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DU PA GI Emr/ab pain
Duke PA Gastrointestinal Emergencies and Abdominal Pain
| Question | Answer |
|---|---|
| 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
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