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Emergency > 10 - abdominal > Flashcards

10 - abdominal Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

In a teen male with abdominal pain, what don’t you want to miss?

A

Testicular torsion

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2
Q

In menstruating females, what lab must you order?

A

HCG

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3
Q

If you suspect a surgical belly, what lab must you order?

A

type and cross

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4
Q

When do you order KUB?

A

suspect obstruction, FB, to see free air

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5
Q

What is MANTRELS?

A 
clinical assessment of Abd pain for appendix:
M--migration to RLQ
A--anorexia
N--n/v
T--tender RLQ**
R--rebound
E--elevated temp
L--leukocytosis**
S--Shift left
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6
Q

Using MANTRELS in combo with what test gives 98% sens for appedicitis

A

CT with oral and IV

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7
Q

What KUB findings help identify the small intestine? Large intestine?

A

plicae circulares (coins), haustra

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8
Q

What causes SBO?

A

ADHESIONS

and hernias

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9
Q

what complaints are common in pt with SBO?

A

1) crampy, colic pain that is severe and intermittent.
2) vomiting
3) no flatus
4) high pitched bowel sounds

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10
Q

Dx SBO?

A

3 view KUB followed by CT if KUB is abnormal

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11
Q

Tx of SBO?

A

1) fluids
2) pain and nausea control
3) decompression with NG tube
4) sx intervention based on obstruction

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12
Q

Air fluid line on KUB is highly indicative of?

A

SBO

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13
Q

What causes LBO?

A

1) NEOPLASMS
2) diverticulitis
3) sigmoid volvulus

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14
Q

How does LBO present?

A

similar to SBO

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15
Q

How do you dx LBO?

A

1) xray

2) CT for abnormal xray

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16
Q

How do you tx LBO?

A

same as SBO?

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17
Q

What xray findings are common with LBO?

A

dilation of colon

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18
Q

sudden severe upper abd pain a/w duodenal ulcer of diverticulitis

A

bowel perf

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19
Q

dx perf

A

xray and IMMEDIATE SX CONSULT. Get CT after sx consult has been called

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20
Q

tx perf

A

broad spectrum abx, sx

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21
Q

What if you see air above the liver on film?

A

AAAHHH, perf

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22
Q

5 F’s of biliary dz

A

1) female
2) 40’s
3) fat
4) fertile
5) fair

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23
Q

what labs are specific to biliary dz?

A

lipase

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24
Q

What imaging is the test of choice for biliary problem?

A

US–thick GB wall, dilated CBD (common bile duct), fluid around GB

25
Q

tx of biliary dz?

A

Abx, fluids, sx

26
Q

Cholelithiasis without infection is treated how?

A

outpatient with elective cholecystectomy (just a stone)

27
Q

The ________ point is the large bowel flexure at the LUQ. The _______ point is the large bowel flexure at the sigmoid to colon flexure

A

Griffith’s, Sudeck’s are most susceptible to ischemia

28
Q

Common arteries affected by mesenteric ischemia

A

celiac, mesenteric, iliac

29
Q

clinical feature of mesenteric ischemia

A

1) central abd pain out of proportion to exam
2) wt loss
3) blood diarrhea

30
Q

Dx of mesenteric ischemia:

A

1) WBC’s, lactic acid

2) CTA

31
Q

Tx of mesenteric ischemia:

A

1) sx–bypass

32
Q

patient c/o fever/chills, flank pain

A

pyelonephritis

33
Q

Do you need to order imaging to dx pyelonephritis? If so, what?

A

No, clinical….if there’s significant pain c/w obstruction get CT

34
Q

How can you tell the difference b/t pyelonephritis and kidney stone without ordering image?

A

radiating flank pain, sudden onset, hematuria are present in stone. Get CT

35
Q

If you suspect appendicitis, what do you expect the WBC to look like?

A

trickster! Completely unreliable and it will vary tremendously

36
Q

another word for parietal pain, which is well localized

A

somatic

37
Q

pt describes abd pain as “constant”. What is most likely to be affected?

A

solid organ

38
Q

“colicky” abd pain

A

obstruction….of ureter, GB, pancreas, any organ (rather than blood supply)

39
Q

epigastric pain that radiates to back, n/v. You r/o cardiac cause. What is next on the DDx?

A

acute pancreatitis

40
Q

how do you dx pancreatitis?

A

LFT’s, lipase, CT

41
Q

this is a bluish discoloration of the flank common in acute pancreatitis

A

gray turner

42
Q

this is a bluish discoloration of the periumbilical region common in acute pancreatitis

A

Cullen sign

43
Q

this complication of cholecystitis is a surgical emergency due to risk of septic shock

A

acute supperative cholangitis

44
Q

What’s the charcot’s triad?

A

indicates cholangitis: RUQ pain, fever, jaundice

45
Q

what’s the reynold’s pentad?

A

indicates cholangitis gone wild: RUQ pain, fever, jaundice, sepsis, shock

46
Q

how do you dx acute cholangitis?

A

US

47
Q

how do you tx acute cholangitis?

A

fluids, broad spectrum abx, emergent surgical consultation

48
Q

female c/o abd pain, amenorrhea and vaginal bleeding. What do you order?

A

HCG, US, type and cross

49
Q

how do you tx ectopic pregnancy?

A

1) Medical–Methotrexate

2) Sx

50
Q

chandelier sign is indicative of what?

A

PID

51
Q

If you suspect PID, what imaging will you order? What other conditions must you r/o?

A

US, r/o TOA, ovarian torsion

52
Q

How is mild PID managed medically?

A

Levaquin or 3rd gen,

flagyl

53
Q

when would you admit a woman with PID? And what abx would they need?

A 
pregnancy
uncontrolled pain
NPO
immunocomp
3rd gen+doxy
54
Q

what s/s would you expect on a pt with peritonitis?

A

involuntary guarding, fever, tachy, ileus, n/v

55
Q

SAD PUCKER–these sites are affected by any retroperitoneal bleed

A 
suprarenal glands
aorta/IVC
duodenum
pancreas
ureters/bladder
colon (ascending/descending)
kidneys
esophagus
rectum
56
Q

a patient with a retroperitoneal bleed will have what s/s?

A

back/flank pain, dizziness/weakness, syncope, grey turner sign

57
Q

What do you order for suspected retroperitoneal bleed?

A

coag’s, type and screen, CT

58
Q

Bedside US is useful for what?

A

1) trauma assessment
2) detect free fluid
3) measure abd aorta diameter
4) GYN probs (pregnancy, ectopic, etc)
5) gallstones
6) hydronephrosis
7) IVC collapse

59
Q

If you see free fluid on CT of a patient with abd trauma, but no solid organ injury, what should you suspect?

A

GI perf

Emergency (10 decks)

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