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27 Cards in this Set
- Front
- Back
What is colicky pain?
If relief post BM, then maybe what organs? If relief post vomiting, then maybe what organs? If improvement with bending forward, then where is the pathology? |
waves of pain, comes and goes (colicky baby)
BM - rectum, small bowel vomiting - stomach, small intestine bending forward - retroperitoneal |
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Board like rigidity of the abdomen implies ___________.
Pt comes in with periumbilical pain shifting to RLQ, elevated WBC/left shift, anorexia - Dx? If pt is vomiting/diarrhea, then _______ likely to have appendicitis. |
general peritonitis
appendicitis less likely |
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When would you NOT do a laparascopic appendectomy?
pt comes in, sudden/severe epigastric pain, radiating to R scapula, worse with respirations - Dx? |
suspected or diagnosed perforation/rupture
perforates duodenal ulcer |
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What are some PE findings with a perforated duodenal ulcer?
Why are 70-80% of SBO's caused by adhesions? Presentation of SBO? |
absent bowel sounds, board-like rigidity, epigastric tenderness
more surgeries intestinal colic, abd distention, epigastric pain, feculent vomiting |
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How can you tell on exam if it is a complete or partial SBO?
Tx of a partial obstruction? Tx of a complete obstruction? |
Is the patient farting?
Yes - partial, No - complete partial - NG tube, IVF complete - surgery |
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Pt with LLQ pain, fever, abd distension, elevated WBC, constipation; Dx?
Where is diverticulitis usually found? Treatment with no perforation? |
diverticulitis
sigmoid colon (90%) IVF, Abx |
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What tests do you NOT run on diverticulitis patients? Why?
Perforation, peritonitis, colonic obstruction due to diverticulitis/abscess are indications for ________________. |
BE, endoscopy - increased irritation
emergency laparotomy |
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Pt presents with severe back/flank/abdomen pain, shock, hypotensive, pulsatile abd mass - Dx?
Pt presents with severe abd distension, anorexia, nausea, resp distress - Dx? |
AAA
ascites |
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The _________ test is used to test for ascites.
What procedure should be done? Where? |
Fluid wave test
paracentesis - midline beneath umbilicus, VOIDED BLADDER, patient sitting up (gravity helps) |
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Characteristic appearance for ascites on CT?
Symptoms of SBP? |
"ground glass" appearance on anterior abdomen
PMN count >250, more immature cells |
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S-A albumin gradient < 1.1 = ________. Why?
S-A albumin gradient > 1.1 = _________. Why? |
<1.1 = exudative process, kidney damage, albumin is pumped into ascites
>1.1 = transudative, liver damage, pumping more albumin into serum |
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Tx for SBP?
_______ peritonitis is spontaneous infection of ascites without any intraabdominal source. ________ peritonitis is caused by disease/injury to intraabdominal organs. |
5-10 d. IV abx
Primary Secondary |
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SBP is usually what kind of bacteria?
Why do patients with acute peritonitis lay supine with legs flexed? |
Gram- - E. coli, Klebsiella
less tension/gravity effect on peritoneum |
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Findings consistent with acute peritonitis?
Tx for acute peritonitis? |
WBC up, left shift, free air under diaphragm, abrupt onset
IVF, Abx, surgery |
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Pt with dull epigastric pain, steattorhea, N/V/D, increased PTH, alcoholic - Dx?
Diagnostic feature on XR? What radiography is usually ordered for pancreatitis? |
chronic pancreatitis
calcification of pancreas CT |
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Pt with >10% BW weight loss, abd pain, painless jaundice, hepatomegaly, +Courvoisier's sign - Dx?
What is Courvoisier's sign? Usual treatment? Generally curable? |
pancreatic cancer
palpable non-tender GB with jaundice palliative surgery - Whipple's procedure, pain control - generally untreatable |
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Sign of recent GI bleed, bright red blood in vomit
previous GI bleed black, tarry, loose stools |
hematemesis
coffee ground emesis melena |
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Major causes of UGI bleeding? (3)
Why are elderly at greater risk for UGI bleeding? Causes of gastritis? (3) |
PUD
Gastric erosions esophageal varices more NSAID use --> ulcers Drugs (NSAIDs, ASA), EtOH, gastric stress |
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Shock occurs when blood loss approaches ____ of total blood.
Postural hypotension implies _____ blood loss. Tx for acute GI bleed? |
40%
20% large bore IV x2, IV rapid infusion, T&X blood, O2 |
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Why is an initial hematocrit not accurate to assess blood loss?
When should you transfuse? What blood products? |
Body compensate by concentrating blood; (IVF dilutes)
Hemoglobin <9, unstable vitals, gross bleeding PRBC's, maybe FFP |
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Two methods to localize an acute GI bleed?
Endoscopy contraindicated in what patients? |
NG tube placement, endoscopy
uncooperative suspected perforation |
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Most common cause of acute lower GI bleed?
Causes of chronic LGI bleed? (2) What is BRBPR? |
Diverticulosis
hemorrhoids, cancer bright red blood per rectum |
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How do you diagnose angiogysplasia (pathologists hate it)?
Most frequent congenital GI anomaly? Why can Meckel's diverticulum cause ulcers? |
colonoscopy
Meckel's diverticulum may can gastric cells --> produce acid |
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Adenoma, dark red, smooth surface, dysplastic:
Adenoma, shaggy, cauliflower like, friable |
tubular
villous |
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F/U of polyp disorders:
Time scale for malignant polyps? Benign? No polyps found? |
malignant - q3-6 mo., then 1 yr, then 3 yrs
benign - q 3 yrs. None - q 10 years |
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Where are the majority of colon cancers found?
Risk factors for colon cancer? Most common colon cancer type? |
descending colon, sigmoid (64%)
genetic, high fat/meat, low fiber diet, vitamin A,C,E deficiency adenocarcinoma |
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Screening:
How often should a person get: stool guaiac? flexible sigmoid testing? colonoscopy? Most common site of colon cancer metastasis? |
stool guaiac: every year
flexible sigmoid - q 5 yrs colonoscopy - q 10 yrs Liver |