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Flashcards in [CLMD] Abdominal Emergencies Deck (42)
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1

What is the progression of pain in an appendicitis?

Visceral pain which may migrate or become localized in the RLQ (McBurney's point) and ends in somatic pain in the RLQ.

2

What are 5 diagnostics for a workup if an acute appendicitis is suspected?

CBC (usually elevated, but can be OK)

Chemistry panel (electrolytes and LFTs)

UA (usually OK, but can be abnormal)

Pregnancy test

Imaging

3

What imaging should be done for adults, kids, and pregnant women in an acute appendicitis?

Adults: CT abdomen and pelvis w/ oral contrast

Kids: US of RLQ first, and if negative try CT

Pregnancy: MRI

4

Initial therapy for acute appendicitis may include... (5)

And the ultimate treatment is...

NPO
IV fluids
Anti-emetic
Pain meds
Possibly pre-op antibiotics

Surgery

5

Early appendicitis may mimic...

Gastroenteritis or viral illness

6

80-90% of ingested foreign bodies will...

How many need surgical intervention?

Pass without the need for intervention

<1% require surgical intervention

7

Most common ingested foreign body in kids vs. adults:

Kids - coins

Adults - food bolus

8

Most common site of obstruction in the GI tract:

Esophagus

9

Drooling and inability to swallow liquids indicative are indicative of...

What should be done?

Esophageal obstruction

Stat EGD (don't get imaging first - begin with this)

10

Approach and management of ingested foreign bodies depends on: (3)

Presence/severity of symptoms

Type of object (size, shape, content)

Location

11

Under what 3 circumstances would you get an emergent endoscopy within 6 hours after ingestion of foreign bodies in the esophagus?

Complete obstruction as evidenced by drooling and an inability to handle oral secretions

Disk batteries

Sharp-pointed objects in the esophagus

12

All foreign bodies in the esophagus require removal within how much time?

24 hrs

13

How long will it take for foreign bodies to be passed if they are in the stomach or proximal duodenum?

What is the management in the meantime?

Should you ever do an EGD?

4-6 days

Weekly XRs until the object passes
Resume normal diet and monitor stools

Still, if the object is deemed to be more dangerous, an endoscopy can be done if not passed within 24 hrs.

14

What is the management of ingested foreign bodies distal to the ligament of Treitz?

When might you want to use some kind of intervention?

Expectant management - weekly imaging and stool monitoring

If these is evidence of inflammation or obstruction (fever, abdominal pain or vomiting)

15

What is the most common type of hernia?

Of them, which sub-type is most common?

75% are inguinal hernias

2/3 are indirect
1/3 are direct

16

What are the 3 ways hernias are classified?

Anatomic location - ventral, groin

Hernia contents - usually bowel or fat

Status of its content - reducible, incarceration, strangulated

17

2 most common ventral hernias

Epigastric and Umbilical

18

Direct vs. indirect inguinal hernias

Direct: passes directly through a weakness in the transversalis fascia in Hesselbach triangle

Indirect: passes from the internal to the external inguinal ring and through a patent process vaginalis and then into the scrotum

19

Reducible hernia =

Incarcerated hernia =

Strangulated hernia =

Reducible hernia = herniated sac is soft and easy to push back through the defect

Incarcerated hernia = herniated sac is firm, often painful, and non-reproducible by direct manual pressure with NO signs of systemic illness

Strangulated hernia = herniated sac is firm and very painful, usually with signs of systemic illness (fever, N/V) and implies an impairment of blood flow

20

Which hernia is an acute surgical emergency?

Strangulated hernia

21

What should be assumed, in terms of treatment, in a patient with a hernia?

Assume a strangulated hernia:
-surgery consult
-broad-spectrum abx.
-fluids and pain meds
-pre-op labs

22

If a hernia is incarcerated, what is the treatment?

Attempt to reduce, and if unsuccessful, consult surgery

23

If a hernia is reducible, what is the treatment?

Outpatient surgery follow-up

24

Age population of patients with AAA

Disease of older patients: almost always >60 y/o

25

At what size is an AAA diagnosed?

What is the most common location?

When the aorta becomes >3 cm (2 cm normally)

Below renal aa.

26

Most AAAs are..

Asymptomatic and found incidentally

27

What are the symptoms (classic triad) of a patient with a symptomatic and ruptured AAA?

Patient looks poor and have a high morbidity/mortality

Triad - Abdominal/flank pain, hypotension, shock

28

How often is AAA misdiagnosed?

What is it mistaken for?

30% of the time

Renal colic, perforated viscus, diverticulitis, GI bleed, ischemic bowel

29

Describe the diagnostic testing for:

Screening AAA

Asymptomatic AAA

Symptomatic (stable vs. unstable) AAA

Screening AAA: one time for at risk patients over 65 with US

Asymptomatic AAA: if known AAA, 6 mo. or annual US or CT abdomen/pelvis

Symptomatic AAA: CT abdomen/pelvis w/ IV contrast (stable); OR w/o imaging (unstable)

30

What sized AAA suggests a good surgical candidate?

>5.5 cm