Term
| layers of the abdominal wall |
|
Definition
| skin, subcutaneous tissue, superficial fascia, muscles (external oblique, internal oblique, transversus abdominis muscle), deep fascia, peritoneal adipose and areolar tissue |
|
|
Term
| abnormal protrusion of an organ tissue through a defect in it's surrounding walls |
|
Definition
|
|
Term
| areas commonly involved in hernias |
|
Definition
| inguinal, femoral, umbilicus, linea alba, sites of prior incision |
|
|
Term
| what type of hernia: contents can be replaced within the surrounding musculature |
|
Definition
|
|
Term
| what type of hernia? contents cannot be reduced |
|
Definition
|
|
Term
| what type of hernia? compromised blood supply to it's contents, which is potentially fatal |
|
Definition
|
|
Term
| what type of hernia? protrudes through all layers of the abdominal wall |
|
Definition
|
|
Term
| what type of hernia? protrusion of intestine through a defect within the peritoneal cavity |
|
Definition
|
|
Term
| what type of hernia? hernia sac is contained within a musculoaponeurotic layer of the abdominal wall |
|
Definition
|
|
Term
| boundaries of Hesselbach's triangle |
|
Definition
lateral = inferior epigastric artery and vein.
medial = rectus sheath.
inferior = inguinal ligament.
posterior = transversalis fascia. |
|
|
Term
|
Definition
|
|
Term
| mc type of inguinal hernia |
|
Definition
| indirect - more common on the right |
|
|
Term
| type of hernia that is more common in women |
|
Definition
| femoral - more common on the right |
|
|
Term
| hernia sac passes from the internal inguinal ring obliquely toward the external inguinal ring (into the scrotum) |
|
Definition
|
|
Term
| sac passes lateral to the inferior epigastric vessels and thus is outside of Hesselbach's triangle |
|
Definition
|
|
Term
| sac protrudes outward and forward, medial to the internal inguinal ring and inferior epigastric vessels |
|
Definition
|
|
Term
| causes of adult abdominal hernias |
|
Definition
| pregnancy, obesity, ascites, or abdominal distention |
|
|
Term
| hernia that occurs in the upper abdomen at the midline |
|
Definition
|
|
Term
| is diastasis recti a hernia? |
|
Definition
| no, a fascial weakness not defect |
|
|
Term
| diagnostic test for hernias |
|
Definition
|
|
Term
|
Definition
|
|
Term
| type of hernia with a high incidence of strangulation? |
|
Definition
|
|
Term
| what type of hernias need not be repaired? |
|
Definition
| small asx umbilical hernias |
|
|
Term
| surgical repair of hernias is called |
|
Definition
|
|
Term
| dominant method for repairing inguinal hernias |
|
Definition
| "tension free" anterior repair |
|
|
Term
| hernia that is the result of inadequate healing of a previous incision |
|
Definition
| incisional (ventral) hernia |
|
|
Term
| how should larger incisional hernias be repaired (>4cm in diameter) |
|
Definition
| repaired with a prosthesis |
|
|
Term
| complications of herniorraphy |
|
Definition
| surgical site infection, nerve injuries, ischemic orchitis, injury to the vas deferens and viscera, hernia recurrence |
|
|
Term
| type of repair with lowest risk of hernia recurrence |
|
Definition
| lowest with tension-free repairs |
|
|
Term
| mc type of sliding hernia |
|
Definition
|
|
Term
| easiest route for repair of a strangulated hernia |
|
Definition
|
|
Term
| non surgical causes of an acute abdomen |
|
Definition
| endocrine and metabolic, hematologic, toxins |
|
|
Term
| most important pat of the eval of an acute abdomen |
|
Definition
| history and careful physical examination |
|
|
Term
| hitory taken in the case of an acute abdomen |
|
Definition
|
|
Term
| vague, crampy pain that is poorly localized to the epigastrum, periumbilically, or hypogastrium. usually the result of smooth muscle stretch, ischemia |
|
Definition
|
|
Term
| type of pain that coresponds to the segmental nerve roots it's innervating in the peritoneum, tends to be sharper and better localized |
|
Definition
|
|
Term
| pain is percieved at a site distant from the source of stimulus |
|
Definition
|
|
Term
| typical causes of peritonitis |
|
Definition
inflammatory insult, noninfectious inflammation, ESRD, ascites, cirrhosis.
in kids = pneumococcus and hemolytic strep. |
|
|
Term
| what procedure should be done in all acute abdomen cases? |
|
Definition
| digital rectal examination |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| appendicitis, retroceccal abscess |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| for what dx would you perform plain radiographs |
|
Definition
| suspected perforated duodenal ulcer, small bowel obstruction, calcifications, volvulus of either the cecum or sigmoid colon |
|
|
Term
| for what dx would you perform abdominal ultrasound? |
|
Definition
| gallstones, gallbladder wall thickness, fluid around the gallbladder, diameter of the extrahepatic and intrahepatic bile ducts |
|
|
Term
| for what dx would you perform transvaginal ultrasound? |
|
Definition
| abnormalities of the ovaries, adenexa, and uterus |
|
|
Term
| advantages of diagnostic laparoscopy |
|
Definition
| high sensitivity and specificity, ability to treat a number of conditions causing an acute abdomen, decreased morbidity and mortality, decreased length of stay, decreased overall hospital costs, avoidance of open laparotomy |
|
|
Term
| all pts no matter how emergent require SOME pre-op preparation, this includes.... |
|
Definition
| IV access, antibiotic infusions (most), ileus pts need an NG tube, foley catheter, most pts should have blood typed and cross matched |
|
|
Term
| most pts with an acute GI bleed do what? |
|
Definition
| stop bleeding spontaneously |
|
|
Term
| Gi bleed proximal to the ligament of Trietz |
|
Definition
| upper GI bleed, usually peptic ulcer or variceal bleeding |
|
|
Term
| MC source of lower GI bleeds |
|
Definition
|
|
Term
| vomiting of bright red blood or coffee-grounds |
|
Definition
| hematemesis (usually UGI) |
|
|
Term
| black, tarry, foul-smelling stool |
|
Definition
|
|
Term
| bright red blood per rectum that may or may not be mixed with stool |
|
Definition
| hematochezia (usually severe lower GI bleed) |
|
|
Term
| this test is highly accurate at identifying an upper GI lesion |
|
Definition
| endogastroduodenoscopy (EGD) |
|
|
Term
| EGD in the urgent setting is associated with |
|
Definition
| increased incidence of complications and airway protection is critical |
|
|
Term
| diagnostic procedure of choice for slow or intermittent bleeding from the lower GI tract |
|
Definition
|
|
Term
| treatment of acute GI hemorhage |
|
Definition
pharmacologic, endoscopic, and surgical therapies are site specific.
angiographic techniques are more generic.
If bleeding has ceased therapy goal is to prevent recurrence. |
|
|
Term
| when is therapy with acute GI bleed more urgent? |
|
Definition
| continuous bleed - if hemodynamically unstable, institute therapy within 2 hrs |
|
|
Term
|
Definition
| H. Pylori, NSAIDs, gastric acid hypersecretion (ZE syndrome) |
|
|
Term
| fever, tachycardia, abdominal tenderness, rigidity and rebound tenderness, bleeding, obstruction |
|
Definition
| perforated duodenal ulcer |
|
|
Term
| how do you dx a perforated duodenal ulcer? |
|
Definition
| fiberoptic endoscopy (most reliable), CT scan of abd, UGI series |
|
|
Term
| treatment for a perforated duodenal ulcer |
|
Definition
| medical management has greatly reduced the need for surgical intervention. PPI, H2RA, antacids, sucralfate, treatment of H. Pylori infection (PrevPac, Helidac, pylera) |
|
|
Term
| MC type of gastric cancer |
|
Definition
|
|
Term
| risk factors for gastric cancer |
|
Definition
| H. Pylori infection, Pernicious anemia, achlorhydria, chronic gastritis, nitrosamines |
|
|
Term
| left supraclavicular node associated with gastric cancer |
|
Definition
|
|
Term
| umbilical node associated with gastric cancer |
|
Definition
| Sister Mary Joseph's node |
|
|
Term
| how do cancer and RT effect gastric cancer |
|
Definition
|
|
Term
| premalignant disease of massive gastric folds in the fundus |
|
Definition
| hypertrophic gastritis (Menetrier's disease) |
|
|
Term
| caused by forceful vomiting, retching, or straining |
|
Definition
|
|
Term
| collections of nondigestable material (can include food) |
|
Definition
|
|
Term
| most common congenital abnormality of SI |
|
Definition
|
|
Term
| MC cause of GI bleeding in children |
|
Definition
|
|
Term
| what is the "rule of 2's" as it pertains to Meckel's diverticulum |
|
Definition
| 2% of the population, 2 inches in length, presents within first 2 years of life, 2 ft from ileocecal valve, contains 2 types of mucosa (ileal and ectopic) |
|
|
Term
| how do you dx Meckel's diverticulum |
|
Definition
| Techentium 99 pertechnate scan, abdomen CT scan, barium studies |
|
|
Term
| treatment of Meckel's Diverticulum |
|
Definition
|
|
Term
| most frequent cause of surgery of the SI |
|
Definition
|
|
Term
| most common causes of small bowel obstruction |
|
Definition
worldwide - hernia (inguinal, incisional).
Western nation - post-surgical adhesions |
|
|
Term
| S&S of small bowel obstruction |
|
Definition
| fever, tachycardia, abdominal distention, diffuse tenderness, tympany, high pitched bowel sounds (absent later on) |
|
|
Term
| how do you dx small bowel obstruction |
|
Definition
| plain abdominal films = best (air fluid levels, thickened small bowel wall), CT |
|
|
Term
| how do you treat small bowel obstruction |
|
Definition
| IV fluids, NG tube decompression, foley cath, possible operative exploration if no improvement within 24-48 hrs |
|
|
Term
| transmural inflammatory bowel disease, immune mediated, chronic from mouth to anus, skip lesions, granulomata, strictures, fistulae, abscesses |
|
Definition
|
|
Term
| how do you dx Crohn's disease? |
|
Definition
| clinical suspicion, small bowel biopsy, barium study, CT enterography |
|
|
Term
| how do you tx Crohn's disease? |
|
Definition
usually medical management. Surgery is avoided as recurrences happen at the areas of anastamosis.
Surgery may be required with obstruction, perforation, strictures, fistulas |
|
|
Term
| most small bowel tumors are |
|
Definition
|
|
Term
| types of malignant small bowel tumors |
|
Definition
| adenocarcinoma, carcinoid, lymphoma |
|
|
Term
| most common presentation of small bowel tumors |
|
Definition
| obstruction, followed by hemorrhage |
|
|
Term
| what should you suspect with cafe au lait spots, telangiectasia, and mucocutaneous pigmentation |
|
Definition
|
|
Term
| how do you dx small bowel tumors? |
|
Definition
| endoscopic identification, barium studies (barium swallow with SBFT), abd/pelvic CT, laparotomy |
|
|
Term
| how do you treat small bowel tumors? |
|
Definition
| all carcinoids are considered malignant due to their potential for invasion and mets, tx = surgical resection of the primary tumor |
|
|
Term
| MC reason for acute abdominal surgery |
|
Definition
|
|
Term
| MC etiology of appendicitis |
|
Definition
| lymphoid hyperplasia (often preceded by a viral illness) |
|
|
Term
| whatis the ultra sound sign associated with appendicitis? |
|
Definition
|
|
Term
|
Definition
| low grade fever, RLQ tenderness at McBurney's point, RLL pain (Rovsing's sign), psoas sign, obturator sign |
|
|
Term
| how do you dx appendicitis? |
|
Definition
| plain xrays, pelvic US, barium enema, abdominal CT scan |
|
|
Term
| how do you treat appendicitis? |
|
Definition
|
|
Term
| what abx are used pre-op with appendicitis? |
|
Definition
| 2nd generation cephalosporins, broad spectrum PCN, or combo flouroquinalones and metronidazole for colonic bacteria |
|
|
Term
| complications of appendicitis |
|
Definition
| post-op wound infection, pelvic abscess, recurrence if appendiceal remnants remain |
|
|
Term
| where do most diverticula occur? |
|
Definition
|
|
Term
| what is the MCC of lower GI bleed? from where? |
|
Definition
| diverticular disease, right colon |
|
|
Term
| diverticular disease is associated with |
|
Definition
|
|
Term
| crampy LLQ pain, diarrhea/bloody stools, fever, local peritoneal signs |
|
Definition
|
|
Term
| how do you dx diverticular disease |
|
Definition
| CT scan, mesenteric angiography |
|
|
Term
| how you treat diverticular disease? |
|
Definition
medical management for most = PO abx (cipro and metro), clear liquids, low residue diet till sxs improve, 80% of bleeds stop spontaneously.
Surgical resection with recurrent attacks. |
|
|
Term
| what should you avoid with acute diverticular attacks? |
|
Definition
| colonoscopy and barium enema |
|
|
Term
| MC site of colonic obstruction |
|
Definition
|
|
Term
| 3 MCC of colonic obstruction |
|
Definition
| adenocarcinoma, diverticulitis, volvulus |
|
|
Term
| in regards to large bowel obstruction it is critically important to distinguish between |
|
Definition
| compelete and partial obstruction |
|
|
Term
| how do you dx colonic obstruction? |
|
Definition
S&S = abd distention, tympany, high pitched metallic rushes, gurgles, localized tender area.
plain abdominal films, laparotomy |
|
|
Term
| signs of a complete large bowel obstruction |
|
Definition
| obstipation - no flatus or stool x 8-12 hrs. Emergent surgery is indicated! |
|
|
Term
| dx and tx of partial large bowel obstruction |
|
Definition
evidence of passage of some stool or flatus.
tx = NGT decompression and IV fluids |
|
|
Term
| complications of bowel obstruction |
|
Definition
| perforation, peritonitis, sepsis |
|
|
Term
| enormous dilation of the right side of the colon without mechanical obstruction (pseudo-obstruction) |
|
Definition
|
|
Term
| treatment for Ogilivie's syndrome |
|
Definition
| bowel rest, IV fluids, colonoscopy with placement of a long rectal decompression tube |
|
|
Term
| rotation of a segment of the colon |
|
Definition
|
|
Term
|
Definition
|
|
Term
| massive abdominal distention, abdominal pain, obstination, tachypnea, coffee bean sign |
|
Definition
|
|
Term
|
Definition
sigmoid = rectal tube for decompression, emergent surgery with suspected perf or strangulation. Surgery = resection without anastomosis and temporary colonostomy.
Cecum = always treated surgically, cecopexy, right hemicolectomy with anastamosis |
|
|
Term
| involves mucosa and submucosa of LI and rectum, rectum involved > 90% of the time, crypts of Leiberkuhn |
|
Definition
|
|
Term
| what percentage of pts with UC have pancolitis? |
|
Definition
|
|
Term
| watery diarrhea with blood, mucous, crampy abdominal pain, tenesmus, urgency, presentation can be mild and insidious or abrupt and life threatening |
|
Definition
|
|
Term
| extracolonic manifestations of UC |
|
Definition
| ankylosing spondylitis, peripheral arthritis, uveitis, pyoderma gangrenosum, sclerosing cholangitis, pericarditis |
|
|
Term
|
Definition
| antidiarrheal agents, sulfasalazine or mesalamine, steroids |
|
|
Term
| surgical treatment for UC |
|
Definition
done when medical management fails or with complications.
total proctolectomy with permanent ileostomy used to be the tx of choice.
current tx of choice = total colectomy with mucosal proctectomy and ileoanal pull through (IAPP) |
|
|
Term
| colonlike pouch created from the last several inches of the ileum. The pouch allows stool to exit through the anus after the colon is removed. |
|
Definition
| ileoanal pouch, also called a J-pouch or pelvic pouch |
|
|
Term
| risk of what increases with long-standing UC |
|
Definition
| colon cancer, 1-2% increase after the initial 10 yrs of the disease |
|
|
Term
| what is mandatory with long standing UC |
|
Definition
|
|
Term
| most common colorectal carcinoma |
|
Definition
|
|
Term
| risk factors for colorectal carcinoma |
|
Definition
| diet (high animal fat, low fiber), carcinogens, IBD, familial history, FAP, Lynch syndrome, Gardner syndrome |
|
|
Term
| S&S of colorectal carcinoma |
|
Definition
| iron deficiency anemia, change in stool, hematochezia, obstruction |
|
|
Term
| how do you Dx colorectal carcinoma |
|
Definition
| DRE with stool testing for occult blood, colonoscopy, flex sig, CBC, CMP, LFT, CEA (carcinoembryonic antigen) |
|
|
Term
| when is a CEA useful for colorectal cancer? |
|
Definition
| it isn't specific for CR cancer, but it's useful in monitoring pts after surgery to detect recurrence |
|
|
Term
| MC organ of mets from CR cancer |
|
Definition
|
|
Term
| what is the treatment of choice for CR cancer with mets? |
|
Definition
|
|
Term
| what are the methods of spread for CR cancer |
|
Definition
blood and lymphatics, intraluminally, peritoneal seeding.
Chemo and RT are used with mets |
|
|
Term
| most CR cancers recur in how long? |
|
Definition
|
|
Term
| repeat colonoscopy or barium enema are recommended when after CR cancer? |
|
Definition
| every 6m x 2 yrs then every 3-5 yrs if no recurrence |
|
|
Term
| transition between visceral (above) and somatic (below) areas, located 2 cm from the anal verge |
|
Definition
|
|
Term
| vascular cushions in the anal canal |
|
Definition
|
|
Term
| dilation of inferior hemorrhoidal plexus below dentate line, a clot may form in the plexus |
|
Definition
|
|
Term
| anal cushions above the dentate line, usually painless |
|
Definition
|
|
Term
| MC problem with internal hemorrhoids |
|
Definition
|
|
Term
| classifications of hemorrhoids |
|
Definition
first = bulge in anal canal lumen, no protrusion
second = protrudes with defecation, reduces spontaneously
third = protrudes with defecation, needs manual reduction
fourth = permanent protrusion, incarcerated |
|
|
Term
| MC type of hemorrhoidectomy |
|
Definition
|
|
Term
| complications of hemorrhoidectomy |
|
Definition
| urinary retention, bleeding, anal stenosis, fecal incontinence, infection |
|
|
Term
| treatment of different hemorrhoid classifications |
|
Definition
first: asx = bulking agents, avoid constipation, increase water intake.
sx = rubber band ligation, infared coagulation.
second: conservative Rx or rubber band ligation.
third: rubber band ligation or surgery
fourth: hemorrhoidectomy |
|
|
