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Sam: Emergency Medicine > Approach to the Acute Abdomen -- SD > Flashcards

Approach to the Acute Abdomen -- SD Flashcards

1
Q

When would we get an MRI for an abdominal complaint?

A

Pregnant woman with abdominal pain – especially in 1st trimester

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2
Q

Women of child-bearing age presenting with abdominal pain, what must we do on PE?

A

Pelvic exam

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3
Q

1 month old presenting with nonbilious vomiting – what’s on your DDx?

A

GERD, hypertrophic pyloric stenosis

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4
Q

2 month old presenting with bilious vomiting – whats on your DDx?

A

malrotation, volvulus, Hirschsprung’s disease, hernias, meningitis, sepsis

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5
Q

2 year old presenting with abdominal pain – DDx?

A

Intussusception, Wilm’s tumor

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6
Q

Most common ages to present with appendicitis?

A

6-18

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7
Q

What is the most common cause of abdominal pain in children?

A

Constipation

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8
Q

Severe, explosive pain should make you think of?

A

Perforation of hollow viscous

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9
Q

Progressive, severe pain?

A

Worsening disease – ischemic necrosis

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10
Q

Localized, then generalized pain?

A

Perforation

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11
Q

Crampy, crescendo-descrescendo pain?

A

Obstruction

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12
Q

Pain radiating to the low back?

A

Salpingitis or cystitis

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13
Q

Pain radiating to the mid-back?

A

Pancreatitis, ulcer, or cholecystitis

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14
Q

When does pain radiate to the shoulder?

A

Diaphragmatic irritation

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15
Q

Can you give pain medication to someone with acute abdominal pain before a surgical consult?

A

Yes!

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16
Q

Localized, unrelieved epigastric pain that increases with swallowing

A

Esophageal perforation

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17
Q

What is an esophageal perforation typically preceded by?

A

Violent emesis

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18
Q

What is the main cause of an esophageal perforation?

A

50-60% iatrogenic

15% Borhaave’s

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19
Q

What populations are at risk for gastric ulcers?

A

Males and older folks

Those with heavy NSAID and ASA use

EtOH and smoking

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20
Q

Periodic pain, awakens patient at night, may be better or worse with food

A

Gastric ulcers

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21
Q

What is a Mallory-Weiss tear?

A

A partial thickness tear of esophagogastric junction

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22
Q

Hematemesis after repetitive vomiting, chest pain, and coughing should make you think of?

A

Mallory-Weiss tear

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23
Q

How do we treat gastric ulcers?

A

GI cocktail – IV PPI/H2 blocker

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24
Q

How do we diagnose a Mallory-Weiss tear?

A

Need EGD but not emergently

Chest x-ray to rule out free air/pneumomediastinum

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25
Q

How do we treat a Mallory-Weiss tear?

A

Conservatively

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26
Q

What are the most common type of gallstones?

A

Cholesterol stones

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27
Q

What do we call the presence of stones in the gallbladder?

A

Cholelithiasis

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28
Q

What are risk factors for developing gallstones? Hint** 5 F’s

A

Female, fat, forty, fair, and fertile

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29
Q

These people will often have pain after a fatty meal in the RUQ – may radiate to chest, right shoulder or scapula

A

Cholelithiasis

30
Q

What is the best diagnostic test for diagnosing cholelithiasis?

A

Ultrasound

31
Q

Should you see gallbladder thickening on ultrasound for someone with cholelithiasis?

A

No

32
Q

How do we treat cholelithiasis?

A

Toradol, morphine, zofran for symptom control

33
Q

Patients will present with fever, chills, vomiting, and severe pain that is often postprandial

A

Cholecystitis

34
Q

What is murphy’s sign?

A

When you push on the RUQ, patient will stop taking breath in due to pain

35
Q

What’s going on with Cholecystitis?

A

gallstone obstructing the cystic duct

36
Q

Who is at greatest risk for developing cholecystitis?

A

Women ages 30-80

37
Q

If cholelithiasis is left untreated, what can develop?

A

Empyema, gangenous gallbladder, perforation

38
Q

How do we treat cholecystitis?

A

Surgery is definitive!

39
Q

This will present with intermittent, colicky pain that may radiate to the back. Patient may be jaundiced.

A

Choledocholithiasis

40
Q

Where is the blockage occurring in choledocholithiasis?

A

Common bile duct

41
Q

Choledocholithiasis is a common cause of?

A

Pancreatitis

42
Q

How do we treat choledocholithiasis?

A

Emergency surgery consult

IV abx necessary because likely have associated cholecystitis

43
Q

What is the most common cause of pancreatitis?

A

Alcoholism

44
Q

What presents with severe, unrelenting pain that radiates to the back? Nausea and vomiting are also very common.

A

pancreatitis

45
Q

True or false

patients with pancreatitis often feel better if they are lying down

A

False!

Pain is worse when lying down – feel better if slumped forward

46
Q

Do patients with pancreatitis typically exhibit both guarding and rebound tenderness?

A

Guarding, yes.

Usually no rebound tenderness.

47
Q

What will a patient’s vitals look like with pancreatitis?

A

Fever, tachycardia, may be hypotensive

48
Q

True or False

patient’s with pancreatitis will have hypoactive bowel sounds?

A

True! Decreased to no bowel sounds.

49
Q

This lab value three times its normal value has greater than 95% positive predictive value for biliary pancreatitis

A

ALT

50
Q

What criteria do we use for prognosis for pancreatitis?

A

Ranson’s

51
Q

What lab value three times its normal has nearly 100% sensitivity and specificity for pancreatitis?

A

Lipase

52
Q

How do we treat pancreatitis?

A

IV hydration with large amounts of fluid. IV nausea and pain meds.

53
Q

Elderly person with back pain is treated as a _________ until prover otherwise

A

AAA

54
Q

Sudden onset of pain, mid abdomen, radiating to back or groin think of?

A

AAA

55
Q

When will you find asymmetric femoral pulses?

A

AAA

56
Q

What do vitals signs look like when someone is experiencing a AAA?

A

Vital signs are initially normal and then tank rapidly

57
Q

What is the only treatment for unstable patient with known leaking AAA?

A

Emergent surgery

58
Q

What population does mesenteric adenitis usually present in?

A

Children and young adults

59
Q

Appendicitis in this population is very difficult to diagnose.

A

Pregnant women

60
Q

How does pain for appendicitis classically present?

A

Starts in periumbilical region and migrates to RLQ

61
Q

Appendicitis is most common between these ages

A

10-40

62
Q

Appendicitis in children less than ______ years old is very rare

A

Five

63
Q

What are four signs we can look for on physical exam to test for appendicitis?

A

Rovsing’s, Heel strike, Obturator, and Psoas

64
Q

90% of diverticulitis occurs in what part of the colon?

A

Sigmoid

65
Q

What are symptoms of diverticulitis?

A

Constant pain, fever, constipation, and anorexia

66
Q

How do we diagnose diverticulitis in the ED setting?

A

CT scan with PO and IV contrast

X-rays not helpful unless looking for obstruction

67
Q

These patients will present with abdominal pain, nausea/vomiting, diarrhea, pencil-like stools, or no bowel movement

A

Bowel obstruction

68
Q

For bowel obstructions –

Abdomen will be distended or non-distended? Have hypo or hyperactive bowel sounds? Be tender or non-tender?

A

Abdomen is distended, hyperactive bowel sounds, and diffusely tender

69
Q

How do we diagnose a bowel obstruction?

A

KUB with upright abdomen

CT if indicated

70
Q

How do we treat a bowel obstruction?

A

NPO, NG tube to wall suction, pain medications, surgery consult

71
Q

Painless rectal bleeding with blood/mucus is associated with crohn’s or ulcerative colitis?

A

Ulcerative colitis

Sam: Emergency Medicine (12 decks)

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