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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
what must you consider if someone presents with ascites and has a fever or painful?
SBP- subacute bacterial peritonitis if they have SBP - give IV abx, monitor, admit
26
First time ascites need to be admitted for w/up. True or False
True
27
Most common causes for urinary retention
prostate (men), meds (women), hematuria (clot) note: men>women
28
Tx for urinary retention
alpha blockers | often home with foley/leg bag for 2-3 weeks
29
Symptoms of gastroparesis
intractable n/v, abd pain, fullness
30
Tx for gastroparesis
IV hydration, metoclopramide
31
Triggers for sickle cell crisis abd pain
infection, dehydration, stress, altitude, cold weather
32
Tx for sickle cell crisis abd pain
iv hydration, pain control +/- opiates
33
what type of drug is a risk for mesenteric ischemia
stimulants
34
what imaging do you use for mesenteric ischemia
CT angio
35
what are the mimics of the abdominal pain
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
DDx for sudden rapid onset for acute abdomen
vascular, perforation, rupture, obstruction, trauma
37
DDx for slower onset acute abdomen
infection, inflammation, abscess
38
Peritoneal signs
pts lie still, movement is painful, involuntary guarding, abd is firm
39
Grey-Turner's Sign
Flank ecchymoses - retroperitoneal bleeding
40
Cullen's Sign
Umbilical ecchymoses - retroperitoneal bleeding
41
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
mesenteric ischemia
42
What are frequently missed dx in the elderly
``` Mesenteric ischemia AAA Appy Acute Cholecystitis Perforated peptic ulcer ```
43
Biggest risk factor for mechanical bowel obstruction
hx of past SBO
44
What commonly causes functional bowel obstruction
infection, irritation, inflammation
45
Functional Ileus Characteristics
both large and small bowel | sentinal loop
46
How is LBO different from SBO
Slower onset low mid abdominal pain (sbo is periumbilical) vomiting is less common
47
Common causes/risk factors for LBO
``` Neoplasm -MCC fecal impaction diverticulitis UC, ischemic colitis pseudo-obstruction (ogilive's syndroe) ```
48
What is pseudo-obstruction (ogilive's syndrome)
distended large bowel but not obstructed | think TCAs and anticholinergics
49
perf-pneumopertoneum presentation
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
What is the MCC of pancreatitis
gallstones | the stone is at ampulla of vater, pancreatic duct
51
What is Charcot's Triad and what Dx is it for?
Triad: RUQ, fever, jaundice Note: reynold's pentad includes the triad plus shock and altered mental status
52
Diverticulitis Presentation
gradual onset, fever, diarrhea, WBC's, lactate up | lower abd/LLQ pain common,
53
What is the MCC of acute abd
Appendicitis
54
What is the gold standard imaging for appendicitis
CT abd/pelvis with IV contrast
55
An Alvarado score of 7-8 indicates what
probably appendicitis * <5 means unlikely appendicitis
56
What is the most common WRONG dx
AGE (acute gastroeneteritis)
57
Presentation of a Strangulated Hernia
no blood supply, dead bowel tender, red, hot fever, tachy, maybe vomiting necrosis-gangrene-sepsis

EMed (5 decks)

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