Surgery Flashcards
(51 cards)
What chronic disease can mimic acute appendicitis?
IBD - Crohns
How to w/u appendicitis?
CBC, CMP, KUB, CXR (look for fecalith), UA
US for kids and women
CT scan if unsure
clinical dx in 80% of cases
How to manage acute appendicitis?
NPO, prophylactic IV abx (24 hrs)*CTX, appendectomy
*continue abx if concerns that arise in surgery
What are complications and tx of them for Appendicitis?
wound infection -abx
intra-abdominal abscess - dx with CT, do CT guided drainage or open drainage
enterocutaneous fistula - might need right ehmicolectomy
small bowel obstruction
Ddx of abd distention, vomiting, and not passing gas?
large bowel obstruction d/t cancer/mass
diverticulitis
pseudo obstruction (functional obstruction - anticholinergic effect of meds)
sigmoid volvulus
What are the most common causes of small bowel obstruction?
- adhesions!
- hernia
- tumors
How to treat large bowel obstruction?
inpt
NPO
IV hydration
manage electrolyte disturbances with repletion
NG tube if bowel is dilated
gastrograffin or barium enema, colonoscopy and emergent ex lap
How to dx colon cancer?
bowel prep with golytely and abx (oral and IV)
must have colonoscopy and biopsy - entire colon must be evaluated
stage with CXR and CT scan
What does a barium enema show when colon cancer is present?
“apple core lesion”
How do you treat pseudo-obstruction?
correct electrolytes, stop anticholinergic meds
colonoscopy can be dx and tx
How to dx and tx colonic volvulus?
dx with ct scan
dx/tx with colonoscopy or contrast enema
surgery only for recurrent or nonviable bowel (acute abdomen)
How to dx/tx diverticulitis?
CT scan
IV abx, IV fluids, bowel rest
if acute abdomen - surgical emergent laparotomy
barium enema or colonoscopy *not in acute stage d/t risk for perforation to make sure not colon cancer!
Initial w/u of suspected small bowel obstruction?
CBC, CMP, LFTs, amylase/lipase
KUB
How to tx small bowel obstruction?
NG tube to decompress
IV fluids
foley catheter
serial abdominal exams and xrays
bowel rest
monitor and replete electrolytes
*if turns to complete obstruction (no flatus or gas in rectum, no bowel movement for 12 hrs, peritonitis) -emergent surgery!
What is the difference between ilues and obstruction?
ileus doesn’t have pain like an obstruction
How to work up and treat concern for an acute arterial embolus in an extremity?
start hepain
angiogram - to dx
surgical embolectomy to remove the clot
*if compartment syndrome - fasciotomy
How do you work up and tx cholecystitis?
RUQ U/S
HIDA scan if US doesn’t dx the cholecystitis
NPO
IV abx
cholecystecomy if symptoms worsen or do not improve in 24-72 hours with abx
*if symptoms improve acutely, f/u with elective cholecystectomy in 6-8 wks
What is long term counseling for a pt without a gall bladder?
avoid large meals amounts of fatty food!
What abdominal dx has the hallmark sign of pain out of proportion to exam?
mesenteric ischemia
What do labs show in mesenteric ischemia?
lactic acidosis - ph acidic
guaiac pos stool
no other significant findsing than pain
hx of a fib
How to tx mesenteric ischemia?
can do supportive treatment with IV NS and anticoagulation with heparin if pt doing ok
otherwise. ..
1. mesenteric angiography
2. surgical exploration for embolectomy and possible bowel resection if peritonitic
What are the 2 most common causes of pancreatitis?
alcohol or gallstones
How to work up and tx testicular torsion?
*clinical - go straight to surgery
if unsure…
doppler US of testicle for blood flow
order KUB to look for signs of incarcerated hernia
tx: emergent surgery to detorse with bilateral orchiopexy (goal within 4 hrs)
How to evaluate and tx stab to abdomen?
CBC, type and cross, floey catheter placement (look for blood), KUB and CXR)
- abdominal CT scan with IV contrast (looking for free air or fluid)
If penetrates fascia (into peritoneum) - surgical exploration
If does not penetrate - close the wound
IF SIGNS OF SHOCK GO STRAIGHT TO OR
