Abdominal Emergencies

Question 1

History for appendicitis

Answer 1

starts with visceral, nonspecific abdominal pain that migrates and becomes localized to the RLQ

Question 2

Epidemiology Ingested Foreign bodies (3 things)

Answer 2

1) 80% occur in children
2) 80-90% pass without the need for intervention
3) <1% require surgical intervention

Question 3

Common ingested FB in kids

Answer 3

coins

Question 4

Common ingested FB in adults

Answer 4

food bolus

Question 5

Ingested FB pathophysiology

Answer 5

• esophagus is most frequent site of obstruction in the GI tract
• esophageal FB are often impacted at sites of physiologic or pathologic luminal narrowing

Question 6

Red flag Signs/Sx ingested FB

Answer 6

• drooling and inability to swallow liquids is indication of obstruction (need emergent endoscopy)
• fever, abdominal pain, repetitive vomiting after FB ingestion are concerning and warrant further workup

Question 7

Factors that determine management of ingested esophageal FB (3)

Answer 7

1) presence and severity of Sx
2) type of object ingested (size, shape, content)
3) location of the object

Question 8

Signs of airway compromise and management

Answer 8

choking, stridor, wheezing, difficulty breathing – must be addressed immediately (ENT/GI)

Question 9

Treatment esophageal foreign bodies

Answer 9

• emergent endoscopy (within 6 hrs) with complete obstruction/disk batteries/sharp objects
• urgent endoscopy (within 24 hours) for all other FB

Question 10

How soon will objects that enter the stomach pass?

Answer 10

four to six days

Question 11

What are the most common types of hernias?

Answer 11

75% are inguinal hernias (2/3 are indirect, 1/3 are direct)

Question 12

What are the common locations of hernias?

Answer 12

ventral: epigastric and umbilical
groin: inguinal

Question 13

describe direct inguinal hernia

Answer 13

passes directly through a weakness in the transversalis fascia in the hesselbach triagnle

Question 14

describe indirect inguinal hernia

Answer 14

passes from the internal to the external inguinal ring through the patent process vaginalis, and then to the scrotum

Question 15

Describe reducible hernia

Answer 15

hernia sac itself is soft and easy to replace back through the hernia neck defect

Question 16

describe incarcerated hernia

Answer 16

hernia sack is firm, often painful, and nonreducible by direct manual pressure, no signs of systemic illness

Question 17

describe strangulated hernia

Answer 17

hernia sack firm and very painful, usually with signs of systemic illness present (N/V/F) implies impairment of blood flow (arterial, venous, or both)

Question 18

management of strangulated hernia

Answer 18

it is an acute surgical emergency (surgery, broad-spectrum IV ABX, fluid resuscitation, analgesics)

Question 19

What age group does AAA mainly affect?

Answer 19

disease of older persons

Question 20

At what size is an AAA diagnosed?

Answer 20

aortic diameter exceeds 3.0cm

Question 21

Classic triad ruptured AAA

Answer 21

1) severe abdominal/flank pain
2) pulsatile mass
3) hypotension

Question 22

Primary survey for critically ill patients

Answer 22

A- Airway
B- breathing
C- circulation with hemorrhage control
D- disability/neuro status
E- exposure/environmental control, completely undress the patient, prevent hypothermia

Question 23

Should you delay transfer to obtain diagnostic studies?

Answer 23

NO

Question 24

purpose of FAST SCAN

Answer 24

detect free intraperitoneal fluid, pericardial fluid, pleural fluid, hemothorax and pneumothorax in trauma patients