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7 Cards in this Set
- Front
- Back
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Inguinal Hernias |
Protrusion of abdominal contents (usually SI) into inguinal region. Direct: ab contents through floor of Hesselbach's triangle (do not go through inguinal ring, contained w/in aponeurosis of external oblique, transversalis fascia defect Indirect: through the internal then external rings into scrotum: most common in M&F; due to congenital patent processus vaginalis Tx: incarceration or strangulation risk, surg management is indicated |
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Hesselbach's Triangle |
Inguinal ligament, inferior epigastric artery, rectus abdominus |
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Cholelithiasis and bilary colic |
Colic: transient cystic duct blockage; Risks 4-Fs: Female, Fate, Fertile and Forty Other risks: OCP, rapid weight loss, +FH, sb resxn, TPN HP: postprandial ab pain, RUQ, radiates to R subscap, pain abrupt, gradual relief N/V, fatty food intolerance, dyspepsia, flatulence Dx: RUQ US Tx: Cholecystectomy, ERCP for common bile duct stones, dietary modifications (fatty foods etc.) Complications: rec biliary colic, acute chole, choledocolithiasis, acute cholangitis, gallstone ileus, gallstone pancreatitis |
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Acute Cholecystitis |
Prolonged blockage of cystic ducts, acaclulous chole occurs in absence of cholelithiasis in chronic debil pts, TPN, trauma, burn victims HP: RUQ pain, N/V, F; inspiratory arrest during deep palp of RUQ=Murphy's sign Dx: CBC: leuko, amylase, bili, alk phos, AST/ALT elevated US: stone, sludge, thickened gallbladder wall, US murphy's; obtain HIDA when US is equivocal Tx: IV ABx and IVF early cholecystectomy (preop ERCP or intraop cholangiogram) Comp: gangrene, empyema, perf, emphysematous gallbladder, fistulization, gallstone ileus, sepsis, abscess *in pts w/ sig med problems (DM) delay surg until acute inflammation resolves |
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Choledecolithiasis |
gallstones in common bile duct HP: biliary colic, jaundice, f, pancreatitis Dx; inc. alk phos, tot bili, Tx: ERCP w/ sphincterotomy |
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Acute Cholangitis |
acute bac infxn, 2* to obstrxn usually from gallstones or 1* sclerosing cholangitis (prog infl of biliary tree assoc w/ UC); G- (E. coli, Enterobactor, Psuedomonas) common path HP: Charcot's triad: RUQ pain, jaundice, fever/chills Reynold's Pentad: +shock and altered mental status Dx: leuko, inc. bili, inc. alk phos, blood cx for sepsis, US or CT, ERCP is both dx and therapeutic Tx: ICU admission, BS Abx, emergent bile duct decompression |
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Primary Sclerosing Cholangitis |
idiopathic, inflammation, fibrosis, strictures of extra and intra hepatic bild ducts, young men w/ IBD (UC) HP: jaundice, pruritis, fatigue Dx: inc. alk phos, inc. bili, MRCP and ERCP: mult bile duct strictures, liver bx: periductal sclerosis (onion skinning) Tx: high dose ursodeoxycholic acid, endoscopic dilatation, Inc. risk of cholangiocarcinoma |
