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Surgery Core Topics > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

0
Q

DDx RLQ Pain

A

Appendicitis, ruptured peptic ulcer, Diverticulitis, Chron’s, Ectopic pregnancy, ovarian cyst, ovarian torsion, endometriosis, psoas abscess

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1
Q

DDx of RUQ pain

A

Cholecystitis, Choledocholithiasis, Hepatitis, Hepatic vein obstruction

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2
Q

DDx for LUQ pain

A

Splenomegaly, splenic infarction, splenic rupture, PUD

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3
Q

DDx for epigastric pain

A

Pancreatitis, Gastritis, PUD
Reflux esophagitis
Cholecystitis
Pericarditis

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4
Q

DDx for LLQ Pain

A

Diverticulitis, Colon cancer, appendicitis, intestinal obstruction, IBD, ectopic, ovarian cyst, salpingitis, endometriousis, renal calculi

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5
Q

Referred pain: Right shoulder

A

Diaphragm, gallbladder, liver capsule

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6
Q

Referred pain: Right scapula

A

Gallbladder, biliary tree

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7
Q

Referred pain: Groin or genitalia

A

Kidney, ureter, aorta or iliac artery

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8
Q

Referred pain: Back-midline

A

Pancreas, duodenum, aorta

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9
Q

Referred pain: Left shoulder

A

Diaphragm, spleen, tail of pancreas, stomach, splenic flexure

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10
Q

Referred pain: Left scapula

A

Spleen, tail of pancreas

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11
Q

Clinical associations with acute pancreatitis

A 
Biliary tract stone disease
Ethanol
Trauma
Infection
HL, hyperparathyroid, drugs: Steroids, diuretics
Pregancy
Hyper
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12
Q

Ranson’s criteria for acute pancreatitis: Admission

A 
Age >55 years
WBC > 16,000
Glucose > 200 mg/dL
LDH >350 IU/L
SGOT (AST) > 250 IU/L
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13
Q

Signs of acute appendicitis?

A 
Fever, Guarding, rebound tenderness
Indirect tenderness (Rovsing's sign)
Psoas sign (95% specificity)
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14
Q

Symptoms of acute appendicitis

A 
RLQ pain (81% sensitive, 53% specific)
Nausea
Vomiting
Onset of pain before vomiting (100% Sensitive)
Anorexia (84% sensitive)
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15
Q

Mortality rate according to ranson’s criteria

A

3 - 28%
5 or 6 - 40%
7 or 8 - 100%

16
Q

Best way to assess patient’s pulmonary status and manage ventilation if labored breathing and pulse ox of 90%? What problems are you looking for?

A

Chest auscultation, ABG, CXR. Supplemental oxygen and pulse oximeter monitor. Problems: Pulmonary edema from overhydration, ARDS from pancreatitis, atelectasis, or PNA.

17
Q

Ranson’s criteria after 48 hours

A 
Hematocrit decrease = 10%
BUN increase 5 mg/dL
Ca2+ level < 60 mm Hg
Base deficit > 4 mEq/L
Fluid sequestration > 6 L
18
Q

Indications for surgery on psuedocyst

A

Fails to improve by 6 weeks.

19
Q

Mneumonic for DDx of acute abdominal Pain

A

‘BAD GUT PAIN’

B - Bowel obstruction (Large, Small)
A - Appendicitis, Adenitis (mesenteric), AAA leaking
D - Diverticulitis, Diabetic ketoacidosis
G - Gastroenteritis
Gall bladder disease/stones/
obstruction/infection
U - Urinary tract obstruction (stone)
infection (pyelo/cystitis)
T - Testicular Torsion
Toxin - Lead, black widow spider bite
P - Pneumonia/Pleurisy
Pancreatitis
Perforated bowel/ulcer
Porphyuria
A - Abdominal aneurysm
IN - Infarcted bowel
Infarcted myocardium (AMI)
Incarcerated hernia
Inflammatory bowel disease
S - Splenic rupture/infarction
Sickle cell pain crisis
sequestration crisis
20
Q

DDx acute abdomen including gynecological problems.

A

“ECTOPIC”

E - Ectopic (This is your priority rule out always)
Endometriosis
C - Cyst rupture (corpus leutium cyst rupture)
T - Torsion of ovary or cyst
O - Ovulation: Mittelschmerz
P - Pelvic Inflammatory Disease,
salpingitis, tubo - ovarian abscess
I - Incomplete abortion
C - Cystitis/pyelonephritis
21
Q

4 Main causes of an acute abdomen

A

Perforation
Obstruction
Inflammatory/Infection
Ischemia

22
Q

When is surgery the answer?

A

Peritonitis
Abdominal pain/tenderness + signs of sepsis
Acute intestinal ischemia
Pneumoperitoneum

23
Q

Diagnosis of obstruction?

A

CBC and lactate level
Supine and erict abdominal X-ray - look for dilated loops of bowel, absence of gas in rectum, bird’s beak sign of volvulus

24
Q

Management of SBO

A

NPO, NG suction, IVF
Gastrograffin contrast study until perforation has been ruled out
Volvulus: Perform proctosigmoidoscopy with rigid instrument. Leave rectal tube in place. Perform sigmoid resection for recurrent cases.
Abdominal hernias: Perform elective repair except umbilical in patients <2 and esophageal sliding hiatal hernia
All other obstructions: Emergency surgery

25
Q

Classic signs of appendicitis

A

Begins with ANOREXIA
vague PERIUMBILICAL pain -> Sharp, severe, constant RLQ pain
Tenderness, guarding, rebound found to right and below umbilicus

26
Q

How do you diagnose acute appendicitis?

A

Look for fever and leukocytosis in the 10,000-15,000 range with neutrophilia and immature forms
Ultrasound or CT if unclear history

27
Q

Management of acute appendicitis

A

Administer IV before appendectomy

If appendix is perforated, continue IV until fever and WBC count have normalized.

28
Q

How does acute pancreatitis present?

A

severe midepigastric abdominal pain and tenderness in an alcoholic or someone with gallstones

29
Q

Best initial test for pancreatitis?

A

Amylase and lipase (lipase higher specificity)

30
Q

Most accurate test for pancreatitis?

A

Abdominal CT - detect dilated common bile ducts and visualize intrahepatic ducts

31
Q

Diagnostic tests for pancreatitits?

A

Amylase, lipase, Abdominal CT
If dilation of CBD without a pancreatic head mass -> ERCP. Remove stones and dilate strictures

Trypsinogen activation peptide - urinary test to determine severity of pancreatitis. Pancreatitis arises from the premature activation of trypsinogen while it is still within the pancreas instead of when it reaches the duodenum.

32
Q

Treatment for Pancreatitis

A

No feeding
Hydration
Pain medications
Prophylactitic ABX for 6-8 weeks - carbapenem or cefuroxime if severe acute pancreatitis, large fluid collections or necrosis.

Low fat diet in chronic

33
Q

Purpose of ranson’s criteria

A

Operative criteria to see who needs pancreatic debridement. Replaced by CT scan

34
Q

Treatment for necrotic pancreatitis

A

CT shows > 30% necrosis of pancreas, patient should:
receive Abx such as imipenem and
undergo CT-guided biopsy

If biopsy shows infected, necrotic pancreatitis, patient should have surgical debridement of pancreas.

35
Q

Diverticulosis

A

condition in which diverticula are present in the intestine without signs of inflammation.
LLQ pain + GI Bleeding

36
Q

Diagnostic testing for diverticulosis

A

Colonsocopy is most accurate

Abdominal CT scan is best diagnostic

37
Q

Signs and symptoms of Diverticulitis

A

LLQ pain + Tenderness + Fever + Leukocytosis

38
Q

Treatment for Diverticulitis

A

Abx - combine gram negative such as quinolone or cephalosporin with an agent against anaerobes such as metronidazole.

Ciprofloxacin + Metronidazole is standard.

Surgery Core Topics (9 decks)

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