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43 Cards in this Set
- Front
- Back
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Epidemiology of small bowel obstruction
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adhesions = 15-42% of SBO
cancer = 20% of sBO hernias = 10% of SBO (most common = ventral and inguinal) |
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Risk factors for SBO
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previous abdo surgery, hernia, IBD, diverticulosis, cholelithiasis, ingested foreign body
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Pathology of SBO
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mechanical obstruction --> accumulation of fluid and gas proximal to obstruction --> distension --> increased luminal pressure & stopping of venous drainage --> bowel wall edema --> large volumes of fluid and electrolytes secreted into lumen --> severe dehydration, hypochloremia, hypoK, met alkalosis, oliguria, azotemia, hemoconcentration, reduced CVP, reduced CO --> hypotension and shock
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Electrolyte imbalance in SBO
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dehydration
hypochloremia hypokalemia metabolic alkalosis oliguria azotemia hemoconcentration |
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Signs and symptoms of SBO
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N&V, distension, colicky abdo pain which becomes more diffuse and constant as ob progresses, constipation, high pitched bowel sounds, fever, leukocytosis
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Dx of SBO
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supine and erect abdo xray
distended loops with air-fluid levels absent air distal to obstruction |
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Management of SBO
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conservative for 48 hours
IV fluids NBM NGT decompression correct electrolytes surgery |
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Definition of AAA
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more than 50% of normal diameter
usually >3 cm |
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Risk factors for AAA
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> 60 years old
Male (M:F 4:1) Smoking Atherosclerosis Family Hx HTN Peripheral vascular disease |
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Signs and symptoms of AAA
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75% asymptomatic!
pulsatile abdo mass epigastric/back pain hypovolemic shock |
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Natural history of AAA
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increases in diameter by 10% per year
only 15% of AAA rupture |
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Risk of AAA rupture related to size
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5-5.9 cm: 25%
6-6.9 cm: 35% >7 %: 75% |
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Indication for AAA repair
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1. leaking or ruptured AAA
2. symptomatic (pain, embolism, ureteric obstruction) 3. expanding AAA >0.5 cm/yr 4. > 5.5 cm diameter |
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Pathophysiology of pseudo-obstruction
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massive colonic dilatation without evidence of mechanical obstruction,
caused by wide range of unrelated conditions that compromise bowel peristalsis, eg retroperitoneal inflammation or hemorrhage, neuro conditions, drugs (anti-cholinergics, pregnancy, ortho injuries, immobilization) |
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Management of diverticulosis
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1. high fibre diet
2. stool softeners |
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Management of mild diverticulitis
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1. Clear liquid diet
2. Oral antibiotics 3. Non-opioid analgesics 4. Colonoscopy once acute infection has subsided |
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What part of bowel is diverticular disease most common?
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Sigmoid colon
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Which investigations are contraindicated in acute diverticulitis?
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colonoscopy
barium enema |
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Prognosis of diverticulitis
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70% of pts have no recurrence after one episode of uncomplicated diverticulitis
after a 2nd episode, 50% recur |
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Surgical management of severe diverticulitis w/ perforation and/or perforation
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2 stage procedure:
1. initial surgical drainage and diverting colostomy 2. colonic reanastomosis 2-3 months later |
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Signs and symptoms of colonic abscess
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constant abdo pain
diarrhea or adynamic bowel disorder swinging pyrexia leucocytosis |
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Diagnosis of colonic abscess
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U/S
CT abdo and pelvis |
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Diagnosis of colonic perforation
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AXR: erect --> free gas in peritoneal cavity, usu subdiaphragmatic (Morrison's pouch)
CT: very sensitive for detecting free gas |
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What testicular pathology is most associated with infertility?
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varicocele
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What is the most common cause of scrotal swellings?
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epididymal cysts
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What is a communicating hydrocele caused by?
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patency of processus vaginalis
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What are the two types of calcium kidney stones?
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calcium oxalate (most common)
calcium phosphate |
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What type of kidney stone is associated with infection?
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struvite (magnesium ammonia phosphate)
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What drug prevents calcium stones?
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thiazide
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Rx of congenital inguinal hernia
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immediate surgery - risk of incarceration
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Rx of infantile umbilical hernia
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vast majority resolve without intervention before 4-5 years old
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Which ulcer has pain that is GREATER with meals?
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gastric ulcer
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Which ulcer has pain that is DECREASED with meals?
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duodenal ulcer
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Features of duodenal ulcers
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epigastric pain
burning pain 1-3 hours after meals relieved by eating and antacids interrupts sleep periodicity - appears in clusters over weeks |
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Which tumor marker is associated with breast cancer?
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CA 15-3
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What is the MOA of tamulosin?
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alpha blocker
decreases smooth mm tone |
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adverse effects of tamulosin
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dizziness, postural hypotension, dry mouth, depression
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MOA of finasteride
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5 alpha reductase inhibitor
blocks conversion of testosterone to DHT |
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What is the first line treatment for BPH
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alpha 1 blockers
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Which kidney stones are radio lucent?
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urate and xanthine
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Which kidney stones are opaque?
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calcium oxalate, calcium phosphate, triple phosphate
cystine are semi-opaque |
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Rx for anal fissure
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bulking agents
stool softener topical GTN chronic - rarely heals without surgery |
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Which type of stone is often in stag-horn calculi?
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struvite
in alkaline urine and bacterial infections, Ureaplasma urealyticum and Proteus infections |
