Surgical Cases

Pt presents with RLQ pain and bilious N/V after pain started. No bowel movements in 2 days, nothing alleviates the pain. What was the diagnosis?

appendicitis

what are the diagnostic tests for appendicitis?

-CT of abdomen

-CBC, CMP

-UA

-pelvic US

-bhCG

-STD testing

what are diagnostic results for appendicitis?

CT shows stones causing distended fluid filled & enlarged appendix

what is the treatment for appendicitis?

admit to surg for laparoscopic appendectomy

what drugs should be on call if needed during appendectomy?

heparin & ciprofloxacin

what is the MC side effect of Zofran?

constipation

what is Colace (docusate sodium)?

surfactant laxative to be used before and after surgery

Pt is 2 months postpartum presenting with sharp chest pain at 3am. No history of heart disease. Pain radiates to back, food intake aggravates pain. +Murphy's sign. What was the diagnosis?

cholecystitis w/ choledocholithiasis

what are the diagnostic tests for cholecystitis?

-CBC, CMP

-abdominal US/CT

-MRCP if needed after US/CT

-UA

-amylase and lipase

-troponins, ECG

what are the diagnostic results for cholecystitis?

gallstones filling the gallbladder, thickened gallbladder wall with pericholecystic fluid collection, enlarged CBD

what is MRCP (magnetic resonance cholangiopancreatography)?

non-invasive imaging technique that uses MRI to visualize the biliary and pancreatic ducts, liver, gallbladder, and pancreas

what is the treatment for cholecystitis with choledocholithiasis?

laparoscopic or open cholecystectomy after ERCP

what is Unasyn (test question)?

combo antibiotic to treat bacterial infections in the body, containing ampicillin & sulbactam sodium

Pt presents with acute, sharp, gnawing pain in epigastric area. Tried peptobismol w/ no relief. Movement aggravates the pain. No lab results came back yet. He also took too much ibuprofen for the designated time period. What is the diagnosis at this time?

pneumoperitoneum

what diagnostic tests should be ordered for pneumoperitoneum?

-ECG, troponin

-CXR

-CBC, CMP

-amylase and lipase

-abdominal CT

what indicates pneumoperitoneum?

HR >100, abrupt onset, rigid abdomen

what is the treatment for pneumoperitoneum?

emergent exploratory laparotomy

Pt has lower abdominal pain that is sharp and wavelike. Associated N/V, and distended abdomen. She said would feel better if she had a bowel movement. What was the diagnosis?

SBO

what are diagnostic tests for SBO?

-CBC, CMP

-abd x-ray/CT

-UA

-lactate

what is fluoroscopy?

type of x-ray machine that shows real-time images

what is SBFT (small bowel follow through)?

type of fluoroscopy to visualize SI, pt ingests liquid contrast (barium) that coats the SI and allows for real-time x-ray images as barium moves through the GI tract

how is SBO managed?

admit to gen surg for serial abd exams, if no improvement -> surgery

Pt has LLQ pain that has worsened and is aggravated by movement. Fentanyl IV helps some. 2 episodes of loose stool. What was the diagnosis?

diverticulitis

what are diagnostic tests for diverticulitis?

-CBC, CMP

-abd CT

-lactate/procalcitonin

-UA

what are diagnostic results for diverticulitis?

inflammatory changes w/ bowel wall thickening on CT

what additional findings are seen with complicated diverticuli (perforated)?

-extraluminal air

-peritoneal inflammation

-abscess formation

what is Ancef (cefazolin)?

antibiotic that inhibits bacterial cell wall synthesis, killing or preventing the growth of susceptible bacteria

how must Ancef be administered (test question)?

IM or IV only (cannot be given oral!)

what is the treatment for diverticulitis?

admit to gen surg for serial abd exams, if no improvement -> Hartmann's procedure

what is Hartmann's procedure?

1. surgical removal of section of rectosigmoid colon (lower LI & upper rectum)

2. remaining rectal stump is closed off creating "Hartmann's pouch"

3. remaining colon is brought out through stoma and colostomy bag is attached, allowing waste to be collected outside the body