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Flashcards in GI Surg Condition Deck (51):
1

Diverticular disease- Eti

DiverticuliItis- acute illness due to points of weakness in near blood supply
Free perforation- infection into peritoneal cavity, may abscess
95% in sigmoid colon sue to increased pressure

2

Diverticular disease- Sx

- LLQ pain
- Constipation
- Bloating
- Subjective fever
- Tachy, abd tenderness, leukocytosis
- Maroon or bright red hematochezia in > 50

3

Diverticular disease- Dx

CT scan

4

Diverticular disease- Tx

- Mild- abx
- Elective colonoscopy after 4-6 weeks
- Operation- Free perforation (sigmoid resection) or abscess (percutaneous drainage)

5

Appendicitis- Eti

- Blockage in lining of appendix leading to infection

6

Appendicitis- Sx

- RLQ tenderness with guarding
- Malaise followed by periumbilical pain, localizes to RLQ followed by fever
- McBurney point
- Anorexia, nausea, vomiting

7

Appendicitis- Dx

- US or CT scan

8

Appendicitis- Tx

- Operation to remove
- Abx- Cephalosporin

9

Cholecystitis/ cholelithiasis- Eti

- cholithiasis- having a gall stone
- Cholecystitis- stuck, bile can't get out

10

Cholecystitis/ cholelithiasis- Sx

- Epigastric pain to RUQ radiating to back and shoulder
- Exacerbated by fatty foods
- Abrupt onset of pain, cessation over mins to hrs
- Bloating and flatulence
- Murphy sign

11

Cholecystitis/ cholelithiasis- Dx

Ultrasound

12

Cholecystitis/ cholelithiasis-Tx

- Laparoscopic cholecystectomy if symptomatic
- Abx
Choledocholitiasis- ERCP

13

Hernia- Eti

- Abnormal protrusion of an organ through abd cavity
- Can be reducible, incarcerated or strangulated (loss of blood supply)
- Higher risk in men
- Right side more common
- Femoral more common in women

14

Hernia- Sx

- Bulge, pain of ache
- Protrusion in canal on exam

15

Hernia-Tx

- Reduce the sac and repair the defect
- Can watch and wait but doesn't get better on own

16

Hernia- Dx

- Diagnostic tests unnecessary
- Clinical exam

17

Ruptured spleen- Eti

- Direct blow or trauma to abd
- Mono, AIDS, malaria, leukemia, sickle cell

18

Ruptured spleen- Sx

- Pain and tenderness radiating to left neck or shoulder (Kehr's sign)
- LUQ at 9th-10th rib
- Shock, falling hematocrit

19

Ruptured spleen- Dx

- Ultrasound- multi view
- CT in stable pts

20

Ruptured spleen- Tx

Emergent splenectomy

21

Perforated bowel- Eti

Appedicitis, diverticulits
- Blunt trauma
- ASA or NSAID OD

22

Perforated bowel- Sx

- Sudden explosive onset of severe mid to lower abd pain
- Shock
- Rigid, tender abd

23

Perforated bowel- Dx

- Abd XR

24

Perforated bowel- Tx

- Crystalloid fluids
- Abx
- Remove infected material
- Repair

25

Peritonitis- Eti

Perforation of abd wall
- D/t trauma, diverticulits, pancreatitis

26

Peritonitis- Sx

- Abrupt pain, distension, fever
- Diminished bowel sounds
- Rebound tenderness

27

Peritonitis- Dx

Examine fluid- bacteria, lactic acid

28

Peritonitis- Tx

- Exploration, debridement and drainage
- Abx x 14 days

29

Bowel obstruction- Sx

- Constipation or obstipation
- Distention and tenderness
- Abd pain
- N/V

30

Bowel obstruction- Dx

- CT with contrast

31

Bowel obstruction- Tx

- Resection and decompression

32

Colon CA- Eti

- Screen at age 50 q 10 yrs
- Yearly fecal occult
- Adenocarcinoma most common

33

Colon CA- Sx

- Blood in feces
- Weakness and anemia
- Change in bowel habits
- Dyspepsia

34

Colon CA- Dx

- Colonoscopy and biopsy of polyps

35

Colon CA- Tx

- Resection of lesion and lymph
- CEA levels pre and post op
- Colonoscopy at 6 mo, 12 mo, 3 yrs, 5 yrs

36

Volvulus- Eti

- Rotation of bowel loops around fixed point
- Ischemia, gangrene
- Sigmoid most common

37

Volvulus- Sx

- Colicky abd pain
- Spasms
- Distension, tympany
- High pitched bowel sounds

38

Volvulus- Dx

- XR: loss of haustra, kidney bean appearance
- Bird beak sign, loop distension

39

Volvulus- Tx

- Decompression with sigmoidoscopy
- Fluid resuscitation

40

Umbilical hernia- Eti

- W>M

41

Umbilical hernia- Sx

- Increased size
- Sharp pain with coughing or sneezing

42

Umbilical hernia- Dx

Clinical

43

Umbilical hernia- Tx

- Repair to avoid incarceration
- Mesh

44

Inguinal hernia- Eti

- M>W
- Indirect > direct

45

Inguinal hernia- Sx

- Bulge and pain in inguinal canal
- Aching

46

Femoral hernia- Eti

- Prone to incarceration/ strangulation
- W>M
- Descend through femoral canal beneath inguinal ligament
- Difficult to reduce

47

Femoral hernia- Sx

- Asymptomatic until incarcerated
- Small bulge in medial thigh
- Colicky abd pain

48

Femoral hernia- Tx

- Open laparoscopy

49

Incisional hernia- Eti

- Complication of laparotomy
- COPD, steroids, wt, smoking

50

Incisional hernia- Sx

- Bulging, pain, ache at incision site
- Protrusion and obstruction at surgical site

51

Incisional hernia- Tx

- Recurrence is common
- Mesh repair