sxs of meckel’s diverticulum
asx, abd pain (SBO), GI bleeding
dx of meckel’s diverticulum
meckel’s scan
tx of meckel’s diverticulum
resection
most common of the rule of 2’s for meckel’s
2 yo at presentation
causes of diffuse abd pain
gastroenteritis, mesenteric ischemia, metabolic, malaria, bowel obstruction, peritonitis, IBS
what is mesenteric ischemia
decreased perfusion to section or/entire colon due to embolic, atherosclerotic, aortic surgery, or hypotension
risk factors for mesenteric ischemia
cardiac arrhythmias, advanced age, low CO states, valvular heart ds, MI, malignancy
sxs of mesenteric ischemia
severe acute midabdominal pain, post-prandial, possible hematochezia/diarrhea
PE of mesenteric ischemia
pain out of proportion to exam
pneumatosis intestinalis
air within the wall of the ascending bolon;sx not a dx; a/w ischemic bowel
tx of mesenteric ischemia
aggressive fluid resuscitation, NGT, foley cath, abx, anticoag, embolectomy or colon resection
sxs of appendicitis
abd pain, anorexia, N/V, dysuria
PE of appendicitis
mcburney’s point tender, guarding, rebound tenderness
rebound tenderness
done anywhere on the abd; pain when released
rovsing’s sign
done on the LLQ and pain when pressing in
pecial tests for appendicitis
rovsing’s, psoas, obturator, DRE pain on right side
dx of appendicitis
CT with contrast
signs of appendicitis on CT
enlargement with wall thickening, fat stranding, and fecalith
tx of appendicitis
periop abx, appendectomy
complications of appendicitis
perforated (most common), peritonitis, abscess
signs of perf append.
more diffuse pain after localized tenderness; pain may be relieved followed by peritonitis
signs of peritonitis from perforated appendix
high fever, localized or generalized pain
location of appendix during 5th month of pregnancy
level of the umbilicus
causes of LLQ pain
diverticulitis, salpingitis, ectopic pregnancy, inguinal hernia, nephrolithiasis, IBS, IBD
where is diverticulitis most prevalent
sigmoid colon
sxs of diverticulitis
LLQ pain, fever, anorexia, N +/- V
PE of diverticulitis
tenderness, guarding, distension, hypoactive/absent BS or hyperactive BS, +guaiac
labs of divertic.
leukocytosis with left shift
tx of divertic
oral abx->clear liquids->low residue diet->high fiber diet
surgery if repeated attacks, complications, or failure to improve with conserv. tx after 3-4d
colostomy
colon divided->proximal end brought through the abdominal wall
hartmann’s procedure
colostomy with distal end oversewn and placed in peritoneal cavity as blind limb
stoma
portion of the intesting outside the abd
loop colostomy
both proximal and distal end drain to the abd wall
proctocolectomy
removal of entire colon and rectum
adominoperineal resection
removal of lower sigmoid colon, entire rectum, and anus (very low rectal CAs)
low anterior resection
removal of distal sigmoid colon and 1/2 of rectum (CA of middle of upper sections of rectum)
diff between internal or external hemorrhoid
internal above dentate line, external below dentate line
most common cause of rectal bleeding
internal hemorrhoids
grade I hemorrhoid
palpable, nonprolapsed
grade II hemorrhoid
prolapse with straining and defecation
grade III hemorrhoid
protrude spontaneously or with straining, require manual reduction
grade IV hemorrhoid
chronically prolapsed and cannot be reduced
tx of grade II and grade III internal hemorrhoids
rubber band ligation
acute and chronic complication of infection of the anal glands
acute=abscess
chronic=fistula
causative organisms or anorectal abscesses
E. coli, proteus sp., strep., bacteriodes
tx of anorectal tx
surgical drainage, abx, wound care
presentation of rectal FB
anorectal/abd pain, blood per rectum, mucus d/c
complications of rectal FB
fistulas
dx of enteric fistula
imaging/endoscopy
tx of enteric fistula
fluid resus., bowel rest, nutritional support, op. tx
what is fistula in ano
abnl communication b/t anal canal and the perianal skin
dx of fistula in ano
goodsall’s rule, cord like tract on DRE, drainage or granulation seen on PE
tx of fistula in ano
drainage and curretage of fistula tract, placement of seton
impact of starvation in Ebb phase
immediate, tissue hypoperfusion, decrease metabolism, catecholamin release
impact of starvation in flow phase
catabolic and anabolic, increase CO, hypermetabolic, hyperglycemia
kcal and protein needed in “stressed” patients
50 kcal/kg/day and 2.5g protein/kg/day
