Abdominal Emergencies Flashcards
Injuries to what type of organs may result in bleeding into the abdominal cavity or dumping their contents into the cavity? Examples include liver, spleen, pancreas
solid organs
Injuries to what type of organs may discharge chemical and bacterial contents? Examples include stomach, duodenum, and intestine
hollow organs
Infection, or rarely some other type of
inflammation, of the peritoneum
peritonitis
term used to encompass a spectrum of surgical, medical and gynecological conditions. defined generally as an intra-abdominal process causing severe pain requiring admission to hospital and possibly surgery
acute abdomen
What does the change in character from dull poorly localized pain to sharp pain in abdomen indicate?
involvement of parietal peritoneum
Describe pain characteristics of gallbladder pathology
radiates to scapula and lasts tens of minutes
Described as a constant burning pain that sometimes radiates to the back
duodenal ulcer
PE finding that’s suggestive of intestinal obstruction
increased bowel sounds
What pathology does a silent abdomen suggest?
peritonitis
What lab result is usually high with acute pancreatitis?
amylase
Patient presents with periumbilical pain that migrates to RLQ and rebound tenderness
acute appendicitis
1/3 the distance between anterosuperior iliac spine and umbilicus. Is the most common location of the base of the appendix where it is attached to the cecum
McBurney’s point
Which position is best for imaging for abdominal detail…organs, bones, joints, fat and gas patterns?
supine
Which position is best for evaluation of air-fluid levels?
erect
possible substitute for erect chest and abdomen imaging if patient can’t sit or stand
left lateral decubitus
Patient presents with rebound tenderness, quiet BS, muscle guarding. WBC is elevated and upright chest imaging shows free air
perforated peptic ulcer
What are the four cardinal features of intestinal obstruction?
abdominal pain with intermittent cramping, vomiting, distension, constipation
most distensible part of the colon. If distended 9cm cause for concern. If distended 11cm there’s impending perforation
the cecum
Usually acute occlusion of the SMA from thrombus or embolism. May need to do embolectomy
acute mesenteric ischemia
Typically smoker, vasculopath with severe atherosclerotic vessel disease (low flow state). weight loss is most consistent sign and is the result of postprandial pain
chronic mesenteric ischemia
Most common cause of air in biliary system
surgery on bile ducts
Used to aid diagnosis for intra-abdominal abscess, pancreatitis , retroperitoneal bleeding , hepatic or splenic pathology and even appendicitis
abdominal CT
Type of injury due to differential movements of fixed and non-fixed structures (e.g. liver and spleen lacerations at sites of supporting ligaments)
deceleration injuries
Top three most frequently injured organ for patient undergoing surgery for blunt trauma in order of frequency
spleen»liver»small bowel
Classically injured in frontal-impact MVA with unrestrained driver; or direct blow to abdomen.
Bloody gastric aspirate, retroperitoneal air on XR or CT, series confirmed with UGI
duodenum
How does an injured diaphragm appear on CXR?
blurred or elevated hemidiaphragm
98% sensitive for intraperitoneal bleeding. generally performed in unstable patients with intermediate FAST exams, or with suspicion for small bowel injury
Peritoneal Lavage
For identifying hemoperitoneum in blunt abdominal trauma. The larger the hemoperitoneum, the higher the sensitivity.
FAST (Focused Assessment with Sonography for Trauma)
far more sensitive than FAST for detecting and characterizing abdominal injury in trauma. The gold standard for characterizing intra-parenchymal injury.
CT
What is the difference between use of CT and FAST?
Unstable patients can’t go to CT, but FAST can be performed during resuscitation
What is the presentation of an extraperitoneal rupture of the bladder?
pain, hematuria and inability to void
Contraindicated in urethral injuries
foleys
More common cause of GI bleeding. Usually presents with hematemesis, melena
upper GI bleed
Location of GI bleed when patient is experiencing hematochezia
lower GI bleed
Determines the status of UGI bleeding and gives indirect information in LGI bleeding. bright red= active UGI. coffee grounds = slow bleed. Bilious = UGI bleed that’s stopped
nasogastric aspirate
Contraindicated in acute GI bleed
barium
Most common cause of lower GI bleed
diverticulosis
