abdomen Reading trigger Flashcards
Pt presents with sudden abdominal pain radiating to the back. On exam he is hypotensive and reports this pain is excruciating. He has a 48 pack year hx and a hx of atherosclerosis. what is the suspected dx? what other PE finding would you expect to see?
rupture of AAA
would see pulsatile abd mass!
this diagnosis is often misdiagnosed as renal colic
AAA
> 50 y/o using cocaine and hx of HTN are both a huge risk factor for what? what other known disorder is a big risk factor for this diagnosis?
aortic dissection
CT disorders (marfans, EDS, CHD)
Class A = ?
Class B = ?
what classification system is this?
Class A = ascending
Class B = descending
stanford!!!
class 1 (both), 2 (ascending) and 3 (descending) is deBakey!
(De’B’akey has a “‘B’oth!” option!!)
diastolic murmur of aortic insufficiency suggests what dx
aortic dissection
CXR shows widening of the mediastinum and deviated trachea. what is the likely dx and what else may you see?
aortic dissection
Abnormal aortic contour + widening of mediastinum, Tracheal deviation, Displacement of aortic intimal calcifications
esmolol and labetolol are the DOC for what diagnosis? what is the goal with these drugs? What do we use if the goal is not met?
aortic dissection to manage HTN
goal is 100-120 SBP while maintaining 60-70 HR
if goal not met use nitroprusside or nicardipine
the test during which a patients abdomen is palpated while they flex the abdominal muscles is known as what? when would this test be positive?
carnett test
pos = abdominal wall pathology
If a patient presents with abdominal pain that is worse when he coughs. On exam his abdomen is rigid and he has referred tenderness generalized throughout the abdomen. what PE test may be positive in this pt? what is the suspected dx?
carnett test!
peritonitis
(remember rigidity + referred tenderness + cough pain = peritonitis!)
What is a large presenting factor in a patient with mesenteric ischemia?
pain out of proportion to the exam!
NSAIDS and H. Pylori are associated w what dx?
PUD
A patient presents with recurrent burning epigastric pain that has begun to wake her from her sleep. You ask if her pain is worse after meals, and she tells you that she actually feels better after eating most of the time. What diagnostic will you order to confirm this patients dx? what is your suspected dx? If this patient presented with sudden abrupt onset of severe pain on top of this history, how would this change your dx?
- diagnose with EGD showing ulcer.
- PUD.
- PUD with perforation.
Imaging of choice is CT scan W IV contrast OR TEE as alternative
aortic dissection
What abdominal complaint may be worrisome for an MI in the elderly population
epigastric pain.
drugs that end in -tidine are what kinds of drugs? what may indicate the use of these drugs?
H2 receptor antagonists!
PUD
a patient has epigastric pain waking them from sleep that is better with eating or drinking milk. You assume this to be infective. What is the infective agent and what is the treatment?
H. Pylori (PUD)
triple therapy! (omeprazole (PPI) + amoxicillin + clarithromycin)
OR
quadruple therapy (omeprazole (PPI) + metronidazole + tetracycline + Bismuth)
when do you use omeprazole + amoxicillin + clarithromycin?
H. pylori eradtication in PUD
(Could also use omeprazole (PPI) + metronidazole + tetracycline + Bismuth)
when do you use this
pre op abx for mechanical SBO requiring surgery
