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Emergency Medicine > Abdomen > Flashcards

Abdomen Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

location of visceral pain and often accompanied with

A

vague and midline →nausea, pallor, diaphoresis

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2
Q

arises from the walls of hollow viscera and solid organs → due to abnormal stretching/distention, ischemia or inflammation

A

visceral pain

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3
Q

pain that is sharp in quality and is well localized

A

somatic pain

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4
Q

arises from the parietal peritoneum, mesneteric roots, and anterior abdominal wall due to chemical or bacterial inflammation

A

somatic pain

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5
Q

pain due to fibers from different organs returning to CNS overlapping with pathways from cutaneous sites which had similar embryologic origin

A

referred pain

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6
Q

Diaphragmatic irritation that refers pain to the shoulder via C4 due to splenic rupture/abscess, renal calculi, ruptured ectopic

A

Kehr’s Sign

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7
Q

pulsatile and well localized pain

burns, lacterations, fractures, infection, inflammations

A

somatic pain

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8
Q

aching and cramping, nonpulsatile, poorly localized pain or referred to distant locations
angina, hepatic distention, bowel distention, hypermobility, pancreatitis

A

visceral pain

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9
Q

spontaneous, burning, lancinating or shooting pain → may be distal or proximal to site of injury
complex regional pain syndrome, sciatica

A

neuropathic pain

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10
Q

stomach, 1st and 2nd parts of duodenum, liver, gallbladder, pancreas

A

epigastric area

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11
Q

3rd and 4th parts of duodenum, jejunum, ileumm, cecum, appendix, ascending colon, first two thirds of transverse colon

A

periumbilical area

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12
Q

last one third of transverse colon, descending colon, sigmoid, sectum, intraperitoneal GU organs

A

suprapubic area

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13
Q

two big history points to hit in patient with abdominal pain

A

social hx. (IVDA, Smoke, EtOH, GU, STD, pregnancy hx)

surgical hx.

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14
Q

respiratory arrest on inspiration during palpatino of RUQ [cholecystitis]

A

Murphy’s Sign

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15
Q

pain referred to RLQ on palpation of LLQ [appendicitis]

A

Rovsing Sign

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16
Q

Pain with internal rotation of flexed hip

A

Obturator Sign

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17
Q

Pain with hyperextension of hip

A

Psoas Sign

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18
Q

patients coming to ED for abdominal pain should be…

A

NPO

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19
Q

where are pediatrics most likely to have foreign body entrapment in their esophagus?

A

upper esophageal sphincter

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20
Q

where are adults most likely to have foreign body entrapment in their esophagus?

A

lower esophageal sphincter

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21
Q

sign that esophageal foreign body has > 80% chance of passing

A

if it reaches the stomach

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22
Q

MC cause of esophageal foreign body in adults

A

mechanical dysfunction

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23
Q

diameters of object that will not pass through the esophagus

A

> 2.5 cm wide and > 6 cm long

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24
Q

MC common GI foreign bodies in pediatrics

A

food boluses and other object (coins, toy, button battery, magnet)

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25
Q

how will esophageal foreign body present in an adult?

A

foreign body sensation → mild/severe pain

can’t swallow/handle secretions, drooling, spitting, vomiting

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26
Q

issue with foreign bodies in pediatrics patients

A

asymptomatic or can’t communicate

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27
Q

Worse cause scenario for foreign esophageal body in pediatric patient

A

In UES → tracheal impingement → stridor, respiratory compromise, death

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28
Q

sodium hydroxide is generated by current produced by the battery → 20 mm button batteries have higher capacitance and generate more current compared to other disc batteries

A

liquefaction necrosis

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29
Q

How can you differentiate button batteries from coins?

A

X-ray will show “double contour” of button battery

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30
Q

Time line for button battery:
liquefaction necrosis
perforation

A

LN → as early as 2 hours

Perforation → 6 hours

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31
Q

methods to remove button battery

A

endoscopy
Foley catheter removal
Magill forceps removal

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32
Q

Even though a button battery is removed, what can continue to cause injury in the body?

A

residual alkali

weakened tissues

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33
Q

You supect patient has foregin body in esophagus that you can’t see on X-ray, what should you order next?

A

CT

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34
Q

Giving this will supposedly help move esophageal foreign body

A

Glucagon

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35
Q

How do you usually remove esophageal foreign body? What if that foreign body is a magnet?

A

endoscopy

magnet → open exploratory laparotomy

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36
Q

which esophageal FB may pass alone?

A

distal smooth solitary FB

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37
Q

MC cause of esophageal perforation

A

iatrogenic (endoscopy and dilation)

Boerhaave Syndrome, Mallory-Weiss tear, trauma, FB, infection, ingestion

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38
Q

why does esophageal perforation have high mortality?

A

gastric contents leaking into mediastinum and pleural space, etc

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39
Q

acute, severe, diffuse , unrelenting chest/neck/abdominal pain that radiates to back/shoulder

A

Esophageal perforation

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40
Q

What is Mackler’s Triad? Indicates?

A

Vomiting, chest pain, SubQ emphysema

Esophageal rupture

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41
Q

Hallmark sign for esophageal rupture

A

Subcutaneous emphysema → will appear usually after 1 hour of onset

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42
Q

raspy, crunchy sound heard over precordium with each heartbeat

A

Hammon crunch

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43
Q

signs of esophageal rupture

A

tachycardia
tachypnea
NO HEMATEMESIS

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44
Q

What makes the pain worse with esophageal rupture?

A

swallowing or laying supine

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45
Q

Chest X-ray indicators for pneumomediastinum

A 
SubQ emphysema 
mediastinal air fluid levels 
pleural effusion 
free air under the diaphragm 
pneumothorax
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46
Q

You see pneumomediastinum on CXR, what do you order next?

A 
contrast esophagogram (+ water soluble agent)
CT Chest with contrast
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47
Q

3 antibiotic options for esophageal rupture

A

piperacillin-tazobactam (Zosyn)
ceftriaxone + metronidazole (flagyl)
clindamycin

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48
Q

Esophageal rupture is a ____

A

emergency surgical consult

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49
Q

suspensatory muscle of duodenum, thin muscle connecting junction between duodenum, jejunum, and duodenojujenal flexure to connective tissue surrounding superior mesenteric artery and coeliac artery

A

Ligament of Treitz

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50
Q

MC location of GI bleed

A

Upper GI Bleed → proximal to ligament of treitz

PUD, erosive gastritis/esophagitis, esophageal/gastric varices, Mallory-Weiss tear, alcoholic, ASA/NSAID use

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51
Q

MC cause of lower GI bleed

A

diverticular disease, anal fissue, AVM, colitis (ischemic or infetious), polyps, malignancy, anticoagulant/NSAID, hemorrhoids

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52
Q

Signs of Upper GI Bleed

A

hematemesis, coffee ground emesis, melena

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53
Q

why is hematochezia worrisome in Upper GI bleed?

A

indicates rapid transit through intestines

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54
Q

subcutaneous emphysema with history of vomiting → presenting with retrosternal CP

A

Boerhaave’s Syndrome

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55
Q

where does Boerhaave’s most likely occur?

A

lower 1/3 esophagus → posterolateral distal esophagusepigastric

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56
Q

severe vomiting then painless hematemesis → 90% are self-limiting

A

Mallory Weis tear

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57
Q

Who are Mallory Weis tears MC in

A

patient with Cirrhosis

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58
Q

Describe the type of tear in in Mallory Weis

A

incomplete → only mucosa and submucosa tear

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59
Q

These are the result of portal HTN due to cirrhosis or banding

A

esophageal varices

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60
Q

Signs of shock

A

tachycardia/hypotension
poor perfusion
AMS

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61
Q

How do you determine if red/black stool is due to blood or other cause?

A

Hemoccult test

62
Q

Maroon stool indicates

A

LGIB from right side or small bowel

63
Q

Bright red stool indicates

A

LGIB from the left side

64
Q

Painless bleeding occurs with…

A

diverticular bleed
anticoag use
internal hemorrhoids

65
Q

Fever + diarrhea + severe/crampy pain + GI bleed

A

UC, Crohns, C. diff

66
Q

management for upper GI bleed

A

protonix
octreotide
balloon tamponade

67
Q

this inhibits flucagon release and other hormones → reduces GI motility and gastric emptying → decreases splanchnic blood flow and portal venous pressure

A

Octreotide

68
Q

who is the Balloon Tamponade for UGIB contraindicated in?

A

Mallory Weis tear

69
Q

when is endoscopy for UGIB contraindicated?

A

perforated stomach, esophagus, instestine

70
Q

Methods to find LGIB

A

colonoscopy
tagged RBC scan
angiography (SMA → IMC → celiac a.)

71
Q

severe and sudden epigastric pain → slight movement worsens the pain → diaphoresis, pale, rebound, tachycardia, guarding, rigidity, hypotension

A

perforated ulcer

72
Q

CXR of perforated ulcer reveals

A

free abdominal air → elevating the diaphragm

73
Q

Treatment for perforated ulcer

A

open laparotomy with washout and repair

74
Q

gallstones obstruct cystic duct for prolonged period of time → inflammation of gallbladder wall results

A

acute cholecystitis

75
Q

Acute cholecystitis develops in 20% of patients with ____ if left untreated

A

biliary colic

76
Q

6 F’s of acute cholecystitis

A 
Female 
Fat 
Forty 
Fertile 
Family history 
Fair
77
Q

pain begins in epigastric region and localizes to RUQ

A

acute cholecystitis

78
Q

Acute cholecystitis may present with ____

A

positive Murphy’s Sign

79
Q

1 diagnostic test for acute cholecystitis

A

Ultrasound of RUQ → pericholecystic fluid, gallbladder wall thickening (>4 mm) → best if NPO 8 hours prior

80
Q

2 diagnostic test for acute cholecystits

A

HIDA scan

81
Q

What should you order to assess complications of cholecystitis nonspecific to US?

A

CT abdomen/pelvis with contrast

82
Q

Antibiotics for acute cholecystits

A

piperacillin-tazobactam (zosyn)
ampicillin - sulbactam
meropenem

83
Q

antibiotic used in severe life-threatening cases of cholecystitis

A

imipenem - cilastatin (primaxin)

84
Q

MC cause of cholangitis

A

choledocholithiasis

stone in cystic or common hepatic duct → obstruction

85
Q

Charcot Triad

A

fever
RUQ pain
jaundice

86
Q

malignant obstruction of gallbladder will have higher levels of what

A

bilirubin

87
Q

antibiotics for cholangitis

A

piperacillin
ceftazadime
ampicillin
metronidazole

88
Q

diagnostic procedure for cholangitis

A

MRCP → Magnetic resonance cholangiopancreatography

89
Q

initial treatment for sever cholangitis

A

endoscopic or perQ biliary drainage and decompression

90
Q

acute inflammation of pancreas where pancreatic enzymes digest the gland → obstruction of pancreatic/bile duct or direct toxicity to pancreatic cells → inflammation resulting in increased pancreatic enzyme activation

A

pancreatitis

91
Q

MC cause of pancreatitis

A

cholelithiasis

92
Q

ecchymosis/discoloration of umbilicus

A

Cullen’s Sign

93
Q

ecchymosis/discoloration of flanks

A

Grey Turner Sign

94
Q

which is more specific for pancreatitis - lipase of amylase?

A

elevated lipase (2-3x normal)

95
Q

Used to predict risk of mortality in pancreatitis

A

Randon Criteria

96
Q

antibiotics for severe pancreatitis

A

Cipro + flagyl
meropenem
imipenden-cilastatin

97
Q

which pancreattis cases get admitted

A

new onset → look for pseudocyst, abscess, mass, hepatits, EtOH withdrawal, gallstone

98
Q

MC cause of spontaneous bacterial peritonitis

A

patient on peritoneal dialysis (PD)

99
Q

MC organism with bacterial peritonitis

A

3/4 due to anaerobic Gram (-) → E. coli

100
Q

How do you diagnose spontaneous bacterial peritonitis?

A

paracentesis

101
Q

Antibiotic treatment for spontaneous bacterial peritonitis

A

cefotaxime
oral ofloaxacin
fluoroquinolone

102
Q

MC cause of infectious diarrhea

A

norovirus

103
Q

Treatment for infectious diarrhea

A

IV fluid
electrolyte replacement
antiemetic
+/- antibiotics (cipro + flagyl)

104
Q

cause of C. dif

A

antibiotic use > 3 months

105
Q

How do you diagnose C. Difficile?

A

stool culture + PCR

106
Q

What must you do with your C. dif patients?

A

place on contact precautions → highly contagious

107
Q

if C. dif colitis patient is healthy and stable what do you discharge them with?

A

metronidazole

108
Q

Treatment for C. dif patients who need hospitalization → severe disease, fever, pain, immunocompromised

A

ORAL vancomycin

109
Q

C. diff coliits with yelowish plaques of exudate replace necrotic intestinal mucosa

A

pseudomembranous colitis

110
Q

Treatment for pseudomembranous colitis

A

metronidazole AND Oral Vanc

111
Q

RLQ pain + N/V + rarely constipation + rectal sparing

A

Crohns

112
Q

periumbilical/LLQ pain + constipation + commonly have bloody stool + always involves rectum

A

ulcerative colitis

113
Q

extraintestinal manifestations of Inflammatory Bowel

A

arthritis
uveitis
liver disease

114
Q

Crohn’s patients typically have

A

perianal disease

115
Q

why do you avoid antibiotics in UC/CD cases?

A

increased risk of antibiotic associated colitis

116
Q

inflammation of diverticular from fecalith

A

diverticulitis

117
Q

Where will patients with diverticulitis have abdominal pain?

A

LLQ is classic

118
Q

best imaging for diverticulitis

A

CT Abdomen/pelvis with contrast

119
Q

Outpatient antibiotic treatment for diverticulitis

A

Cipro + metronidazole (1st choice)
TMP-SMX + metronidazole
amoxicillin/clavuanic acid

120
Q

MC type of bowel obstruction

A

ileus

121
Q

MC cause of small bowel obstruction

A

adhesions

122
Q

bilious vomiting may indicate

A

proximal bowel obstruction

123
Q

feculent vomiting may indicate

A

distal bowel obstruction

124
Q

what may small bowel obstruction progress to

A

bowel strangulation

125
Q

1 cause of larger bowel obstruction

A

cancer

126
Q

large bowel obstruction in children - consider?

A

intussusception

127
Q

diagnostic test for bowel obstruction

A

CT abdomen/pelvis with oral and IV contrast

128
Q

How do you differentiate complete vs partial obstruction?

A

loop of small bowel > 2.5 cm dilated proximal to distinct transition zone of collapsed bowel < 1 cm

129
Q

treatment for small bowel obstruction

A

NG tube to decompress + supportive treatment

130
Q

MC cause of mesenteric ischemia

A

embolic

mural thrombi after MI, thrombus due to mitral stenosis/Afib, vegetative endocarditis, septic emboli, AAA rescetion

131
Q

risk factors for mesenteric ischemia

A 
age 
artherosclerosis 
arrhythmias 
hypovolemia 
CHF 
recent MI 
valve disease 
intra-abdominal malignancy 
IBD 
mesentary artery stenosis 
cocaine use 
smoking
132
Q

Patient presents with disproportionate pain than what found on exam

A

acute mesenteric ischemia

133
Q

two lab values used to order with mesenteric ischemia

A 
Troponin 
Lactic acid (sepsis vs volume depletion)
134
Q

1 diagnostic study for mesenteric ischemia in ED

A

CT/CTA with and without contrast

135
Q

You just diagnose Mesenteric Ischemia → next step

A

emergency consult with surgery

136
Q

Vasodilator administered to mesenteric ischemia

A

papaverine

137
Q

main therapy for mesenteric vein thorbus

A

heparin

138
Q

MC cause of inlammation of veriform appenix (acute appendicitis)

A

obstruction from facalith

139
Q

line between umbilicus and ASIS

A

McBurney Point Tenderness

140
Q

Patient presents with RLQ pain that suddenly goes away and is no longer tender

A

perforation

141
Q

Female with RLQ or LLQ pain → top of Ddx?

A

ectopic pregnancy

142
Q

appendicitis on CT will show…

A

appendiceal diameter > 6-8 mm, wall thickening >3mm, periappendiceal fat stranding, wall enhancement

143
Q

Antibiotics for appendicitis

A

piperacillin-tazobactam

PCN allery → carbapenem

144
Q

forcal dilation of aorta causing weakness to integrity of vessel

A

abdominal aortic aneurysm

145
Q

separation of layers within aortic wall → disruption of intima into media → false lumen

A

aortic dissection

146
Q

Type A vs Type B aortic dissection

management?

A

A → ascedning aorta → surgery

B → beyond L subclavian → BP control

147
Q

hypertensive, agitated, diaphoretic, anxious, tamponade, etc →

A

aortic dissection

148
Q

diagnostic test for aortic dissection

A

CT angio chest/abdomen/pelvis with contrast

149
Q

Goal BP for aortic dissection

A

systolic → 90 - 100/60-80

150
Q

diameter for AAA

A

> 3 cm

151
Q

Triad for AAA

A

abdominal pain
hypotension
syncope

152
Q

medication for managing AAA BP and tachycardia exacerbations

A

BB

morphine sulfate

Emergency Medicine (6 decks)

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