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EM Exam 2 > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Patients over 65 have ____ fold increase in mortality when presenting with abdominal pain compared to younger patients

A

6-8

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2
Q

Right upper quadrant pain, usually post-prandial, radiates to right shoulder, lasting 30 minutes to 6 hours, with associated diaphoresis, nausea, and vomiting but no fever and a negative Murphy’s sign is consistent with what diagnosis?

A

Biliary colic

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3
Q

What is the acute vs. definitive management of biliary colic?

A
  • acute = pain control and anti-emetics

- definitive = discharge with surgical referral for elective cholecystectomy

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4
Q

Right upper quadrant pain that is ofter greater than 4-6 hours and fever with a positive Murphy’s sign is consistent with what diagnosis?

A

Acute cholecystitis

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5
Q

What is the ED management for acute cholecystitis?

A
  • NPO, pain control (IV morphine), anti-emetics, IV antibiotics (Zosyn 3.375g)*
  • admit to surgery

*if PCN allergy = Cipro 400mg BID IV + Flagyl 500mg TID IV

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6
Q

What pathogens cause ascending cholangitis? (3)

A
  • E. Coli
  • Klebsiella
  • Enterococcus
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7
Q

RUQ pain, jaundice, and fever is consistent with what diagnosis?

A

Ascending cholangitis

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8
Q

What is Charcot’s triad?

A
  • RUQ pain
  • Fever
  • Jaundice
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9
Q

What is Reynold’s pentad?

A
  • Charcot’s triad (RUQ pain, fever, jaundice)
  • AMS
  • Hypotension
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10
Q

What are Charcot’s triad and Reynold’s pentad consistent with?

A

ascending cholangitis

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11
Q

What labs would you order in ascending cholangitis? (6 total)

A

CBC, chem, LFTs, lipase, lactate, blood cultures

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12
Q

Who should you consult in the setting of ascending cholangitis? (2 options)

A
  • gastroenterology

- surgery or interventional radiology

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13
Q

What are the 2 most common causes of pancreatitis?

A
  • gallstones

- alcohol

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14
Q

A patient presents with epigastric pain that radiates to the back with nausea and vomiting. He has a positive Cullen’s sign. What is the diagnosis?

A

Pancreatitis

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15
Q

What is the difference between Cullen’s sign and Grey Turner sign?

A
  • cullen’s sign = ecchymosis around umbilicus

- grey turner sign = ecchymosis around flank

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16
Q

What is the best lab test to order for pancreatitis?

A

lipase

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17
Q

What labs do we get in pancreatitis that is unique compared to other abdominal emergencies?

A
  • lipase, tox screen, triglycerides
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18
Q

What is the ED management of pancreatitis? (4 part)

A
  • NPO
  • ALOT of fluids
  • pain control
  • anti-emetics

NO antibiotics

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19
Q

A 55-year-old male presents to the emergency department complaining of left lower quadrant pain for 3 days. His pain is 6/10, left lower quadrant, worse with bumps driving to the ED. He has had a fever to 101 today. No diarrhea, bloody stool, black tarry stools, urinary symptoms. What is the diagnosis?

A

diverticulitis

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20
Q

Which of the following is a risk factor for developing diverticulitis?

  • Low fiber diet
  • Low fat diet
  • Low red meat diet
  • Seeds and nuts
  • Exercise
  • Lack of smoking
  • Young age
A

Low fiber diet

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21
Q

What is the difference in management of uncomplicated vs. complicated diverticulitis?

A
  • uncomplicated = discharge with oral antibiotics (Cipro 500mg BID + Flagyl 500mg TID)*
  • complicated = general surgery consult, IV antibiotics (Zosyn or Cipro/Flagyl), and admission
  • could use Augmentin IV as 2nd line if contraindication*
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22
Q

What CT protocol do you use for diverticulitis?

A

CT abdomen O+/I+

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23
Q

What defines uncomplicated vs. complicated diverticulitis?

A
  • if there is abscess, perforation or fistula = complicated diverticulitis
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24
Q

A 25-year-old male presents to the emergency department complaining of right lower quadrant pain for 3 days. His pain is 7/10, radiates to back, associated with nausea and fevers. No diarrhea, bloody stool, black tarry stools, urinary symptoms. What is the diagnosis?

A
  • appendicitis
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25
Q

Which of the following physical exam findings for appendicitis has the greatest sensitivity?

  • McBurney’s point tenderness
  • Rovsing’s sign
  • Psoas sign
  • Obturator sign
  • Percussion of the appendix
A
  • McBurney’s point tenderness
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26
Q

What is the CT scan protocol for appendicitis?

A
  • CT scan I+/O+
27
Q

What is the IV antibiotics of choice for appendicits if is non-perforated vs. perforated?

A
  • non-perforated = cefoxitin
  • perforated = IV Zosyn

*allergy to either = cipro + flagyl

28
Q

Which of the finding would raise suspicion for acute mesenteric ischemia?

  • post-pandrial abdominal pain
  • melena
  • history of CAD
  • abdominal distension
  • pain out of proportion to exam
A
  • pain out of proportion to exam
29
Q

A 60-year-old female presents to the emergency department complaining of diffuse abdominal pain. Her pain is 10/10, diffuse with associated with nausea and vomiting. No fevers, diarrhea, bloody stool, black tarry stools, urinary symptoms. What is the diagnosis?

A
  • mesenteric ischemia

* pain out of proportion to exam

30
Q

What are the 2 main risk factors for mesenteric ischemia?

A
  • atrial fibrillation or atherosclerosis
31
Q

What is the most important lab to order in mesenteric ischemia?

A
  • lactate to look for necrosis
32
Q

What is the CT protocol for mesenteric ischemia?

A

CTA I+/O-

33
Q

What is the ED management for mesenteric ischemia? (4 part)

A
  • Pain control
  • IV fluids
  • A/C = Heparin
  • IV antibiotics = broad spectrum
34
Q

What are 2 main risks factors of perforated PUD?

A
  • H. pylori

- excessive NSAIDs

35
Q

What 2 physical exam findings are consistent with perforated PUD?

A
  • tachycardia

- Peritonitis (abdominal rigidity)

36
Q

A 21-year-old female presents to the emergency department complaining of nausea, vomiting, and diarrhea for 24 hours. She first developed a stomachache, followed by multiple episodes of vomiting and diarrhea. She endorses chills. Her last oral intake was pizza last night. What is the most likely diagnosis?

A

acute gastroenteritis

37
Q

What is the most common cause of acute gastroenteritis?

A

viral

38
Q

Which of the following is NOT part of the ED work up for gastroenteritis?

a. labs
b. urinalysis and HCG
c. consider sinister etiologies (e.g. food borne illness)
d. stool studies

A

d. stool studies

39
Q

What anti-emetic would you use if a patient has a prolonged QT?

A
  • Ativan
40
Q

A 64-year-old female presents to the emergency department complaining of diffuse abdominal pain. Her pain is 8/10, diffuse, associated with nausea and vomiting. She is not passing gas. No fever, bloody stool, black tarry stools, urinary symptoms. PMHx of appendectomy and cholecystectomy. what is the likely diagnosis?

A

SBO

41
Q

In a patient with small bowel obstruction, what is the best way to protocol a CT scan in a patient with normal renal function?

A

CT abdomen and pelvis with I+/O+

42
Q

What are the 2 most common causes of SBO?

A
  • adhesions

- hernias

43
Q

____________ is diagnostic and therapeutic for SBO.

A

gastrogaffin

44
Q

What is the acute management of SBO? (4 part)

A
  • pain control
  • anti-emetics
  • IVF
  • NG tube for decompression**
45
Q

Abdominal aortic aneurysm is defined as a focal aortic dilation of greater than ____cm

A

3 cm

46
Q

A 74-year-old male presents to the emergency department complaining of diffuse abdominal pain. His pain is 8/10, diffuse, associated with nausea and vomiting. He is passing gas. No fever, bloody stool, black tarry stools, urinary symptoms. On physical exam you feel a palpable pulsatile mass. What is the diagnosis?

A

AAA

*STAT vascular consult

47
Q

What is the ideal CT protocol for AAA?

A

CTA

48
Q

What is the difference in blood pressure control if the patient has a symptomatic vs ruptured AAA?

A
  • symptomatic = keep SBP <120

- ruptured = allow permissive HYPOtension (lower limit is 80 SBP)

49
Q

A 66-year-old female presents to the emergency department complaining of black stool x 3 days. He has associated lightheadedness and nausea but denies any abdominal pain, fever, bloody stool, urinary symptoms. What is the most likely diagnosis?

A

GI bleed

50
Q

What is the anatomic landmark for an upper vs. GI bleed?

A

Ligament of Treitz

51
Q

What type of bleeding is consistent with upper GI bleed?

A

melena (black tarry stools)

52
Q

What 2 medications/supplements can cause black stools?

A
  • Pepto-bismol

- Iron supplements

53
Q

What is the ED work up for GI bleed? (3 part)

A
  • Guaiac (better for lower GI bleed)
  • EKG for ischemia
  • Labs
54
Q

An elevated BUN out of proportion to Cr should clue you in to what diagnosis?

A

GI bleed

55
Q

What vasoactive medication is used in the setting of GI bleed if the patient has cirrhosis?

A

IV octreotide

56
Q

Do you want to give antibiotics in the setting of GI bleed if the patient has cirrhosis?

A

yes, IV Ceftriaxone

57
Q

What acid suppression medication is used in the setting of GI bleed?

A

IV PPI

58
Q

What is the hemoglobin threshold for transfusion in the setting of a GI bleed?

A

< 7

59
Q

What type of tube is used in the setting of unstable hemorrhage?

A

blakemore tube

60
Q

What type of bleeding is consistent with lower GI bleed?

A

hematochezia or maroon stools

61
Q

In a lower GI bleed this diagnosis should always be on your differential.

A

diverticular bleeding

62
Q

What is the AAA size cut off for surgical indication?

A

> 5.5 cm

63
Q

This is defined as an abnormally large artery in the lining of the gastrointestinal system

A

Dieulafoy lesion

EM Exam 2 (5 decks)

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