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10 - abdominal 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
tx of biliary dz?
Abx, fluids, sx
26
Cholelithiasis without infection is treated how?
outpatient with elective cholecystectomy (just a stone)
27
The ________ point is the large bowel flexure at the LUQ. The _______ point is the large bowel flexure at the sigmoid to colon flexure
Griffith's, Sudeck's are most susceptible to ischemia
28
Common arteries affected by mesenteric ischemia
celiac, mesenteric, iliac
29
clinical feature of mesenteric ischemia
1) central abd pain out of proportion to exam 2) wt loss 3) blood diarrhea
30
Dx of mesenteric ischemia:
1) WBC's, lactic acid | 2) CTA
31
Tx of mesenteric ischemia:
1) sx--bypass
32
patient c/o fever/chills, flank pain
pyelonephritis
33
Do you need to order imaging to dx pyelonephritis? If so, what?
No, clinical....if there's significant pain c/w obstruction get CT
34
How can you tell the difference b/t pyelonephritis and kidney stone without ordering image?
radiating flank pain, sudden onset, hematuria are present in stone. Get CT
35
If you suspect appendicitis, what do you expect the WBC to look like?
trickster! Completely unreliable and it will vary tremendously
36
another word for parietal pain, which is well localized
somatic
37
pt describes abd pain as "constant". What is most likely to be affected?
solid organ
38
"colicky" abd pain
obstruction....of ureter, GB, pancreas, any organ (rather than blood supply)
39
epigastric pain that radiates to back, n/v. You r/o cardiac cause. What is next on the DDx?
acute pancreatitis
40
how do you dx pancreatitis?
LFT's, lipase, CT
41
this is a bluish discoloration of the flank common in acute pancreatitis
gray turner
42
this is a bluish discoloration of the periumbilical region common in acute pancreatitis
Cullen sign
43
this complication of cholecystitis is a surgical emergency due to risk of septic shock
acute supperative cholangitis
44
What's the charcot's triad?
indicates cholangitis: RUQ pain, fever, jaundice
45
what's the reynold's pentad?
indicates cholangitis gone wild: RUQ pain, fever, jaundice, sepsis, shock
46
how do you dx acute cholangitis?
US
47
how do you tx acute cholangitis?
fluids, broad spectrum abx, emergent surgical consultation
48
female c/o abd pain, amenorrhea and vaginal bleeding. What do you order?
HCG, US, type and cross
49
how do you tx ectopic pregnancy?
1) Medical--Methotrexate | 2) Sx
50
chandelier sign is indicative of what?
PID
51
If you suspect PID, what imaging will you order? What other conditions must you r/o?
US, r/o TOA, ovarian torsion
52
How is mild PID managed medically?
Levaquin or 3rd gen, | flagyl
53
when would you admit a woman with PID? And what abx would they need?
``` pregnancy uncontrolled pain NPO immunocomp 3rd gen+doxy ```
54
what s/s would you expect on a pt with peritonitis?
involuntary guarding, fever, tachy, ileus, n/v
55
SAD PUCKER--these sites are affected by any retroperitoneal bleed
``` suprarenal glands aorta/IVC duodenum pancreas ureters/bladder colon (ascending/descending) kidneys esophagus rectum ```
56
a patient with a retroperitoneal bleed will have what s/s?
back/flank pain, dizziness/weakness, syncope, grey turner sign
57
What do you order for suspected retroperitoneal bleed?
coag's, type and screen, CT
58
Bedside US is useful for what?
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
If you see free fluid on CT of a patient with abd trauma, but no solid organ injury, what should you suspect?
GI perf

Emergency (10 decks)

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