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Abd Pain EM
Gastroenterology
| Question | Answer |
|---|---|
| What is the most life threatening gynecologic cause of acute abdomen in the female patient | Ectopic pregnancy |
| Amylase is elevated in __ | Pronounced: acute pancreatitis; moderate: small bowel obstruction, salivary gland infxn/inflam, mumps, panc ca, perf'd peptic ulcer |
| 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 Meckel’s diverticulitis | 2% of the pop, 2 feet proximal to the ileocecal valve, 2 types of mucosa, 2 years of age, 2:1 M:F ratio |
| What is the treatment for Meckel’s diverticulitis | Resection |
| Severe epigastric pain radiating to the back, often associated with ETOH, usually elevated amylase/lipase | 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 and facilitate assessment of S/S | metoclopramide |
| what is the most reliable symptom of appendicitis | abdominal pain |
| palpation of the LLQ quadrant with pain referred to the RLQ is referred to as the __ and is indicative of __ | Rovsings sign, acute appendicitis |
| the diagnosis of acute appendicitis is generally __ | clinical |
| 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 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 there 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 |
| R/LLQ pain, purulent cervical dc, CMT, adnexal tenderness = | tubo-ovarian abscess |
| AAA RFs | atherosclerosis, elderly, HTN, smoking, CTD/Marfan, +FH, hyperlipidemia |
| S/S in abd trauma | seat belt sx; Chance fx; Grey Turner sx; Cullen sx |
| Chance fx | ecchymosis across lower abd 2/2 seat belt, assoc L-spine fx |
| Grey Turner sx | ecchymosis over flanks, usu dev after 12 hrs = retroperitoneal hemo |
| Cullen sx | ecchymosis over umbilicus, usu dev after 12 hrs = retroperitoneal hemo |
| mesenteric ischemia: cause | embolus to SMA 2/2 intracardiac thrombus 2/2 A-fib |
| pancreatitis s/s | fever, tachy; poss tachypnea, hypoxia, dec breath sounds if pleural effusion; hypoactive BS, guarding, TTP; abd distension if ileus; Cullen & Gray Turner sxs if hemo |
| pancreatitis tx | supportive: IVF 2/2 n/v; NPO, poss NG tube; pain ctrl |
| SBO tx | NGT for bowel decompression; surg; IVF 2/2 n/v; broad abx (flagyl, amp/ gent) |
| SBO s/s | colicky abd pain in waves, n/v, obstipation; tachy, hypotension; no peritoneal sxs; early: distended tympanitic; later: tinkling BS |
| Tx for diarrhea 2/2 Shigella, Yersinia, ETEC, V cholerae | oral quinolone |
| Infxs diarrhea: no abx for: | SA, B cereus; salmonella, EHEC |
| Ranson's criteria predict M&M for: | pancreatitis |
Created by:
Abarnard
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