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