Gallbladder Disease, Diverticular Disease and Hernias - Ritesma Flashcards Preview

Adult/Ped Medicine 4 > Gallbladder Disease, Diverticular Disease and Hernias - Ritesma > Flashcards

Flashcards in Gallbladder Disease, Diverticular Disease and Hernias - Ritesma Deck (22):
1

Strangulated Hernia

not reducible

vascular supply compromised

surgical emergency

1

Hernia Causes

  • congenital defect
  • obesity
  • pregnancy
  • chronic cough
  • constipation
  • heavy lifting
  • family history

2

Reynolds Pentad

  1. Pain
  2. Fever/chills
  3. Jaundice
  4. Altered Mental Status
  5. Hypotension

2

Ventral and Umbilical Hernia

 

frontal wall of abdomen

secondary to tears or seperation of muscle

  • pregnancy
  • surgical incisions
  • congential weakness

TX:

  • attempt to reduce & assess for danger signs
  • surgical referral
  • hernia belt or binder
     

3

Diverticulitis

microperforation of the diverticula: inflammation & infection

SYMPTOMS:

  • lower abdominal pain
  • constipation or loose stools are common
  • nausea and vomiting
  • can be mild (microperforation) to severe (macroperforation - abscess)

PHYSICAL EXAM

  • low grade fever
  • LLQ tenderness and palpable mass
  • rectal exam - + occult blood
  • Lekocytosis
  • perforation would have more dramatic peritonal signs (Obturator, Psoas, Markle)

IMAGING TREATMENT

  • Abdominal CT - more severe symptoms or not responsive to antibiotics

TREATMENT

  • MILD: liquid diet & oral antibiotics
  • MODERATE: admit to hospital, NPO, IV fluids, IV ABX
  • SEVERE: surgery

COMPLICATIONS

  • fistula formation
  • bowel obstruction
  • abscess
  • perforation

3

Hernia

protrusion of intra-abdominal contents through a weakness or abnormal fascia opening in abdominal wall

4

Diverticulosis

presence of diverticula (pockets/puches) of intestinal mucosa and submucosa

PATHOPHYSIOLOGY:

  • sigmoid and descending colon
  • lack of fiber in the diet
  • patients with connective tissue disorders are predisposed

PHYSICAL EXAM:

  • often an incidental finding
  • LLQ discomfort on exam, thickened palpable sigmoid and descending colon

IMAGING: None

TREATMENT: high fiber diet

5

Epididymitis

STD: men

UTI and Prostatitis: older men; gram negative rods

pain in FLANK or ABDOMEN

urinary retention, urgency

nausea/vomiting, fever

EXAM: tender and swollen epididymis, scrotum inflamed, warm, and red

6

Cholecystitis

INFLAMMATION & DISTENSION of the GALLBLADDER

CAUSES:

  • obstruction
  • acalculus cholecystitis - due to biliary stasis from fasting, TPN, trauma
  • infection: CMV, cryptosporidosis, vsculitis

PATHOGENESIS

  • gallbladder inflammed, lysolecithin is released due to trauma to gallbladder wall

SYMPTOMS

  • RUQ pain may radiate to back or R shoulder
  • pain is constant and severe
  • nausea
  • vomiting
  • anorexia
  • fever

PHYSICAL

  • RUQ + guarding
  • + Murphy's sign
  • fever
  • tachycardia

LABS

  • complete blood count
  • metabolic panel
  • amylase (may be elevated), lipase

DIAGNOSTIC

  • ultrasound - can detect stones, thinckened wall and sonographic murphy's sign

TREATMENT

  • GI rest - NPO
  • IV pain medications, anti-emetics, hydration,
  • surgery?
  • IV antibiotics - 2nd or 3 rd generation

7

Reducible Hernia

can be manually of spontaneously repositioned into abdominal cavity

9

Charcot Triad

  1. Pain
  2. Fever/chills
  3. Jaundice

10

Testicular Torsion

MEDICAL EMERGENCY

acute, severe unilateral testicular pain

pain on palpation

most common 12-18 yo; left

11

Indirect Hernia

passes THROUGH inguinal ring

LATERAL TO EPIGASTRIC A.

occurs in younger males and females

12

Testicular Tumor

painless enlargment of testis

negative urinalysis

14

Cholelithiasis

GALLSTONES

classified according to chemical composition

RUQ episodic pain due to stones moving, no infection, inflammation or blockage; often eating fatty or fried foods

no fever, no elevated WBC/liver enzymes

EXAM

  • RUQ tneder to palpation
  • + Murphy's sign

LAB

  • CBC, LFT, chemisty, amylase, lipase - usually normal

IMAGING

  • ULTRASOUND gold standard
  • HIDA scan

TREATMENT

  • Pain medication
  • IV hydration
  • Elective laprascopic cholecystectomy

15

Direct Hernia

passes through abdominal wall

MEDIAL TO EPIGASTRIC A.

more common in older men; uncommon in females

16

Gallbladder Disease Prevalence

  • 9x greater prevalence in Native American women
  • 5.5% in men
  • 8.6% in women

Special Populations

  • family hx of gallbladder
  • cystic fibrosis patients
  • pancreatic disease
  • patients on TPN
  • male/female > 60

18

Risk for Gallbladder Disease (5 F's)

  • Female
  • Fat
  • Fair
  • Fertile
  • Forty

other risks:

  • estrogen/progesterone replacement tx
  • rapid weight loss
  • dyslipidemia
  • DM2/glucose intolerance/insulin resistance
  • medications

19

Incarcerated Hernia

cannot be reduced

can lead to bowel obstruction but no vascular compromise

20

Choledocholithiasis

Bile Duct Stones

Features:

  • hx of recurrent RUQ pain
  • chills and fever w/ pain episode
  • jaundice w/ pain episode

Charcot Triad

  1. Pain
  2. Fever/Chills
  3. Juandice

Reynolds Pentad - acute cholangitis - EMERGENCY

  1. Pain
  2. Fever/Chills
  3. Jaundice
  4. Altered Mental Status
  5. Hypotension

EXAM

  • hepatomegaly
  • tenderness of RUQ or epigastrium
  • charcot triad or tirad + lab evidence of inflamation, elevated liver enzymes or biliary dilation on imaging

TREATMENT:

  • surgery

21

Hydrocele

painless accumulation of fluid in the tunica vaginalis or along spermatic cord (bag of worms)

tx: aspiration (temporary), surgery

22

Murphy's Sign

when palpating at the edge of the gallbladder fossa just beneath the liver edge, ask patient to inspire deeply

+ patient stops inspiration or has increased pain