Abdominal emergencies — Flashcards

Flashcard 121: Perforation pain is _____

Answer: constant

Flashcard 122: What is the treatment for gallstone ileus? _____

Answer: Enterolithotomy (surgical removal of stone)

Extra: The primary goal is to relieve the mechanical bowel obstruction via enterolithotomy. Cholecystectomy and fistula repair are typically deferred to a later date, as these patients are often elderly with multiple comorbidities.

Flashcard 123: What do you do to keep bowel decompressed during omphalocele/gastroschisis? _____

Answer: NG tube

Flashcard 124: Free air under the diaphragm on upright chest X-ray indicates _____

Answer: perforation of the bowel

Flashcard 125: What is the management for stable patients with acute mesenteric ischemia after medical therapy? _____

Answer: Balloon angioplasty and stenting

Flashcard 126: Adhesions are the most common cause of _____

Answer: mechanical bowel obstruction

Flashcard 127: Why can **lactulose** use make surgery for a liver transplant more challenging? _____

Answer: It causes gaseous bowel distention

Extra: Lactulose is an osmotic laxative fermented by gut flora into gas (CO2, H2). This gas causes bowel distention, which limits the available space in the abdominal cavity, making the transplant surgery technically more difficult. Rifaximin is often preferred pre-operatively because it does not cause this gaseous distention. (Source: OnlineMedEd)

Flashcard 128: What early abdominal aortic aneurysm repair complication results in progressive abdominal pain and bloody diarrhea? _____

Answer: Bowel ischemia/infarction

Flashcard 129: If a **carcinoid** tumor in the appendix is **< 2 cm**, _____ is definitive management. If a **carcinoid** tumor in the appendix is **> 2 cm**, right hemicolectomy is definitive management.

Answer: appendectomy

Extra: Management of appendiceal carcinoid (neuroendocrine tumor): • < 2 cm and confined to the tip/body: Appendectomy is sufficient. • > 2 cm, involvement of the appendiceal base, or mesoappendiceal invasion: Right hemicolectomy. Note: Adenocarcinoma of the appendix (much less common than carcinoid) requires a right hemicolectomy regardless of size.

Flashcard 130: When is surgery indicated in Crohn's disease? _____

Answer: Only for **complications** (e.g., strictures/obstruction, fistulas, abscess, or perforation)

Extra: Surgery in Crohn's disease is not curative (unlike in Ulcerative Colitis) and is therefore reserved for the management of complications.