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DU PA GI Emr/ab pain

Duke PA Gastrointestinal Emergencies and Abdominal Pain

What is the suspensory ligament of the duodenum Ligament of Treitz
What is the most common cause of lower GI bleeding Hemorrhoids
Common, painless and can be massive, caused from an erosion into penetrating artery from the diverticulum Diverticulosis
What is the most common cause of upper GI bleed Peptic ulcer disease
Cause of esophageal and gastric varices Portal hypertension
Longitudinal mucosal tear in the cardioesophageal region, caused by repeated retching Mallory-Weiss syndrome
Common cause of lower GI bleeding, seen in people with hypertension and aortic stenosis Arteriovenous malformations
Spider angiomata, palmer erythema, jaundice, and gynecomastia are seen in __ Liver disease
Petechiae and purpura seen in __ Coagulopathy
Why would you do a careful ENT exam on a patient suspected of GI bleed Rule out causes that can mimic GI bleed such as epistaxis
Can be diagnostic and therapeutic but requires a brisk bleed at .5-2ml/min angiography
Can only be diagnostic but are more sensitive than angiography and require a bleeding rate of only .1ml/min bleeding scans
Is diagnostic and therapeutic and more accurate than bleeding scans and angiography Colonoscopy
Class __ bleed replace volume with crystalloid I and II
Class __ bleed replace volume with crystalloid and blood III and IV
Hemorrhaging is broken down into how many categories by the ACS 4
Class __ hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary I
Class _ hemorrhage involves 15-30% of total blood volume. A patient is often tachy, narrowed pulse pressure. Peripheral vasoconstriction, pale cool skin, slight changes in behavior, volume resuscitation with crystalloids II
Class __ hemorrhage involves loss of 30-40% of blood volume. The patient’s pressure drops, heart rate increases, peripheral perfusion decreases (prolonged cap refill), mental status worsens. Crystalloid and blood transfusions usually necessary III
Class __ hemorrhage involves loss of >40% of blood volume. Limit of bodies compensation is reached and aggressive resuscitation is required to prevent death IV
__ ulcers do not extend through the muscularis mucosa Stress
Only __ % of patients who are infected with H. pylori will develop ulcers 10-20
Inhibits bicarbonate ion production and increases gastric emptying Cigarette smoking
Main compliant of gastric ulcer Gnawing, aching or burning epigastric pain
Physical exam of uncomplicated PUD, there may be a finding of __ Epigastric tenderness
Inhibit gastric acid secretion, equally as effective as antacids with better compliance due to decreased frequency of doses H2 antagonists
Inhibits gastric acid secretions, heals ulcers faster than H2-antagonists and antacids PPI
Locally binds to the base of the ulcer and therefore protects it from acid Sucralfate
Prostaglandin E1 analogue which acts as natural prostaglandin in the body Misoprostol
Vomiting and diarrhea is most often __ Gastroenteritis
What is the most life threatening gynecologic cause of acute abdomen in the female patient Ectopic pregnancy
Amylase is elevated in __ Pancreatitis, small bowel obstruction, salivary gland infection
ALT/AST is elevated in __ Hepatitis
Bilirubin/Alk Phosphatase is elevated in __ Common bile duct obstruction
Never place __ above an obstruction Barium
Indications for barium studies Volvulus, colon cancer, mucosal detail
Barium studies are not only useless for evaluation of __ they are dangerous Perforation
For what disease process are the five F’s used for Acute cholecystis
Five F’s of acute cholecystis Female, Fertile, Forty, Fat, Flatulent
Murphy’s sign is used to help diagnose __ Acute cholecystitis
Periumbilical pain that migrates to RLQ, anorexia is a possible history of __ Acute appendicitis
Obturator sign/psoas sign is used to help diagnose __ Acute appendicitis
__ hours after acute appendicitis symptom onset there is a >95% perforation rate 48
What is the rule of 2’s for Mecke’s diverticulitis 2% of the pop, 2 feet proximal to the ileocecal valve, 2 types of mucosa, 2 years of age, 2:1 male female ratio
What is the treatment for Meckel’s diverticulitis Resection
Severe epigastric pain radiating to the back, often associated with ETOH, usually elevated amylase Acute pancreatitis
Distended abdomen, surgical scars, high pitched bowel sounds, tympanic to percussion, nausea w/ bilious vomiting, constipation, often severely dehydrated Small bowel obstruction
Non-operative treatment for small bowel obstruction NPO, NGT (decompression), IV fluids
Most common causes of large bowel obstruction Diverticulitis, cancer, volvulus
LLQ pain, fever Diverticulitis
Sudden onset of sharp ab pain, N/V, diarrhea, GI bleeding, pain out of proportion to physical exam, may have history of angina, atherosclerosis, smoking Mesenteric ischemia
Midline ab pain with tearing sensation to the back, patients often present in shock, exam reveals pulsatile mass Ruptured AAA
>__ cm AAA has an increased risk of rupture 20-30% within 5 years 5
patients with __ pain tend to lie still peritoneal
patients with __ pain tend to move about visceral
__ should be considered in any patient older than 50 with ab pain out of proportion to physical findings mesenteric ischemia
CT is the preferred imaging modality for what emergencies pancreatitis, biliary obstruction, aortic aneurysm, appendicitis, and urolithiasis
__ in appropriate doses may decrease guarding and improve localization of abdominal pain opiates
antiemetics such as __ increase patients comfort an facilitate assessment of signs and symptoms metoclopramide
which is more common upper or lower GI bleeding upper
what is the most common cause of acute lower GI bleeding hemorrhoids, followed by diverticular disease
what is the most important lab test for a patient with a significant GI bleed type and crossmatch
what is the most reliable symptom of appendicitis abdominal pain
palpation of the left lower quadrant with pain referred to the right lower quadrant is referred to as the __ and is indicative of __ Rovsings sign, acute appendicitis
the diagnosis of acute appendicitis is generally __ clinical
what is now considered the imaging study of choice for diagnosing acute appendicitis CT
the most significant predictors of acute appendicitis in the elderly are __ tenderness, rigidity, pain at diagnosis, fever, and previous abdominal surgery
what are the main features of intestinal obstruction crampy, intermittent, progressive ab pain
what radiographs should be obtained to assess for intestinal obstruction flat and upright abdominal, and upright chest
what causes the pseudoobstruction that commonly occurs in the low colonic region depression of intestinal motility from medications such as anticholinergic agents, or tricyclic antidepressents
in the case of pseudoobstruction what is diagnostic as well as therapeutic colonoscopy
predominant means of diagnosis for hernias physical examination
should you attempt hernia reduction if the is a question about the duration of the incarceration no
__ hernias in children are common umbilical
when should a child with an umbilical hernia be referred for surgical evaluation children older than 4 or with hernias greater than 2cm in diameter
treatment of choice for patients with pseudomembranous colitis metronidazole for mild to moderate disease in patients who do not respond to supportive measures
__ should be reserved for patients with pseudomembranous colitis who have not responded to or are intolerant of metronidazole and for children and pregnant patients vancomycin
for patients with pseudomembranous colitis __ may prolong or worsen symptoms and should be avoided antidiarrheal agents
when is surgical treatment for hemorrhoids indicated severe, intractable pain, continued bleeding, incarceration, or strangulation
Created by: bwyche