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Abd Pain EM


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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