ACS Readings Flashcards
(42 cards)
Does conjugated or unconjugated bilirubin cause normal-colored urine and stools?
- UNconjugated
What does conjugated bilirubin do to urine and stools?
- dark urine and pale stools
What is cholestatic syndrome?
- cholestasis= decreased delivery of bilirubin into the intestines (w/subsequent accumulation in hepatocytes and in blood), irrespective of the underlying cause.
How does SEVERE cholestasis present?
- CONJUGATED hyperbilirubinemia presenting as jaundice.
- dark urine, pale stools, pruritis, brusiing, steatorrhea, night blindness, or chronic malabsorption of fat-soluble vitamins (A, D, E, and K).
Are CXRs done in all pts with bowel obstruction?
YES to exclude sub-diaphragmatic free air.
What would a gas throughout the entire length of colon indicate?
- ileus or partial mechanical obstruction
What would a paucity of distal colonic gas or an abrupt cutoff of colonic gas w/proximal colonic distention and air-fluid levels indicate?
- complete or near-complete obstruction
What would bowel strangulation show on abdominal radiograph?
- thickened bowel loops, mucosal thumb printing, and free intestinal air
How do you distinguish between small and large bowel gas?
- small bowel outlines the valvulae conniventes, which traverse the entire diameter of the bowel lumen. Usually occupy the central abdomen.
- large bowel outlines the colonic haustra and usually seen in the periphery.
What will you see with ileus?
- distension usually extending uniformly throughout the stomach, small bowel, and colon.
What should you do if H&P indicates intestinal obstruction, but abdominal radiograph is normal?
do US, CT or fast MRI.
Is ultrasound better or worse than XRAY in emergency setting?
US
What does the American College of Radiology recommend pt with suspected high grade SBO and plain equivocal film undergo?
- CT with contrast
What situations necessitate URGENT OR?
- failure of water-soluble contrast medium to reach the colon within 24 hours
- progressive bowel obstruction at any time after nonoperative measure are started.
- failure to improve with conservative therapy within 36 hrs.
- early postop technical complications
What situations suggest EMERGENT OR?
- incarcerated, strangulated hernias.
- peritonitis
- pneumatosis cystoides intestinalis
- pneumoperitoneum
- suspected or proven intestinal strangulation
- closed-loop obstruction
- nonsigmoid colonic volvulus
- sigmoid volvulus associated with toxicity or peritoneal signs.
What situations deem delaying operation is safe
- immediate postop obstruction (just give the bowel some time to recover)
- chronic, recurrent partial obstruction
- paraduodenal hernia
- gastric outlet obstruction
- postop adhesions
What is important to know about esophagogastroduodenoscopy (EGD)?
- nearly always revelas the source of an UGI bleed
What is an indication for emergent EGD within 1 hr of presentation?
- HEMATEMESIS
* use saline lavage to clear the stomach of blood and clots of bleeding rate is very high.
With what should you pretreat a pt with hematemesis before EGD?
- erythromycin to facilitate gastric emptying
* decreases need for multiple endoscopies
Can most UGI bleeds be controlled endoscopically?
YES
What other imaging modalities can be used for upper GI bleed?
- tagged RBC scan= can confirm the presence of an ACTIVE bleeding site, but fairly nonspecific at determining the anatomical location.
- arteriography= can only identify if bleeding is brisk (greater than 1 mL/min).
What is the overall diagnostic success of finding an upper GI bleed with EGD + other modalities?
- greater than 90%
What is the Blatchford prediction score for upper GI bleeding?
- a screening tool to assess the likelihood that a patient with an acute upper GI bleed will need to have medical intervention such as a blood transfusion or endoscopic intervention. Uses blood urea, hemoglobin, and systolic BP to grade 0-6.
What is the Rockall prediction score for upper GI bleeding?
- attempts to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding. Uses shock, comorbidities, diagnosis, and stigmata of recent hemorrhage to grade 0-3.
