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EMed > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Why order a KUB?

A

bowel obstruction, foreign body, radio opaque pills (CHIPES).

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2
Q

what is the gold standard imaging for obstructed bowel?

A

CT scan

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3
Q

what is an NG Tube helpful for?

A

decompression (SBO), sample contents (GI bleed), bowel rest (protracted vomiting).

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4
Q

What is in the GI cocktail

A

Mylanta 30cc, 2% viscous Lidocaine 15 cc, addition of donnatol 10cc falling out of favor

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5
Q

Belly labs include

A

cmp, cbc w. diff, lipase, ua, upreg

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6
Q

What is the next step in tx for a GERD/PUD pt who tries and fails H2’s and PPIs

A

Endoscopy

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7
Q

If you see hematochezia, BRBPR where is the bleed?

A

ligament of treitz (duodenal jejunal junction); lower GI bleed

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8
Q

What must be done for Big UGIB or melena

A

add 2 IVs, type/screen, lactic acid, CXR, O2, monitor, NG tube

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9
Q

Tx for major UGIB

A

IV PPIs with drip, urgent endoscopy, octerotide for varices, GI surgery consult

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10
Q

Common reasons for abd pain in alcoholics

A

etoh gastritis, pancreatitis, GIB

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11
Q

The “banana bag” is important for tx in alcoholics, what is it?

A

multivitamins w/ Mg and thiamine

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12
Q

What are some signs of EtOH Withdrawal

A

tongue wag, fever, tremor

these are a red flag in abd pain in alcoholics

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13
Q

prodrome for jaundice and hepatitis

A

malaise, fatigue, anorexia, n/v

this will then turn into abd pain, jaundice, dark urine, “light colored” stools

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14
Q

what imaging would you do for jaundice and hepatitis

A

ULS biliary tract, CT if suspect cancer/mets

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15
Q

Painless jaundice is the hallmark for what diagnosis

A

Pancreatic CA

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16
Q

Red Flags for Jaundice

A

EtOH w/d, altered, ascites, asterixis, bleeding

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17
Q

What is the most common cause of pancreatitis

A

gallstones

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18
Q

What is a significant lab finding for pancreatitis?

A

lipase up x3 for dx

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19
Q

What is the Ranson Criteria, what does it measure?

A

Predicts mortality from pancreatitis (~75% sens)

age>55
Glucose>200
WBC>16k
SGOT (AST) > 250 
LDH > 350
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20
Q

If the ranson criteria score is 3 or greater, what does this mean?

A

pancreatitis likely

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21
Q

If a mortality score for pancreatitis is 7-8 after 48hrs onset, what does this mean

A

100% mortality

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22
Q

What imaging must you get for someone who has their 1st episode of renal colic

A

CT w/o contrast to confirm

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23
Q

Outpatient tx for Renal Colic

A

oral pain meds, alpha blockers (-zosins), urology f/u

24
Q

Biliary colic

A

stones plus symptoms

25
Q

what must you consider if someone presents with ascites and has a fever or painful?

A

SBP- subacute bacterial peritonitis

if they have SBP - give IV abx, monitor, admit

26
Q

First time ascites need to be admitted for w/up. True or False

A

True

27
Q

Most common causes for urinary retention

A

prostate (men), meds (women), hematuria (clot)

note: men>women

28
Q

Tx for urinary retention

A

alpha blockers

often home with foley/leg bag for 2-3 weeks

29
Q

Symptoms of gastroparesis

A

intractable n/v, abd pain, fullness

30
Q

Tx for gastroparesis

A

IV hydration, metoclopramide

31
Q

Triggers for sickle cell crisis abd pain

A

infection, dehydration, stress, altitude, cold weather

32
Q

Tx for sickle cell crisis abd pain

A

iv hydration, pain control +/- opiates

33
Q

what type of drug is a risk for mesenteric ischemia

A

stimulants

34
Q

what imaging do you use for mesenteric ischemia

A

CT angio

35
Q

what are the mimics of the abdominal pain

A

AMI/ACS: upper abd pain gets EKG

AAA: older pts, LLQ abd pain - CT

Thoracic Aortic Dissection: chest and abd pain, atypical

Appy: always on list!

36
Q

DDx for sudden rapid onset for acute abdomen

A

vascular, perforation, rupture, obstruction, trauma

37
Q

DDx for slower onset acute abdomen

A

infection, inflammation, abscess

38
Q

Peritoneal signs

A

pts lie still, movement is painful, involuntary guarding, abd is firm

39
Q

Grey-Turner’s Sign

A

Flank ecchymoses - retroperitoneal bleeding

40
Q

Cullen’s Sign

A

Umbilical ecchymoses - retroperitoneal bleeding

41
Q

What must you think about if you have an elderly person with abd pain out of proportion to exam or a pt taking stimulants with abd pain

A

mesenteric ischemia

42
Q

What are frequently missed dx in the elderly

A 
Mesenteric ischemia 
AAA
Appy
Acute Cholecystitis 
Perforated peptic ulcer
43
Q

Biggest risk factor for mechanical bowel obstruction

A

hx of past SBO

44
Q

What commonly causes functional bowel obstruction

A

infection, irritation, inflammation

45
Q

Functional Ileus Characteristics

A

both large and small bowel

sentinal loop

46
Q

How is LBO different from SBO

A

Slower onset
low mid abdominal pain (sbo is periumbilical)
vomiting is less common

47
Q

Common causes/risk factors for LBO

A 
Neoplasm -MCC 
fecal impaction 
diverticulitis 
UC, ischemic colitis 
pseudo-obstruction (ogilive's syndroe)
48
Q

What is pseudo-obstruction (ogilive’s syndrome)

A

distended large bowel but not obstructed

think TCAs and anticholinergics

49
Q

perf-pneumopertoneum presentation

A

rapid onset, constant, epigastric then generalized pain, vomiting; tachy/tachy; fever 50%
usually see on R side first
look ill first, then peritoneal, then shock

50
Q

What is the MCC of pancreatitis

A

gallstones

the stone is at ampulla of vater, pancreatic duct

51
Q

What is Charcot’s Triad and what Dx is it for?

A

Triad: RUQ, fever, jaundice

Note: reynold’s pentad includes the triad plus shock and altered mental status

52
Q

Diverticulitis Presentation

A

gradual onset, fever, diarrhea, WBC’s, lactate up

lower abd/LLQ pain common,

53
Q

What is the MCC of acute abd

A

Appendicitis

54
Q

What is the gold standard imaging for appendicitis

A

CT abd/pelvis with IV contrast

55
Q

An Alvarado score of 7-8 indicates what

A

probably appendicitis

  • <5 means unlikely appendicitis
56
Q

What is the most common WRONG dx

A

AGE (acute gastroeneteritis)

57
Q

Presentation of a Strangulated Hernia

A

no blood supply, dead bowel

tender, red, hot
fever, tachy, maybe vomiting

necrosis-gangrene-sepsis

EMed (5 decks)

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