Under the initiative http://emilienko.blogspot.com/ MIR 2.0 I have reviewed the exam and I chose 17 questions from surgery or that may be related with it, there are several gastroenterology or oncology that hopefully meet other students. The hanging will go as the answer and Emilienko (Emilio Dominguez) the hang of Wikisanidad.
Question 1 Female 83 years old with a history of diabetes mellitus, hiatus hernia , duodenal ulcer and inguinal hernia. Follow standard treatment with metformin, omeprazole, and iron anemia for months. Go to the emergency department with nausea, abdominal cramping, vomiting and constipation than 48 hours of onset. Physical examination diffusely distended and painful abdomen no signs of peritoneal irritation. Decreased bowel sounds. No palpable masses. Laboratory tests: Hb 8.5 g / dl, MCV 80, Palquetas 240000/uL, 10.200/ul leukocytes (81% granulocytes), pH 7.31, HCO3 17 mmol / L, amylase 150U / L (28-100), LDH 252 U / L, creatinine 1.1 mg / dL. Normal rest. Radiology of the abdomen: see iamgen1. His tentative diagnosis is:
1. Constipation secondary to iron therapy
2.
Acute Pancreatitis 3. Acute Gastristis
4. Ileus secondary to ionic alterations.
5. Mechanical intestinal obstruction at the distal ileum and cecum.
I think the answer is 5 think there is no doubt that the Rx shows a dilated distal small bowel with no gas in the colonic frame, if we add the absence of previous surgery, the extraperitoneal operation is hernorrafia and gives no adhesions. Anemia at 83 focuses on gastrointestinal tumor colon probably has no right under the VCM treatment with iron. I think it's a question easily resolved because there are other possible answers.
1. Constipation secondary to iron therapy
2.
Acute Pancreatitis 3. Acute Gastristis
4. Ileus secondary to ionic alterations.
5. Mechanical intestinal obstruction at the distal ileum and cecum.
I think the answer is 5 think there is no doubt that the Rx shows a dilated distal small bowel with no gas in the colonic frame, if we add the absence of previous surgery, the extraperitoneal operation is hernorrafia and gives no adhesions. Anemia at 83 focuses on gastrointestinal tumor colon probably has no right under the VCM treatment with iron. I think it's a question easily resolved because there are other possible answers.
Question 2. Question
linked to the image # 1. The most appropriate initial clinical management for the patient would be:
1. NPO, nasogastric tube with suction and fluid therapy with KCl. Request emergency abdominal CT.
2. Enemas until complete resolution. Repeat Rx control.
3. Fluid therapy with bicarbonate 1 / 6 M, NaCl and KCl intravenously.
4. NPO 8h. tolerance test and discharged via lactulose and oral domperidone.
5. Analgesia and omeprazole intravensoso. If not better assess urgent gastroscopy.
I think the answer is 1. Aspiration and the volume and electrolyte replacement is the mainstay of treatment of mechanical intestinal obstruction. CT is necessary to objectify the cause of obstruction without surgery prior to the indication for surgery in this case is indicated. The acidosis is treated with volume expansion and intervention to resolve the case, there may be intestinal necrosis. The second most likely answer is 3 but omits the vacuum and makes no reference to the TC, is the trap of bicarbonate and probably have been answered as correct by many, see the official response. Tomorrow
more and better to me very late ..... linked to the image # 1. The most appropriate initial clinical management for the patient would be:
1. NPO, nasogastric tube with suction and fluid therapy with KCl. Request emergency abdominal CT.
2. Enemas until complete resolution. Repeat Rx control.
3. Fluid therapy with bicarbonate 1 / 6 M, NaCl and KCl intravenously.
4. NPO 8h. tolerance test and discharged via lactulose and oral domperidone.
5. Analgesia and omeprazole intravensoso. If not better assess urgent gastroscopy.
I think the answer is 1. Aspiration and the volume and electrolyte replacement is the mainstay of treatment of mechanical intestinal obstruction. CT is necessary to objectify the cause of obstruction without surgery prior to the indication for surgery in this case is indicated. The acidosis is treated with volume expansion and intervention to resolve the case, there may be intestinal necrosis. The second most likely answer is 3 but omits the vacuum and makes no reference to the TC, is the trap of bicarbonate and probably have been answered as correct by many, see the official response. Tomorrow
Sweet dreams after so much stress and dream of the first post ....
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