Surgery > STUDY GUIDE > PAEA Surgery Study Guide | PAEA Surgery Blueprint Gastrointestinal/Nutritional ; ABDOMINAL PAIN. (All)

PAEA Surgery Study Guide | PAEA Surgery Blueprint Gastrointestinal/Nutritional ; ABDOMINAL PAIN.

Document Content and Description Below

PAEA Surgery Blueprint Gastrointestinal/Nutritional (50%) ABDOMINAL PAIN Acute Abdomen  Caused by Perforation o Sudden onset o Constant, generalized, very severe o Tenderness, msl guarding, ... rebound, silent abdomen o Pt lies still o Diagnosis  Free air under diaphragm in upright Xray o Treatment  Emergency surgery  Caused by obstruction of a narrow duct o Ureter, cystic, common o Sudden onset of very severe colicky pain o Location according to source o Pt constantly moving  Caused by inflammatory process o Gradual onset (6-12 hrs) o Constant pain, starts general but becomes localized o Systemic signs (fever, leukocytosis) Treatment for generalized acute abdomen = exploratory laparotomy HEARTBURN/DYSPEPSIA Gastroesophageal Reflux Disease (GERD)  Basics o Transient relaxation of LES (incompetent) => gastric acid reflux => esophageal mucosal injury o Complications  Esophagitis, esophagus stricture, esophageal adenocarcinoma  Barrett’s esophagus: esophageal squamous epithelium replaced by precancerous metaplastic columnar cells  Manifestations o Hallmark = heartburn  Retrosternal, postprandial o Regurgitation o Dysphagia o Cough at night o “ALARM” sx  Dysphagia, odnophagia, weight loss, bleeding  Suspect malignancy  Diagnosis o Clinical o Endoscopy  Often used first o Esophageal manometry  Done is endoscopy normal o 24hr ambulatory pH monitoring  Gold standard 1 PAEA Surgery Blueprint  Not done often  Management o Stage 1: Lifestyle Modifications  Elevation of the head of the bed  Avoid recumbence for three hours after eating  Eat small meals  Avoid certain foods (fatty, spicy, citrus, chocolate, caffeine)  Decrease fat & ETOH intake  Weight loss  Smoking cessation o Stage 2: As Needed” Pharmacological Therapy  Antacids  OTC H2 receptor antagonists (“-tidine”)  ***If “ALARM” sx, do endoscopy o Stage 3: Scheduled Pharmacologic Therapy  Meds  H2RA  Proton Pump Inhibitors (“-azole”) o Drug of choice in severe disease  Cisapride  Nissen Fundoplication  If refractory Achalasia  Basics o Loss of Aurbach’s plexus => increased LES pressure  Failure of LES relaxation  Manifestations o Dysphagia to BOTH solids & liquids o Weight loss o Regurgitation of undigested food o Chest pain o Cough  Diagnosis o Esophageal manometry (gold standard)  Increased LES pressure (> 40 mmHg) o Double-contrast esophagram  Bird’s beak appearance  Management o Decrease LES pressure  Botox injection (temporary relief)  Nitrates  CCBs  Dilation of LES  Esophagomyomectomy JAUNDICE Basics  Yellowing of skin, nail beds, sclera o Due to tissue bilirubin distribution  *Not a disease but a sign of disease  Occurs when bilirubin > 2.5 mg/dL 2 PAEA Surgery Blueprint Types  Hemolytic o Low level (6-8) o Elevated bilirubin is unconjugated (indirect) o Work up should determine what is causing issue with RBCs  Hepatocellular o Elevated bilirubin (conjugated & unconjugated), transaminases, alk phos (modest) o Hepatitis (direct workup this way)  Obstructive o Elevated bilirubin (conjugated & unconjugated), transaminases, alk phos (v. high) o Workup => U/S  Look for obstruction HEMATEMESIS Denotes upper GI source Diagnosis: UGI endoscopy Corrosive Esophagitis  Basics o Etiology: ingestion of corrosive substance  Manifestations o Odynophagia, dysphagia, hematemesis, dyspnea  Diagnosis o Endoscopy  Management o Supportive o Pain meds o IV fluids Boerhaave’s Syndrome  Basics o Full thickness rupture of distal esophagus o Associated with repeated vomiting (bulimia), iatrogenic perforation  Manifestations o Retrosternal chest pain worse with deep breathing and swallowing o Hematemesis o PE: crepitus on chest auscultation due to pneumomediastinum  Diagnosis o Chest CT  Management o Surgical repair Mallory-Weiss Syndrome (Tears)  Basics o UGI bleeding due to longitudinal mucosal lacerations @ gastroesophageal junction or gastric cardia (superficial) o Sudden rise in intragastric pressure or gastric prolapse into esophagus  Persistent retching/vomiting  Alcohol binge  Bulimia 3 PAEA Surgery Blueprint  Manifestations o Retching/vomiting => hematemesis after an alcohol binge o Melena, hematochezia, syncope, ab pain, hydrophobia  Diagnosis o Upper endoscopy  Management o Supportive if no active bleeding o Active bleeding => epi injection, sclerosing agent, band ligation, hemo-clipping or balloon tamponade [Show More]

Last updated: 1 year ago

Preview 1 out of 67 pages

Add to cart

Instant download

document-preview

Buy this document to get the full access instantly

Instant Download Access after purchase

Add to cart

Instant download

Reviews( 0 )

$14.50

Add to cart

Instant download

Can't find what you want? Try our AI powered Search

OR

REQUEST DOCUMENT
35
0

Document information


Connected school, study & course


About the document


Uploaded On

May 24, 2022

Number of pages

67

Written in

Seller


seller-icon
Academia1434

Member since 4 years

211 Documents Sold


Additional information

This document has been written for:

Uploaded

May 24, 2022

Downloads

 0

Views

 35

Document Keyword Tags

Recommended For You

Get more on STUDY GUIDE »

$14.50
What is Browsegrades

In Browsegrades, a student can earn by offering help to other student. Students can help other students with materials by upploading their notes and earn money.

We are here to help

We're available through e-mail, Twitter, Facebook, and live chat.
 FAQ
 Questions? Leave a message!

Follow us on
 Twitter

Copyright © Browsegrades · High quality services·