Abdominal Emergencies

Question 1

What lab will help you determine if a problem is CHF vs COPD?

Answer 1

BNP

Question 2

What can a petechial rash indicate?

Answer 2

Meningococcal meningitis

Question 3

A 32 year old male, no past medical history complains of nausea and epigastric pain off and on for 4 weeks. Worse after meals, lasts about 30-60 minutes, pain free now. Brown stools. No history of ulcers, endoscopy, or alcoholism. Walked into the ER, does not have a primary care physician.
Vitals: HR 65, RR 12, BP 120/84, O2 sat 98% RA

What is the next step in management of this pt?
A. CBC, Chem-7, LFTs
B. 2 large bore IVs, 2 liters of normal saline.
C. Acute Abdominal Series for perforation, if negative send home.
D. Prescription for PPI or H2 blocker
D. Call GI on-call for endoscopy in 1-2 days, discharge home with prescription.

Answer 3

D. Prescription for PPI or H2 blocker

4 weeks of pain=low risk. if pain > 6 weeks, do an endoscopy

Question 4

What 2 patient populations are at risk for spontaneous bacterial peritonitis? What will these present with?

Answer 4

• cirrhosis and dialysis pts

- diffuse (mid) abdominal pain

Question 5

How quickly can mesenteric ischemia result in full gut necrosis? What is the main presenting symptom?

Answer 5

6 hours

Pain out of proportion (acute) or pain after eating (chronic)

Question 6

A 65 year old male presents to the emergency department via ambulance. He states that he was walking to the restroom and passed out. He does not recall the details, just that he was on the floor when EMS arrived. He denies abdominal pain but complains of Left Flank pain, “probably from the fall.” BP 100/85, HR 120, RR 18, O2 sat is 93% on RA.
What is the diagnosis until proven otherwise?

Answer 6

AAA

Question 7

What PE findings could a AAA present with? Who should we consider a AAA in?

Answer 7

• Vital signs may be normal
• Hypotension and Shock
• Abdominal tenderness, distention, or pulsatile mass (70%)
• Cullen’s Sign: Peri-umbilical ecchymosis
• Grey-Tuner’s Sign: Flank ecchymosis
• Massive GI Bleeding (Aorto-enteric fistula)

*consider this in every patient over 50 with abd pain

Question 8

What is the most common cause of small bowel obstructions? Large bowel obstructions?

Answer 8

• SBO: adhesions

- LBO: colorectal cancer (#1) and diverticulitis (#2)

Question 9

What imaging is needed to diagnose acute appendicitis?

Answer 9

NONE! it is a clinical diagnosis

Question 10

If a pt sticks a button battery in their esophagus or nose, how long will it take to erode through?

Answer 10

4-6 hours

Question 11

How can you determine the difference between a simple and complex seizure?

Answer 11

actually seeing the seizure!