Term
|
Definition
Pruritis or pain
Lesion at anal verge
E.coli and Enterococcus common agents |
|
|
Term
| 4 Types of Anorectal Abscesses |
|
Definition
1. Perianal
2. Ischiorectal
3. Intrasphincteric
4. Supralevator |
|
|
Term
| Sensation above dentate line |
|
Definition
Distention and inflammation
*No pain |
|
|
Term
| Sensation below dentate line |
|
Definition
| Pain, pressure, texture, (gas/solid) |
|
|
Term
|
Definition
Sxs: LLQ pn, Change of BM, Straining
+/- N/V/D/C bloating and/or flatulance
Labs: +/- Leukocytosis
NL LFTs/Amylase/Lipase
Elevated CRP |
|
|
Term
| Diverticulitis Radiologic Eval |
|
Definition
Confirmed by CT w/ Contrast
Thickened bowel walls with localized inflamm changes |
|
|
Term
| Diverticulitis Tx (outpatient) |
|
Definition
1. Clear liquid diet, advance slowly with decrease in sxs.
2. Broad Spectrum Abx (ie. cipro and flagyl) |
|
|
Term
| Diverticulitis Tx (non-op inpatient) |
|
Definition
*Systemic signs of infection/peritonitis
1. NPO; IV fluid hydration
2. IV Abx (ie. Piperacillin/tazobactam)
3. Pn Control = Morphine
4. Advance to liquid diet as tol.
5. D/C w/ PO Abx |
|
|
Term
| Diverticulitis Tx (operative) |
|
Definition
1. CT guided percutaneous drainage for peridiverticular abscesses >4cm
2. Resection of diseased portion + colostomy.
* >40% will have recurrance |
|
|
Term
| Choledocholithiasis (definition) |
|
Definition
| Presence of gallstones in common bile duct |
|
|
Term
|
Definition
| Gallstone obstruction of the biliary or hepatic ducts, causing inflammation and infection |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Choledocholithiasis is the MC cause |
|
|
Term
| Charcot's Triad (cholangitis) |
|
Definition
1. Jaundice
2. Fever
3. RUQ pn |
|
|
Term
| Cholecystis (Preferred Imaging) |
|
Definition
*US
(CT can be used to assess the severity and complications) |
|
|
Term
|
Definition
*WBC, AST/ALT, and Alk Phos elevated
(amylase/lipase may be elevated if "gallstone pancreatitis")
*RUQ US: thickened GB wall, GB distention |
|
|
Term
|
Definition
Used for Cholecystis
*IV isotope taken up by NL BG, but not in cholecystitis. (100% sensitive, but reserved for "mystery cases") |
|
|
Term
|
Definition
1. Palpate RUQ beneath costal Margin
2. Have pt take a deep breath
3. Pt. has inspiratory arrest due to pn
*indicates Cholecystitis |
|
|
Term
|
Definition
Sxs: pn more diffuse than that of GB dz
Jaundice, anorexia & wt. loss =advanced
Courvoisier's sign
Sister Mary Joseph Nodes
Virchow node
Blumer shelf
CA 19-9 may be elevated |
|
|
Term
|
Definition
| Palpable nodes bulging into umbilicus |
|
|
Term
|
Definition
| Left Supraclavicular Adenopathy |
|
|
Term
|
Definition
| Palpable mass on digital rectal exam, indicative of metastatic tumor cells |
|
|
Term
|
Definition
|
|
Term
|
Definition
*Steady and boring epigastric/ periumbilical pn that comes on suddenly and lasts >1 day. Pn may radiate to the back, chest, flanks, and lower abdomen.
*Pn more intense in supine position.
N/V/D and anorexia common present
NO FEVER |
|
|
Term
| Acute Pancreatitis (Labs) |
|
Definition
*Amylase (initially rises)
*Lipase (elevated longer)
Both at least 3x the NL range
*Leukocytosis
*Elevated LFTs with amylase/lipase suggest "gallstone pancreatitis" |
|
|
Term
|
Definition
*2 of the 3
1. Typical Abdominal Pn
2. Amylase/Lipase 3x NL
3. Confirmatory Radiological studies |
|
|
Term
| Acute Pancreatitis (Tx mild dz) |
|
Definition
1. NPO; IV fluid hydration
2. Analgesia
3. Cholecystectomy following recovery
*PO intake can be resumed when pt is pn free w/out drugs, no N/V, NL bowel sounds, and is hungry |
|
|
Term
|
Definition
* chronic inflammation leading to fibrosis
*MC cause in adults = Alcohol
*MC cause in children = Cystic Fibrosis
*Maldigestion = chronic diarrhea, steatorrhea, wt loss & fatigue
*mild tenderness, inconsistent with severity of reported pn
(+) Secretin stimulation test |
|
|
Term
Pancreatic CA
*4th leading cause of CA death in men and women |
|
Definition
Gradual onset of non-specific sxs = malaise/N/Anorexia/Fatigue and wt loss
*Mid-epigastric pn +/- radiation to mid/lower back
Courvoisier's sign
Virchow's node, Sister Mary Joseph, hepatomegaly, ascites. |
|
|
Term
| Signs of metastatic disease |
|
Definition
1. Virchow's node
2. Sister mary joseph nodes
3. Blumer Shelf
4. hepatomegaly |
|
|
Term
|
Definition
Caused by infection, trauma, or inflamm of underlying organs or leakage of blood/bile/urine/gastric juice into the abd. cavity
*abd pn, fever, N/V, rebound pn and guarding |
|
|
Term
|
Definition
*10-30yo MC, but can occur at any age!
*Anorexia
Nausea +/- vomiting
+/- low grade fever
Abd. pn = migration from periumbilical to RLQ |
|
|
Term
| Acute Appendicitis (PExam) |
|
Definition
1. McBurney's point
2. Psoas sign
3. Obturator sign
4. Rovsing's sign
5. Rebound tenderness |
|
|
Term
| Acute appendicitis (Labs) |
|
Definition
*WBC elevated 86% of the time. May not be!
CT w/ oral contrast
(may be able to read w/out contrast in obese)
*US for prego or children (decrease exposure to radiation) |
|
|
Term
|
Definition
1. Pn 30-60min after meals
2. RUQ pn
3. N/V
4. Fever/toxic appearance
5. Murphy's sign |
|
|
Term
|
Definition
*Sudden severe abd pn, usually epigastric, often radiates to back
*Often vomiting
*Marked abd. tenderness, bowel sounds possibly absent
*Tachycardia/hypotension |
|
|
Term
|
Definition
* 1 of 2 reasons to get X-rays
1. US shows free air (look to R)
2. CT may be necessary if X-ray fails to show Dx |
|
|
Term
|
Definition
1. Vigorous IV fluid resuscitation
2. NG tube w/ suction
3. Broad Spectrum Abx.
4. Emergency Laparotomy |
|
|
Term
| Acute Pancreatitis (3 usual causes) |
|
Definition
1. EtOH
2. Gallstones (choledocholithiasis)
3. Hyperlipidemia |
|
|
Term
| Gallbladder Pancreatitis Tx |
|
Definition
| ERCP - Endoscopic Retrograde Cholangio-pancreatography |
|
|
Term
|
Definition
VODKA
V: vomiting
O: Obstipation
D: Distention
K: Krampy A:bdominal pain
Tympany to percussion
Bowel sounds "tinkly" or non-existant |
|
|
Term
| Small Bowel Obstruction (etiology) |
|
Definition
MC 1. Adhesions from prior surgery
2. Incarcerated hernias
CA or polyps possible |
|
|
Term
| Large Bowel Obstruction (etiology) |
|
Definition
MC: Colon CA
*diverticulitis or volvulus possible |
|
|
Term
|
Definition
* 1 of 2 reasons for X-ray
X-ray shows air-fluid levels in bowel or distended bowel loops (3/6/9) |
|
|
Term
|
Definition
*NG tube to suction for decompression
NPO; IV fluid resuscitation
Admit
Surger if no resolution |
|
|
Term
|
Definition
*Usually seen in elderly and those with severe vascular disease
1. Severe diffuse pn (out of proportion to tenderness on exam)
2. Fever
3. Often N/V |
|
|
Term
|
Definition
1. Elevated WBC
2. Acidosis (elevated lactate from anaerobic metabolism)
3. Plain X-ray and CT show Thumbprinting, possible free air if perforated |
|
|
Term
|
Definition
1. Aggressive IV fluids
2. IV Abx
3. Immediate surgical consultation to resect infarcted bowel |
|
|
Term
|
Definition
1. elderly
2. HTN
3. DM
4. Peripheral Vascular Disease
5. >5cm significant risk |
|
|
Term
|
Definition
Acute onset of abd and/or back pn (severe)
Possibly syncope
Hypotensive/tachycardic/frank shock
*pulsatile tender abd. Mass |
|
|
Term
|
Definition
*Type and Cross 6 units of PRBC's
CBC, lytes, BUN/Cr, PT/PTT
(CT or US will make dx, but don't wait for tests in unstable pt) |
|
|
Term
|
Definition
1. ABC's and O2 (monitor)
2. At least 2 large-bore IV's, rapid IV fluid
3. Blood transfusion
4. Immediate Surgical Consult (IMMEDIATE REPAIR!!!) |
|
|
Term
|
Definition
*prego test in all women w/ abd pn and of child bearing age
Sxs: Low abd. pn +/- vag bleed
(unstable if ruptured)
Lab: (+) preg test, anemia?, Pelvic US (look for ectopic and where it should be if it's not)
Tx: ABC's, IV fluids/blood
Immediate OB consult for surgery |
|
|
Term
|
Definition
Sxs: Appear in great distress
Severe Abd. pn, possible vomiting
*Lab: Pelvic US makes Dx*
(dopplar flow into ovaries diminished)
Tx: Surgical |
|
|
Term
| Pelvic Inflammatory Disease (PID) |
|
Definition
Sxs: low abd. pn & tenderness, purulent vag discharge, F/N/V
*Cervical motion tenderness*
Labs: STI cultures, CBC
Tx: Abx, admit if toxic |
|
|
Term
|
Definition
| R/O SBO or free air from ruptured viscus |
|
|
Term
|
Definition
1. GB dz
2. R/O prego or ovarian/tubal pathology
3. AAA, hydronephrosis/hydroureter
4. Appy in prego or child |
|
|
Term
| IVP (intravenous pyelogram) |
|
Definition
Used to detect renal stones/ureteral obstruction
*Dye injected and accumulates in KUB. Look for dilation of Ureters |
|
|
Term
| If no definitive dx despite thorough workup |
|
Definition
1. Consider admission for monitoring
2. If D/C, instruct pt to be rechecked within 12-24 hours, and return sooner if sxs worsen |
|
|
Term
| Risk factors for GI bleed |
|
Definition
1. NSAIDS, aspirin, Steroids
2. Coumadin/Heparin/Thrombolytics
3. Alcohol
4. Cirrhosis/Esophageal Varices
5. Thrombocytopenia, leukemia, etc
6. Hemophilia, vonWillebrands, etc |
|
|
Term
|
Definition
1. epistaxis/oral lesion
*2. Esophageal Varices (most likely to rebleed)
3. Mallory-Weis tears
4. Esophagitis/gastritis
*5. Gastic/duodenal Ulcers (MC cause of UGI bleed) |
|
|
Term
|
Definition
1. Upper GI bleed
2. Carcinoma
3. Diverticulosis (MC Cause of LGI bleed)
4. Angiodysplasia/Arteriovenous Malformation (AVM)
5. Infectious Diarrhea
6. IBD (esp. UC)
7. Hemmorrhoids/anal fissure |
|
|
Term
| GI bleed vital sign changes |
|
Definition
1. Hypotension
2. Tachycardia
3. Decreased Pulse pressure
4. Tachypnea
5. Orthostatic Hypotension |
|
|
Term
|
Definition
* Type and match immediately if severe
1. CBC (don't be assured by NL Hgb)
2. PT/PTT
3. Lytes, BUN/Cr, Glucose
4. LFTs
5. EKG (if underlying CAD suspect)
6. Hemoccult/GUIAC, gastroccult
7. Technecium-labeled RBC scan |
|
|
Term
| Managing an acute GI bleed |
|
Definition
1. high flow O2
2. Intubation if profuse to avoid aspiration
3. Cardiac Monitor
4. Volume replacement via large bore IV lines
a. Begin with crystalloid (NS or LR)
b. Transfuse blood if continued bleed, severe anemia, failure to improve after 2 liters of NS)
c. replace clotting factors prn |
|
|
Term
| NG tube for Acute GI bleed |
|
Definition
1. Helps establish source
2. can check aspirite for blood
3. Monitor ongoing UGI bleed
4. Can lavage clots with saline or tap |
|
|
Term
Sengstaken-Blakemore tube
"Minnesota Tube" |
|
Definition
Balloon tamponade; can controll significant UGI hemorrhage
* Gastric and esophageal balloons inflated to tampnade source of bleed
(Possibility of rupture) |
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