acute care surgery and general surgery

Question 1

describe how visceral pain usually presents

Answer 1

• dull, achy
• poorly localized

Question 2

describe how parietal pain usually presents

Answer 2

• sharp
• well-localized
• ex: peritoneal irritation

Question 3

describe how referred pain usually presents

Answer 3

• aching
• percieved near surface of body

Question 4

sites of pain (inc referred) for gallbladder

Answer 4

• RUQ
• right mid back
• right shoulder

Question 5

sites of pain (inc referred) for pancreas

Answer 5

• mid epigastric pain
• mid back pain

Question 6

clinical presentation

• anorexia
• abd pain
• bloating
• N/V
• obstipation
• high pitched or absent bowel sounds
• tympany on percussion

Answer 6

• obstruction

Question 7

extrinsic causes of small bowel obstruction

Answer 7

• adhesions
• hernia
• volvulus

Question 8

clinical presentation

• patients lie still
• rebound tenderness, tenderness to percussion
• pain with light palpation
• diminished bowel sounds

Answer 8

peritonitis

Question 9

what imaging should you get if you suspect bowel obstruction

Answer 9

• abd plain films: dilated bowel loops, free air
• CT without oral contrast: provides better information

Question 10

what imaging should you get if you suspect peritonitis

Answer 10

• US
• CT

Question 11

what is a positive murphys sign

Answer 11

• performed by asking pt to breathe out and then placing the hand below the costal margin on the right side at the mid-clavicular line.
• The patient is then instructed to breathe in.
• If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner’s fingers) and winces with a ‘catch’ in breath, the test is considered positive

Question 12

when should cholecystectomy be performed once acute cholecystitis is diagnosed

Answer 12

• within 3 days of symptom onset
• high risk pt (DM, chronic steroid use) need immediate operative tx

Question 13

non-operative management of acute cholecystitis

Answer 13

• IV fluid
• Abx (1st or 2nd generation cephalosporin)
• lack of improvement within 1-2 days -> operative intervention

Question 14

what structures make up the triangle of calot

Answer 14

• cystic artery
• cystic duct
• common bile duct

Question 15

what is the most common cause of choledocholithiasis

Answer 15

• secondary
  
  • stones formed in gallbladder and get stuck in common bile duct

Question 16

treatment of choledocholithiasis

Answer 16

• ERCP

Question 17

what is cholangitis

Answer 17

• ascending bacterial infection -> medical emergency
• due to obstruction of the biliary ducts

Question 18

what is the most common cause of cholangitis

Answer 18

choledocholithiasis

Question 19

what is charcot’s triad and what condition is it associated with

Answer 19

• cholangitis
  
  • fever
  • RUQ pain
  • jaundice

Question 20

what is Reynold’s pentad and what condition is it associated with

Answer 20

• cholangitis
  
  • fever
  • RUQ
  • jaundice
  • hypotension
  • altered mental status

Question 21

clinical presentation

• acute upper abd pain radiating to the back
• N/V
• pain relieved with sitting or leaning forward
• amylase, lipase elevated

Answer 21

pancreatitis

Question 22

grey-turner sign

Answer 22

• refers to bruising of the flanks
  
  • retroperitoneal hemorrhage seen with acute pancreatitis

Question 23

culen’s sign

Answer 23

• bruising in the subcutaneous fatty tissue around the umbilicus
  
  • observed with acute pancreatitis

Question 24

management of pancreatitis

Answer 24

• ICU
• NPO
• IV fluids
• pain management

Question 25

what is a pancreatic pseudocyst

Answer 25

• collection of pancreatic fluid within wall of inflammatory tissue
  
  • no epithelial lining
  • seen in 1/3 pts with chronic pancreatitis

Question 26

treatment of pacnreatic pseudocyst

Answer 26

• resolve spontaneously (50%)
• percutaneous drainage (after 6 weeks)

Question 27

most common type of gastric cancer

Answer 27

adenocarcinoma

Question 28

splenic abscess typically results from

Answer 28

• endocarditis
• or seeding from other infection site

Question 29

classic symptoms of splenic abscess

Answer 29

• fever​
• LUQ pain
• +/- splenomegaly

Question 30

typical symptom of splenic infarct

Answer 30

• acute LUQ pain
• without fever

Question 31

what vaccine should a patient with splenectomy be given

Answer 31

• pneumococcal

Question 32

define dehiscence

Answer 32

• partial or total disruption of any or all layers of the operative wound

Question 33

define evisceration

Answer 33

• rupture of all layers and extrusion of abdominal viscera

Question 34

when is dehiscence most common

Answer 34

• between 5th and 8th day post-op

Question 35

what medication should be avoided in initial management of an acute abd pain in the ER

Answer 35

• NSAIDs

Question 36

pain before vomiting typically associated with

Answer 36

• surgical abdomen