Abdominal Emergencies

Question 1

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

Answer 1

solid organs

Question 2

Injuries to what type of organs may discharge chemical and bacterial contents? Examples include stomach, duodenum, and intestine

Answer 2

hollow organs

Question 3

Infection, or rarely some other type of

inflammation, of the peritoneum

Answer 3

peritonitis

Question 4

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

Answer 4

acute abdomen

Question 5

What does the change in character from dull poorly localized pain to sharp pain in abdomen indicate?

Answer 5

involvement of parietal peritoneum

Question 6

Describe pain characteristics of gallbladder pathology

Answer 6

radiates to scapula and lasts tens of minutes

Question 7

Described as a constant burning pain that sometimes radiates to the back

Answer 7

duodenal ulcer

Question 8

PE finding that’s suggestive of intestinal obstruction

Answer 8

increased bowel sounds

Question 9

What pathology does a silent abdomen suggest?

Answer 9

peritonitis

Question 10

What lab result is usually high with acute pancreatitis?

Answer 10

amylase

Question 11

Patient presents with periumbilical pain that migrates to RLQ and rebound tenderness

Answer 11

acute appendicitis

Question 12

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

Answer 12

McBurney’s point

Question 13

Which position is best for imaging for abdominal detail…organs, bones, joints, fat and gas patterns?

Answer 13

supine

Question 14

Which position is best for evaluation of air-fluid levels?

Answer 14

erect

Question 15

possible substitute for erect chest and abdomen imaging if patient can’t sit or stand

Answer 15

left lateral decubitus

Question 16

Patient presents with rebound tenderness, quiet BS, muscle guarding. WBC is elevated and upright chest imaging shows free air

Answer 16

perforated peptic ulcer

Question 17

What are the four cardinal features of intestinal obstruction?

Answer 17

abdominal pain with intermittent cramping, vomiting, distension, constipation

Question 18

most distensible part of the colon. If distended 9cm cause for concern. If distended 11cm there’s impending perforation

Answer 18

the cecum

Question 19

Usually acute occlusion of the SMA from thrombus or embolism. May need to do embolectomy

Answer 19

acute mesenteric ischemia

Question 20

Typically smoker, vasculopath with severe atherosclerotic vessel disease (low flow state). weight loss is most consistent sign and is the result of postprandial pain

Answer 20

chronic mesenteric ischemia

Question 21

Most common cause of air in biliary system

Answer 21

surgery on bile ducts

Question 22

Used to aid diagnosis for intra-abdominal abscess, pancreatitis , retroperitoneal bleeding , hepatic or splenic pathology and even appendicitis

Answer 22

abdominal CT

Question 23

Type of injury due to differential movements of fixed and non-fixed structures (e.g. liver and spleen lacerations at sites of supporting ligaments)

Answer 23

deceleration injuries

Question 24

Top three most frequently injured organ for patient undergoing surgery for blunt trauma in order of frequency

Answer 24

spleen»liver»small bowel

Question 25

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

Answer 25

duodenum

Question 26

How does an injured diaphragm appear on CXR?

Answer 26

blurred or elevated hemidiaphragm

Question 27

98% sensitive for intraperitoneal bleeding. generally performed in unstable patients with intermediate FAST exams, or with suspicion for small bowel injury

Answer 27

Peritoneal Lavage

Question 28

For identifying hemoperitoneum in blunt abdominal trauma. The larger the hemoperitoneum, the higher the sensitivity.

Answer 28

FAST (Focused Assessment with Sonography for Trauma)

Question 29

far more sensitive than FAST for detecting and characterizing abdominal injury in trauma. The gold standard for characterizing intra-parenchymal injury.

Answer 29

CT

Question 30

What is the difference between use of CT and FAST?

Answer 30

Unstable patients can’t go to CT, but FAST can be performed during resuscitation

Question 31

What is the presentation of an extraperitoneal rupture of the bladder?

Answer 31

pain, hematuria and inability to void

Question 32

Contraindicated in urethral injuries

Answer 32

foleys

Question 33

More common cause of GI bleeding. Usually presents with hematemesis, melena

Answer 33

upper GI bleed

Question 34

Location of GI bleed when patient is experiencing hematochezia

Answer 34

lower GI bleed

Question 35

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

Answer 35

nasogastric aspirate

Question 36

Contraindicated in acute GI bleed

Answer 36

barium

Question 37

Most common cause of lower GI bleed

Answer 37

diverticulosis