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Gastrointestinal II Exam 2 > GI Trauma and Emergencies > Flashcards

GI Trauma and Emergencies Flashcards

(55 cards)

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1
Q

What is the H/P for acute appendicitis?

A

visceral periumbilical pain evolving to somatic RLQ pain

fever, n/v

McBurney’s point tenderness

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2
Q

What are the diagnostic tests for acute appendicitis?

A

CBC (elevated WBC), chem panel, UA, pregnancy test

CT abd/pelvis with IV and oral contrast in adults

US and/or CT scan in kids

MRI in pregnant women

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3
Q

Treatment for appendicitis?

A

NPO, IVF, Antiemetic and pain control, pre-op abx

Surgery

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4
Q

What percentage of foreign body ingestions occur in children?

A

80%

<1% need surgical intervention

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5
Q

what percentage of foreign object ingestions pass without the need for intervention?

A

80-90%

<1% require surgery

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6
Q

What FB objects do children tend to ingest?

What FB objects tend to occur in adults?

A

coins, button batteries, toys, magnets, etc.

food bolus (meat, bones, pills)

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7
Q

Where is the most frequent site of obstruction in the GI tract?

A

esophagus (points of pathological or physiological narrowing)

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8
Q

What are some physiologic narrowings of the esophagus?

A

upper esophageal sphincter

level of aortic arch

diaphragmatic hiatus

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9
Q

What esophageal pathologies can increase risk for food bolus impaction?

A

diverticula

webs

rings

strictures

achalasia

tumors

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10
Q

What percentage of individuals with esophageal food impactions have underlying eosinophilic esophagitis?

A

50%

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11
Q

what are the s/s of ingestd foreign body?

A

may be asymptomatic

drooling, unable to swallow (requires emergent endoscopy)

fever, abd pain, vomiting (further work up needed)

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12
Q

If there are s/s of esophageal obstruction (drooling, not handling secretions), what imaging study do you order?

A

Emergent EGD

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13
Q

Treatment for FB ingestion varies based on what?

What indications need emergent care by ENT or GI?

A

presence and severity of sx

type of object ingested

location of object

signs of airway compromise (choking, stridor, etc)

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14
Q

Wha types of esophageal FB injestions need emergent endoscopy (within 6hrs)

A

complete obstruction

disk batteries

sharp-pointed objects

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15
Q

What FB injestions require urgent endoscopy (within 24hrs)

A

all foreign bodies in esophagus

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16
Q

How long does it take for FBs in the stomach or proximal duodenum to pass?

A

4-6 days

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17
Q

urgent endoscopy for FB in stomach or prox. duodenum is indicated for what objects?

A

sharp objects

longer than 5cm

magnets

blunt objects over 2cm in diameter

disk and cylindrical batteries

lead

everything else is expectant management

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18
Q

What is the management of FB objects distal to Lig. of Treitz?

A

expectant mangement

surgery or endoscopy if signs of inflammation or obstruction

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19
Q

What percentage of hernias are inguinal hernias?

of that, how many are indirect?

A

75%

2/3

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20
Q

Where are ventral hernias mostly located?

A

epigastric and umbilical

spigelian, incisional, parastomal

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21
Q

Where are groin hernias typically located?

A

inguinal (direct and indirect)

femoral, obturator

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22
Q

What are the most common ventral hernia locations?

A

epigastric and umbilical hernias

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23
Q

Where do indirect inguinal hernias pass through?

Study These Flashcards
A

pass from the internal to the external inguinal ring through the patent process vaginalis and then scrotum

24
Q

Where do direct inguinal hernias pass through?

Study These Flashcards
A

passes directly through the weakness in the transveralis fascia in the Hesselbach triangle

25
What is a reducible hernia?
hernia sac itself is soft and easy to repalce back through the hernia neck defect
26
What is an incarcerated hernia?
hernia sac is ferm, often painful, nonreducible by direct manual pressure no signs of systemic illness
27
What is a strangulated hernia?
hernia sac is firm and very painful systemic illness present implies impaired blood flow
28
Which type of hernia is an acute surgical emergency?
strangulated hernia
29
What is the protocol for a strangulated hernia?
exquisite tenderness with toxic s/s consult gen surg IV abx (broad spectrum) IVF and narcotics pre-op labs
30
At what size is a AAA diagnosed?
AAA is diagnsoed when the aortic diameter exceeds 3.0cm
31
Most AAAs are asymptomatic, but symptoms of unruptured AAA can include:
Abd pain, flank pain, limb ischemia, fever, malaise
32
What is the classic triad for ruptured AAA?
**Abd and/or flank pain** **hypotension** **shock**
33
What are the risks of AAA?
Old, white, smoker male with fmhx and hx of vascular disease MOSTLY ASYMPTOMATIC
34
AAA is misdiagnosed how often? What is it often mistaken for?
30% renal colic, perforated viscus, diverticulitis, GI hemorrhage, ischemic bowel
35
For a symptomatic AAA that is stable, what is the testing? For unstable symptomatic AAA, what is the testing?
CT abd/pelvis with IV contrast If known hx, go to OR without imaging if unknown or suspected hx, CT abd/pelvis with IV contrast
36
Screen for AAA when? Monitor AAA how?
one time for risky patients over 65 with US if known AAA, monitor every 6 months or annually with US or CT abd/pelvis
37
What is blunt trauma?
direct blow causing rupture of hallow organs and bleeding can be from deceleration causing sheering injuries
38
What is penetrating trauma?
GSW, stab, lac, etc GSW can cause kinetic energy transfer to viscera, worsening damage
39
What is explosive trauma?
blunt/penetrating/lung and hollow viscus injury inhalation injury
40
What are the most commonly injured abdominal organs from blunt trauma?
spleen and liver
41
What sort of hx do you need for MVC?
restrained? intoxicated? location in vehicle? airbags? LOC? ejection? roll over? fatality at scene?
42
What hx do you want for penetrating injury?
time? type of injury? number of penetrations
43
What hx do you want for an explosive trauma?
enclosed space? distance from detonation? combo of injury types? inhalation?
44
What are the ABCDEs for trauma care?
A-airway maintance by C spine control B-breathing and ventilation C-circulation with hemorrhage control D-disability and neuro status E-Exposure/environmental control
45
Besides normal IAPP for the abdomen during PE for trauma, what else should be assessed?
pelvic stability urethral meatus, perinala, rectal and vaginal vaults
46
When to suspect diaphragm injuries?
after MVC or blunt trauma to thoracoabdominal region most often on left
47
When to suspect duodenal injuries?
unrestrained driver in MVC bicycle handlebar injury order CT abd/pelvis with IV and oral contrast
48
When to suspect pancreatic injuries?
direct blow to pancreas that compresses it to vertebral column watch amylase/lipase trends CT abd/pelvis with IV and oral contrast
49
When to suspect GU injuries? What is a clue that there might be anterior pelvic injuries present?
direct blow to back or flank gross or microscopic hematuria CT abd/pelvis with IV contrast urethral dusruption
50
When to suspect hollow viscus injuries?
sudden decel. injury from MVC Chance fractures early US and CT may not ID these injuries
51
If liver/spleen lac and pt is hemodynamically stable, what is management? if unstable, what is management?
close observation by gen surg in hospital if unstable, surgery
52
When to suspect pelvic fracture and assx injury?
MVC, auto v. pedestrian, fall from heights **Hypotension and pelvic fx have high mortality rate** can have venous plexus damage or internal iliac artery damage
53
What is the main diagnostic studies for trauma in general?
CBC, chem, UA, pregnancy test, Pt/PTT/INR, type and screen C spine, CXR, AP pelvis Xrays FAST scan CT abd/pelvis wiht IV contrast **DO NOT DELAY TRANSFER** in order to obtain labs/images, if they need to be transfered, just send them.
54
Blunt abdominal trauma with hypotension with a positive fast scan or clinical evicence of intraperitoneal bleeding gets sent where?
to surgery for a laparotomy
55
What is the purpose of a FAST scan?
detect free intraperitoneal fluid, pericardial fluid, pleural fluid, hemothorax, pneumothorax in trauma patients can check heart with subxiphoid view Morrison's pouch for kidney/liver perisplenic view retrovesicular view (pelvis)

Gastrointestinal II Exam 2 (10 decks)

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