a fever in the late port-op period indicate? |
distant infection (UTI, DVT, PE) |
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What prophylaxis measures can be taken to prevent post-op complications?
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heparin for DVT/PE Resp: O2, epidural cath GI: proper nutrition, H2 blockers, NG tubes to prevent aspiration renal: proper fluid levels, dialysis Immune: antibiotics, prevent hypothermia Endocrine: tight glucose control |
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What is primary peritonitis? What causes it?
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causes: nephrotic syndrome, cirrhosis, peritoneal dialysis, TB |
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What is secondary peritonitis? What causes it?
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Causes: cancer, appendicitis, duodenal ulcer, Crohn's disease, mesenteric artery embolus, divertiulitis |
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What investigations should be done if abdominal sepsis is suspected?
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What antibiotics should be used to treat rectal abcess?
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cipro + metronidazole |
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What is a pilonidal sinus?
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impaction of hair and debris in the natal cleft of the buttocks |
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List common complications of stomas?
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retraction, peristomal hernia, prolapse, necrosis of stromal tissue, skin problems (ie. dermatitis) |
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What is the difference between Mallory Weiss tears and Boerhaav's syndrome?
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Beohavvrs syndrome is a spontaneous rupture of the esophagus and is more proximal. this is a medical emergency. |
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How do you treat an inguinal hernia?
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Surgery with mesh |
