Term
| T/F: The vagus nerves (parasympathetic) transmits of visceral pain, although 10% of the fibers are efferent. |
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Definition
| F: The vagus nerves (parasympathetic) do not transmit visceral pain, although 90% of the fibers are afferent. |
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Term
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Definition
No visceral pain fibers.
Visceral nerves transmit distention, traction on mesentery and ischemia.
The brain interprets these inputs (sometimes) as painful. |
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Term
| T/F: The visceral peritoneum and omentum have pain transmission fibers |
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Definition
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Term
| How is somatic pain transmitted? |
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Definition
Conducted by myelinated fibers beneath the mesothelium of the somatic peritoneum.
Dermatomally organized.
Unilateral in projection to CNS. |
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Term
| px has rebound tenderness...what is it and what does she have? |
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Definition
| Rbd tenderness – peritonitis – you push in your hand hard to make it hurt, then pull it back to make it hurt more. – b/c you scrape across a hurt organ. You can alternatively just percuss or have the patient themselves do this. |
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Term
McBurney’s Sign
Rovsing’s Sign
Iliopsoas Sign
Obturator Sign |
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Definition
First described the point on an imaginary line, 1/3 of the distance from the right ASIS to the umbilicus, as the position of maximal tenderness and rigidity in appendicitis
Rovsing's: palpation of LLQ elicited pain at McBurney’s point in appendicitis in 1907
Reported in greater than 60% of cases
Iliopsoas: Pain on extension of right leg at the waist
May suggest a retrocecal appendix |
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Term
| T/F: Appendicitis is a diagnosis made by CT scans |
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Definition
| F: Acute appendicitis is a clinical diagnosis, made by history, confirmed by physical exam and supported by laboratory and imaging tests. |
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Term
In px with Periumbilical Pain
Anorexia
RLQ Pain
what test must you do on her? |
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Definition
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Term
| T/F: an appendicolith is present in over 50% of cases |
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Definition
| F ~ 17% cases = calcification of appendicolith |
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Term
| Role of US in dx of appendicitis? |
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Definition
Ultrasound may be useful in identifying the “target lesion” – thick-walled, non-compressible RLQ luminal structure
May suggest an alternate diagnosis, especially in young women, where Gyn pathology may be cause of RLQ pain
However, it is highly user-dependent, and unreliable both in sensitivity and specificity. |
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Term
| What are results of the primary determinant of morbidity in acute appendicitis? |
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Definition
perforation => Wound infection
Intraperitoneal abscess
Fecal fistula
Intestinal obstruction |
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Term
| What are Findings at Negative Appendectomy |
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Definition
Mesenteric lymphadenitis
Crohn’s disease
Meckel’s diverticulitis
Cecal diverticulitis
Cecal carcinoma
Ectopic pregnancy
Pelvic inflammatory disease
Ovarian cyst |
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Term
| What's the primary goal in decision-making? |
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Definition
| In chronic abdominal diseases, accuracy of diagnosis is the cardinal consideration. In acute abdominal disease, exact diagnosis is not necessary, or always desirable. The primary goal is to decide whether to intervene. |
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Term
| Risk of death with perforated ulcer depends on? |
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Definition
Concurrent medical illness
Preoperative shock
Delayed diagnosis > 48 hours |
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Term
Number of risk factors
0
1
2
3 |
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Definition
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Term
| normal vs. perforation bacteriology |
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Definition
Normal <102 organisms/ml
Lactobacilli
Aerobic streptococci
Perforation Coliforms
Clostridia
Candida |
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Term
| Causes of small intestinal obstruction |
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Definition
Postoperative adhesions 71%
Metastatic carcinoma 9%
Internal hernias 6%
Crohn’s disease 4%
External hernias 3% |
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Term
| Electrolyte abnormalities with prox vs. distal obstruction |
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Definition
Proximal obstruction
Hypochloremic alkalosis
Compensatory hypokalemia
Azotemia
Distal obstruction
Normal electrolytes
Azotemia
Hemoconcentration |
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Term
| Delay of operation by 12 hrs in case of intestinal infarct => |
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Definition
| 40% inc in mortality, normally 5-10% |
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Term
| Signs and symptoms of infarction (that ppl suck at dxing) |
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Definition
Continuous abdominal pain
Fever
Peritoneal signs
Mass
Tachycardia
Leukocytosis
Acidosis |
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