Emergency Medicine: Gas Under Diaphragm & Esophagus

Peritonitis

24-hour pH monitoring

The three constrictions in the esophagus are at 15cm, 25cm, and 40cm from the upper incisors. The narrowest constriction is at 15cm, corresponding to the pharyngoesophageal junction or C6.

<p>An invertogram is used. The patient is turned upside down with a metallic pointer placed at the proposed site of the anal opening. An X-ray is then taken, revealing a gas shadow and the marker. The distance between these two helps distinguish between low and high anorectal malformations.</p> Signup and view all the answers

<p>Esophageal varices</p> Signup and view all the answers

<p>Early dumping syndrome occurs within 10-15 minutes of eating and is caused by rapid fluid influx into the small intestine. Late dumping syndrome starts 30-40 minutes after eating and is caused by rebound hypoglycemia.</p> Signup and view all the answers

<p>Immediate laparotomy (opening the abdomen to explore) and IV fluids.</p> Signup and view all the answers

<p>Mallory-Weiss tear is a tear in the lining of the esophagus usually caused by forceful vomiting and is often self-limiting. Esophageal varices are dilated blood vessels in the esophagus due to portal hypertension often seen in patients with liver disease.</p> Signup and view all the answers

<p>The two possible diagnoses are achalasia cardia and carcinoma esophagus. Upper GI endoscopy and esophageal manometry are crucial investigations to differentiate between them.</p> Signup and view all the answers

<p>Hypochloremic hypokalemic metabolic alkalosis.</p> Signup and view all the answers

<p>String sign, double track sign, and mushroom sign.</p> Signup and view all the answers

<p>Post-gastrectomy deficiencies include vitamin B12 deficiency, vitamin D3 deficiency, and iron deficiency. Megaloblastic anemia due to vitamin B12 deficiency is most likely to cause neurological symptoms.</p> Signup and view all the answers

<p>The terminal ileum is crucial for the absorption of vitamin B12.</p> Signup and view all the answers

<p>Clostridium difficile.</p> Signup and view all the answers

<p>TLO triad: a periumbilical lump that moves at right angles to the line of attachment of the umbilicus, a transverse band of resonance associated with the lump, and a characteristic dullness on percussion over the lump.</p> Signup and view all the answers

<p>Corkscrew appearance.</p> Signup and view all the answers

<p>Sister Mary Joseph's nodule is a periumbilical nodule that often indicates metastasis in advanced cancers.</p> Signup and view all the answers

<p>Virchow's node (left supraclavicular lymph node), and Irish nodule (left axillary lymphadenopathy).</p> Signup and view all the answers

<p>The most commonly performed bariatric surgery procedure is laparoscopic sleeve gastrectomy, while Roux-en-Y gastric bypass is considered the most acceptable.</p> Signup and view all the answers

<p>Oral propranolol can be used for prophylaxis against esophageal hemorrhage, but IV propranolol is not used for managing esophageal hemorrhage.</p> Signup and view all the answers

<p>The hepatic venous pressure gradient is a measure of portal hypertension. A gradient of 6-10 mmHg indicates preclinical sinusoidal portal hypertension, while a gradient exceeding 10 mmHg is considered clinically significant. A gradient greater than 12 mmHg is associated with an increased risk of variceal rupture.</p> Signup and view all the answers

<p>Endoscopy.</p> Signup and view all the answers

<p>Barium swallow.</p> Signup and view all the answers

<p>A stepladder pattern of dilated small bowel loops.</p> Signup and view all the answers

<p>Nil per oral, IV fluids, IV antibiotics, pain relief, and nasogastric tube placement.</p> Signup and view all the answers

<p>A collapsed cecum suggests a small bowel obstruction as the obstruction is upstream of the cecum. On the other hand, a distended cecum indicates a large bowel obstruction as the obstruction is within the colon.</p> Signup and view all the answers

<p>A double bubble sign.</p> Signup and view all the answers

<p>A 'coffee bean' appearance, which represents the dilated sigmoid colon twisted on itself.</p> Signup and view all the answers

<p>Bleeding, usually due to ectopic gastric mucosa.</p> Signup and view all the answers

<p>A &quot;triple bubble&quot; sign on X-ray.</p> Signup and view all the answers

<p>A loop ileostomy has two openings, while an end ileostomy has only one opening.</p> Signup and view all the answers

<p>Skin excoriation.</p> Signup and view all the answers

<p>Abdominal pain, vomiting, and diarrhea.</p> Signup and view all the answers

<p>Jejunum.</p> Signup and view all the answers

<p>A polyp with an arborizing pattern.</p> Signup and view all the answers

<p>Ulcerative colitis presents with continuous inflammation along the colon, while Crohn's disease exhibits skip lesions.</p> Signup and view all the answers

<p>It is characteristic of ileocecal tuberculosis, indicating inflammation and stricture at the ileocecal junction.</p> Signup and view all the answers

<p>Skin excoriation.</p> Signup and view all the answers

<p>Eating small, frequent meals, avoiding sugar-rich liquids and simple sugars, and avoiding liquids with meals.</p> Signup and view all the answers

<p>The most common complication of bariatric surgery is iron deficiency. Other common deficiencies include vitamin B12, calcium, and Vitamin D3.</p> Signup and view all the answers

<p>A trichobezoar is a hairball in the stomach. It is associated with trichophagia, a psychiatric condition where the patient eats their own hair.</p> Signup and view all the answers

<p>Achalasia cardia is a motor disorder of the esophagus characterized by impaired relaxation of the lower esophageal sphincter. Barium swallow reveals a gradual tapering of the esophagus, referred to as a &quot;bird's beak appearance&quot;, which is suggestive of achalasia cardia.</p> Signup and view all the answers

<p>Acute abdominal pain, guarding, and gas under the diaphragm are suggestive of peritonitis.</p> Signup and view all the answers

<p>A Mallory-Weiss tear is a self-limiting tear in the lower esophagus that extends into the cardia. The left gastric artery is the vessel that commonly bleeds.</p> Signup and view all the answers

<p>Bladder, testicular, and oral cancers all utilize the TNM staging system.</p> Signup and view all the answers

<p>Gastric cancer can be staged using the Borrmann staging and the Japanese classification. The Borrmann classification is used for advanced gastric cancer, while the Japanese classification is used for early gastric cancer.</p> Signup and view all the answers

<p>Nutcracker esophagus is characterized by increased pressure in the esophagus, leading to chest pain and dysphagia.</p> Signup and view all the answers

<p>McBurney's point is located at the junction of the lateral one-third and medial two-thirds of a line joining the anterior superior iliac spine to the umbilicus. In acute appendicitis, this is the site of maximum pain and tenderness.</p> Signup and view all the answers

<p>Right hypochondrial pain radiating to the back, vomiting, and guarding in the right hypochondrium are suggestive of acute cholecystitis. Ultrasound is the investigation of choice for this condition.</p> Signup and view all the answers

<p>An appendicular lump is a localized mass of inflammation that forms after appendicitis. They are often managed conservatively. If conservative management fails, an appendicular abscess can form, requiring drainage. This strategy is known as the Asna Sharin regime.</p> Signup and view all the answers

<p>Scaphoid abdomen, respiratory distress, and bowel seen in the thorax on x-ray are suggestive of congenital diaphragmatic hernia. The most common type is a Bochdalek hernia, occurring on the left posterolateral side.</p> Signup and view all the answers

<p>Boerhaave syndrome is a spontaneous esophageal perforation characterized by sudden onset of chest pain after vomiting, tachycardia, decreased air entry, and a crunching sound on heart auscultation (Hamman's sign). The classic triad includes wretching, chest pain, and subcutaneous emphysema.</p> Signup and view all the answers

<p>Barrett's esophagus is a condition where the normal squamous epithelium lining the esophagus is replaced by columnar epithelium, similar to the intestines. Goblet cells are pathognomonic for Barrett's esophagus and are identified on biopsy.</p> Signup and view all the answers

<p>Zenker's diverticulum develops at Killian-Dehiscence, a potential space between the thyropharyngeus and cricopharyngeus muscles. Regurgitation is the earliest symptom, while aspiration pneumonitis is the most common complication.</p> Signup and view all the answers

<p>Rectal biopsy</p> Signup and view all the answers

<p>Parks system</p> Signup and view all the answers

<p>Delorme procedure</p> Signup and view all the answers

<p>Ultrasound</p> Signup and view all the answers

<p>Adherence between the gallbladder and the common bile duct</p> Signup and view all the answers

<p>Terminal ileum or the last 60 cm of the ileum</p> Signup and view all the answers

<p>To drain the collection</p> Signup and view all the answers

<p>MRCP (Magnetic resonance cholangiopancreatography)</p> Signup and view all the answers

<p>Sinus bradycardia</p> Signup and view all the answers

<p>Varies needles are specifically designed for pneumoperitoneum creation with a beveled edge and stop valve.</p> Signup and view all the answers

<p>Lipase</p> Signup and view all the answers

<p>Whipple's procedure</p> Signup and view all the answers

<p>Anastomotic leak</p> Signup and view all the answers

<p>Lesser sac</p> Signup and view all the answers

<p>Failure of the ventral pancreatic bud to rotate correctly</p> Signup and view all the answers

<p>Parastomal hernia</p> Signup and view all the answers

<p>Calcium oxalate</p> Signup and view all the answers

<p>Ranula</p> Signup and view all the answers

<p>Herniotomy</p> Signup and view all the answers

<p>Hand hygiene</p> Signup and view all the answers

<p>Superficial spreading melanoma</p> Signup and view all the answers

<p>Struvite or staghorn stones</p> Signup and view all the answers

<p>Prophylactic antibiotics are most effective when administered shortly before the surgical procedure.</p> Signup and view all the answers

<p>The spleen is a fragile organ located in the left upper quadrant of the abdomen and is often injured in blunt abdominal trauma.</p> Signup and view all the answers

<p>Seat belt syndrome typically involves injury to the mesentery of the small bowel due to the pressure of the seat belt.</p> Signup and view all the answers

<p>A core needle biopsy is preferred over fine-needle aspiration for the investigation of breast lumps as it provides a larger tissue sample for diagnosis.</p> Signup and view all the answers

<p>The liver is a large, vascular organ that is vulnerable to injury in penetrating abdominal trauma.</p> Signup and view all the answers

<p>Primary vaginal hydrocele is the most common type, affecting the tunica vaginalis of the testicle.</p> Signup and view all the answers

<p>Basal cell carcinoma is a common type of skin cancer that is often described as a rodent ulcer due to its appearance and behavior.</p> Signup and view all the answers

<p>Excision is the preferred treatment for ranulas as it removes the source of the cyst and reduces the risk of recurrence.</p> Signup and view all the answers

<p>T4b classification of breast cancer refers to skin involvement, characterized by a prominent peau d’orange appearance of the breast, ulceration, satellite nodules, or orange peel appearance, or ulceration. Retraction and dimpling are not considered skin involvement.</p> Signup and view all the answers

<p>Frey's syndrome occurs when nerve endings from the superficial lobe of the parotid gland, which is often removed during surgery, grow into the skin. This results in sweating on the cheek during meals, as the sweat glands are stimulated by the parasympathetic nerves.</p> Signup and view all the answers

<p>Chest wall involvement (T4a) in locally advanced breast cancer extends beyond the pectoralis muscle, indicating invasion of other structures within the chest wall.</p> Signup and view all the answers

<p>T3N1M0 indicates that the tumor is larger than T2 (greater than 5cm), and involves 1-3 axillary lymph nodes, but there is no distant metastasis (M0). Conversely, T4N0N2 indicates a tumor size of T4 or greater, with no involvement of axillary lymph nodes, but 2 or more distinct lymph nodes outside the axilla.</p> Signup and view all the answers

<p>The digastric or stylohyoid muscle flap acts as a barrier, preventing the regrowth of nerve endings from the parotid gland into the skin, thereby reducing the risk of gustatory sweating (Frey's Syndrome) after parotid gland surgery.</p> Signup and view all the answers

Indicated by x-ray in peritonitis cases, often requiring laparotomy.

A sign that indicates peritonitis, caused by inflammation.

Shows difficulty swallowing in a child; confirmed via x-ray.

Three narrow spots in the esophagus common for obstruction.

24-hour pH monitoring is the gold standard for diagnosing GERD.

Diagnosed using an invertogram, assessing distances for anomalies.

Enlarged veins in esophagus, likely the cause of hematemesis and melena.

Symptoms like dizziness after eating in patients post-gastric surgery.

Cancer of the esophagus characterized by symptoms like dysphagia and weight loss.

A condition where the esophagus fails to relax properly affecting swallowing.

A procedure to obtain tissue samples for diagnosing cancers like esophageal cancer.

A narrowing of the pylorus, leading to non-bilious vomiting in infants.

A radiological sign seen in hypertrophic pyloric stenosis indicating an abnormal pylorus.

Common after total gastrectomy, leading to megaloblastic anemia and neurological symptoms.

Bacteria causing diarrhea after antibiotic use, leading to pseudomembranous colitis.

A motility disorder of the esophagus marked by intermittent chest pain and dysphagia.

A periumbilical nodule indicating metastasis from abdominal cancers.

Surgical procedures to aid weight loss, predominantly sleeve gastrectomy.

Increased blood pressure in the portal venous system, associated with liver disease.

A clinical sign associated with mesenteric cysts featuring periumbilical lump, resonance, and findings.

A metabolic disorder found in hypertrophic pyloric stenosis due to electrolyte imbalances.

The most commonly performed bariatric surgery aimed at reducing stomach size.

A congenital condition involving absence of ganglion cells in part of the colon, causing constipation.

A localized collection of pus near the anus, often needing drainage.

A system to classify perianal fistulas based on their anatomy.

Protrusion of the rectal mucosa through the anus.

A cyst in the natal cleft, often seen in people who sit a lot.

Swollen hemorrhoids that are painful due to clot formation.

An abnormal connection between the gallbladder and common bile duct, often forming due to obstructing stones.

A condition where gallstones obstruct the cystic duct, causing dilation of the common bile duct.

Classic symptoms of gallstone ileus: pneumobilia, bowel obstruction, and radiopaque shadow.

A minimally invasive surgery to remove the gallbladder, often leading to bile leaks.

Inflammation of the pancreas, typically presenting with severe abdominal pain and elevated lipase levels.

A complex surgery for periampullary cancers, involving removal of pancreas head, duodenum, and stomach part.

A fluid-filled cavity near the pancreas, often following pancreatitis.

A rare condition where the pancreas encircles the duodenum due to improper rotation during development.

An abdominal protrusion through a weakened area around a stoma.

A protrusion of tissue through the inguinal canal in the groin area.

A hernia at the umbilicus with an inverted appearance.

A birth defect where intestinal organs protrude through the umbilicus, covered by a membrane.

A squamous cell carcinoma resulting from a long-standing venous ulcer or burn.

A type of skin cancer with pearly white margins that invades locally.

A guideline to identify suspicious moles based on Asymmetry, Border, Color, Diameter, and Evolution.

The preferred imaging method for diagnosing renal stones.

Usually managed with herniotomy for congenital hydrocele.

A benign tumor of a milk duct, often presenting with bloody discharge.

A system for categorizing breast imaging findings to guide management.

Core needle biopsy is the investigation of choice for breast lumps.

Administered 30 minutes to 1 hour before surgery to prevent infections.

Effective hand hygiene is key to preventing surgical wound infections.

To prevent dumping syndrome, eat small meals, avoid sugar-rich liquids, and liquids with meals.

Common complications include iron, vitamin B12, calcium, and vitamin D3 deficiencies.

A hairball in the stomach, linked to trichophagia, needing psychiatric referral.

Acute abdominal pain and gas under the diaphragm suggest peritonitis.

Self-limiting tear in lower esophagus with hematemesis due to stress or vomiting.

A cancer staging system using Tumor, Node, and Metastasis categories.

Condition with increased esophageal pressure causing chest pain and dysphagia.

The site of maximum tenderness in acute appendicitis, on the right side.

Inflammation of the gallbladder causing right hypochondrial pain and vomiting.

Formation of abscess post-appendicitis requiring drainage after conservative management fails.

A defect allowing abdominal organs into the thorax, common type is Bochdalek hernia.

Spontaneous esophageal perforation with chest pain and Hamman's sign.

Metaplasia of esophageal epithelium, replaced by columnar epithelium.

A false diverticulum caused by Killian-Dehiscence, leading to regurgitation.

Includes classifications such as T3N1M0, T4N0N2, and T4N3.

Denoted by T4d; causes swelling and redness in breast tissue.

Involvement of the chest wall does not include the pectoralis muscle (T4a).

Gustatory sweating occurs after parotid gland surgery due to nerve growth into the skin.

Using a digastric or stylohyoid muscle flap during surgery can prevent this syndrome.

A condition where the small intestine is blocked, causing inability to pass feces.

Dilated small bowel loops arranged in a stepladder pattern on X-ray indicate small bowel obstruction.

The preferred methods are erect and supine X-ray of the abdomen to detect obstruction.

The cecum is the first structure assessed during surgery for suspected bowel obstruction.

Characterized by low-grade fever, anorexia, weight loss, and a specific barium meal finding.

A condition where bowel muscles temporarily stop working, shown by X-ray with distended bowel.

A true diverticulum located 2 feet from the ileocecal junction, often presenting with bleeding.

Twisting of the sigmoid colon causing obstruction, often showing 'coffee bean' on X-ray.

Congenital blockage of the duodenum, indicated by bilious vomiting and 'double bubble' sign on X-ray.

A procedure to visualize the entire colon for tumors when suspicious symptoms are present.

A condition in newborns where the vitellointestinal duct doesn't close, leading to discharge from the umbilicus.

An inherited condition characterized by polyp growth and dark spots around the mouth.

Inflammatory bowel disease presenting with blood and mucus in stool, involving rectal inflammation.

An ileostomy has two openings while a colostomy is flush with the skin.