surgical abdomen Flashcards by Lux Smith

Sudden/rapid onset and escalation

Vascular -

hemorrhage, ischemia

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Sudden/rapid onset and escalation

Perforation

hollow viscous, ulcer/tumor erosion

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meds that matter with a surgical abdomen

Steroids
coumadin

NSAID’s
Pepto Bismal
anticholenergics
CAM
 current/recent antibiotics

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Sudden/rapid onset and escalation

Vascular - hemorrhage, ischemia
Perforation - hollow viscous, ulcer/tumor erosion
Rupture - appy, ectopic pregnancy, ovarian etiology
Obstruction - bowel, gallbladder, ureter
Trauma

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PMH you want to consider in a surgical abdomen

GI, DM, atherosclerosis, cardiac, renal, CA, Sickle Cell, HIV

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Elderly - pain out of proportion to exam

Think mesenteric ischemia

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Stimulants w/ abdominal pain (stimulants are vasoconstrictors)

Think mesenteric ischemia

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Abd pain, hypotension, tachy, pale, syncope

think

hemorrhagic 
AAA
Massive GI bleeds
hemorrhagic pancreatitis
eroding tumors
massive bleeding in pregnancy

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Testicular torsion

Testicle pain, abd/flank pain (referred)
Doppler ULS

refer to a urologist

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ddx for all female pelvic pain

i. In DDx for all female pelvic pain
ii. +/- Ovarian cyst hx
iii. Formal ULS for flow, upreg

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Ischemic colitis - General Surgeon

Hx Crohn’s, ulcerative colitis

ii. Fever, WBC’s/lactate up, +/- peritoneal; CT for dx

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incarcerated vs strangulate

Can’t reduce incarcerated

skin over the hernia is hot, red, and hurts to the touch, fever; WBC’s, lactate up

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Mesenteric ischemia

can be

SMA or IMA

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mesenteric ischemia presentation

Pain out of proportion to exam – severe tenderness but soft abd, non-peritoneal
N/V/D, bloody BM, hx pain after eating

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labs seen with mesenteric ischemia

Metabolic acidosis, high WBC’s, lactic acid, amylase; hypotension, tachycardia

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dx mesenteric ischemia

CT angiography for dx

IV fluids, antibiotics, surgical consult
Time to surgery predictor of survival

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different presentation with elderly

Mesenteric Ischemia
AAA
Appendicitis
Acute Cholecystitis
Perforated Peptic Ulcer

20-40% of elderly w/ abdominal pain will require surgery!

> 60yo + Abd Pain = High Risk patient

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Small Bowel Obstruction

Intermittent, crampy, periumbilical
Rapid, not sudden onset - hours

Distention, diffusely tender, “tinkling” bowel sounds

Dehydration, low grade temp, tachy/tachy, +/- hypotension

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Intermittent, crampy, periumbilical
Rapid, not sudden onset - hours

first orders and second orders

IV fluids, pain control, antiemetic, belly labs, lactic acid, EKG, CXR-KUB

Dehydration, low grade temp, tachy/tachy, +/- hypotension

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Bowel Obstruction

functional

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Ileus - adynamic/paralytic; bowel stops functioning due to infection, irritation, inflammation –>
Search for the cause and fix it
Distention both large/small bowel
“Sentinal Loop” can be seen in both

Mechanical

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Obstruction, compression, rotation

Usually needs surgical intervention

sentinal loops

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is a sign seen on a radiograph that indicates localized ileus from nearby inflammation.

functional;

MCC of LBO

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Labs that would indicate necrosis in a pt owth LBO

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Fever, toxic, WBC’s or high lactate = worrisome for necrosis

Ogilvie’s Syndrome)

Distended large bowel but not obstructed Think tricyclics, anticholenergic agents in old people

Elderly, bedridden, psych, anticholinergics Same presentation as LBO Elderly, bedridden, psych, anticholinergics Same presentation as LBO think

volvulus

MC site of a volvulus

Sigmoid (most common) cecal CT AP IV contrast for dx and for location Antibiotics, surgical consult

Pneumoperitoneum

Perforated viscous: air, bowel contents escape – air rises, see it under diaphragm Rapid onset, constant, epigastric then generalized pain Vomiting; fever 50%; tachy/tachy

RF for pneumoperitoneum

Hx PUD/gastritis, NSAIDS, steroids. CXR negative in 50%! Get CT

51yo male, epigastric pain

WBC 17k, | Lactate 3.0

Cholecystitis labs seen with

LFT’s: AST 95 (nl ~5-35), ALT 112 (nl ~10-40), Alk Phos 180 (nl ~40-140), T.Bili 2.2 (nl ~0.3-2.0)

charcots triad what is it and what is it for

RUQ pain, fever, jaundice Plus - shock, altered mental status reynolds cholangitis

unlikely alvardo

5 unlikely

possible alverado

5-6 possible

probably appy alvarado

7-8 prob,

probably alvarado

>9 very prob

how would retrocecal appy present

(flank/genital pain),

pelvic appy sxs

(rectal/pelvic pain: less abd pain

psitive psoas, obturator, rebound, Rovsings seen when

9. Positive psoas, obturator, rebound, Rovsings | a. ONLY if peritoneal irritation – late signs, usually perf’ed

presentations of appy in elderly

No RLQ pain in 25%, no migration of pain in 50% UTI, kidney stone, AGE all common misdiagnoses

story of TOA

a. Late progression/complication of PID b. Low abd pain, n/v, fever, +CMT c. Hypotensive? Sepsis if ruptures

TOA workup

Endovaginal US first, then CT for extent

Sudden unilateral pain, n/v, usually afebrile

d. Endovaginal US w/ doppler for flow, cysts e. Gyn consult, admit 12-24 hr

Sudden unilateral pain, +/- n/v

Transabd US for fluid, endovag US for DDx

MCC of 1st trimester bleeding

Pregnancy MAY progress or ABORTION MAY follow **MC of 1st Trimester BLEEDING NO POC expelled from Uterus closed

threatened picture

5wks - gestational sac with fetal cardiac activity Supportive: Rest @ HOME Return to ER if SX. Persist of PASAGE of POC. *Serial B-hCG to se if Doubling

* Os closed * +/- abd pain, no passage of POC’s * No fetal cardiac activity on EVUS

Missed abortion (fetal death <20wks)

Septic abortion

• EVUS: thickened, irregular endometrium, no clear sac * Os open or closed * Abd pain, fever, + CMT, foul smelling d/c, may be peritoneal

what do you do for a packer.

Go-Lytely (they will poop it all out) if stable, not obstructed Plain KUB, CT if need surgery to remove

surgical abdomen Flashcards

(49 cards)