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27 Cards in this Set

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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
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
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
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
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
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
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
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
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)
Characteristic appearance for ascites on CT?

Symptoms of SBP?
"ground glass" appearance on anterior abdomen

PMN count >250, more immature cells
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
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
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
Findings consistent with acute peritonitis?

Tx for acute peritonitis?
WBC up, left shift, free air under diaphragm, abrupt onset

IVF, Abx, surgery
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
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
Sign of recent GI bleed, bright red blood in vomit

previous GI bleed

black, tarry, loose stools
hematemesis

coffee ground emesis

melena
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
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
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
Two methods to localize an acute GI bleed?

Endoscopy contraindicated in what patients?
NG tube placement, endoscopy

uncooperative
suspected perforation
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
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
Adenoma, dark red, smooth surface, dysplastic:

Adenoma, shaggy, cauliflower like, friable
tubular

villous
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
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
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