Abdominal Emergencies

Question 1

What is Boerhaave syndrome?

Answer 1

Full-thickness tear in esophagus, actual penetration.

- increased intra-esophageal pressure.

Question 2

Describe the form of pain of colicky pain

Answer 2

starts and stops abruptly, d/t muscular contractions of a hollow tube to relieve an obstruction bu forcing contents out

Question 3

What is kehr’s sign?

Answer 3

pain from lower abdominal region radiates to shoulder or scapular causing a dull ache

Question 4

What is melana?

Answer 4

dark tarry foul-smelling stools, upper GI bleed

Question 5

Separation of lower and upper GI bleeds is defined as?

Answer 5

Upper: Proximal of Ligament of Treitz
Lower: Distal of Ligament of Treitz

Question 6

Whats an ileus?

Answer 6

Disruption of the normal propulsive ability of the GI tact

Question 7

Pigmented gallstones is composed of?

Answer 7

Bilirubin

Question 8

+ Chvosteks sign and Trusseaus sign indicates?

Answer 8

hypocalcemia

Question 9

Whats hematochezia?

Answer 9

Fresh bight red blood in or on stool

Question 10

False-positive tox screen of amphetamines can be?

Answer 10

Asthma meds

Pseudoephedrine

Dexatrim

OTC nasal spray

Ritalin

Dexedrine

Question 11

False-positive tox screen of cocaine can be?

Answer 11

Ampicillin

Amoxicillin

Question 12

False-positive tox screen of opioids can be?

Answer 12

cough suppressants

poppy seeds

Quinine in tonic water

T3, pain meds

Amitriptyline

Question 13

False-positive tox screen of Phencyclidine (PCP) can be?

Answer 13

Diazepam

Question 14

False-positive tox screen of Tetrahydrocannabinol can be?

Answer 14

Ibuprofen

Ketoprofen

Naproxen

Phenergan

Riboflavin

Question 15

Free air under the diaphragm indicates?

Answer 15

Bowel perforation

Question 16

Air - fluid levels in the diaphragm indicate?

Answer 16

Small bowel obstruction

Question 17

What dx do you think of in a pt presenting with acute a-traumatic abdominal pain?

Answer 17

Appendicitis

Question 18

MC early sign of appendicitis?

Answer 18

Peri-umbilical/central abdominal pain discomfort

Question 19

Imaging used for suspected appendicitis?

Answer 19

Graded compression US
- (good choice in pregnancy and <2 yrs old)

Abdominal CT

Question 20

Infectious agents causing cholecystitis?

Answer 20

AIDS

Cytomegalovirus

Cryptosporidium

Question 21

Is emergent surgery needed for cholecystitis?

Answer 21

No! Admit and start with: IV hydrate, NPO, antiemetics, analgesia, and referral for surgery

Question 22

What causes a dissecting/ruptured aorta?

Answer 22

blood passing through intimal tear causing separation of the intima from the medial layer

Question 23

PE/clinical presentation of dissecting/ruptured aorta?

Answer 23

Acute onset of severe, sharp, tearing, or ripping sensation.

Pain is out of proportion to PE.

Question 24

Back and abdominal pain caused by ascending or descending dissection?

Answer 24

Descending dissection

Question 25

CXR finding with pr w/ dissecting/ruptured aorta?

Answer 25

widened mediastinum

Question 26

Sources of upper GI bleeds?

Answer 26

peptic ulcer dz erosive gastritis and esophagitis esophageal/gastric varices

Question 27

PE findings up GI bleeds?

Answer 27

HyoTN Tachy Diaphoretic Ascites

Question 28

Sources/causes of lower GI bleeds?

Answer 28

Diverticular dz (MC) Vascular ectasia Mesenteric ischemia Meckles diverticulum

Question 29

Grossly abnormal vital signs can be found in?

Answer 29

Lower GI bleed | - however, vital signs may be masked by medications (BBs)

Question 30

Mesenteric venous thrombosis more common in what age group?

Answer 30

Younger age group

Question 31

Arterial embolism/thrombosis more common in what age group?

Answer 31

Elderly age group

Question 32

What is key for diagnosing mesenteric ischemia?

Answer 32

Early recognition!!!!

Question 33

Risk factor for mesenteric ischemia?

Answer 33

>65 yrs A.Fib CHF Recent MI

Question 34

Clinical presentation of mesenteric ischemia?

Answer 34

Rapid onset of severe periumbilical pain out of proportion to PE findings. N/V Distention w/ absence of bowel sounds Mental status changes

Question 35

Top 3 etiology of pancreatitis?

Answer 35

Gallstones (MC in women) Alcohol use/abuse (MC in men) ERCP w/in 30 days ---> procedure used to dx pancreatitis

Question 36

PE/Clinical presentation of pancreatitis?

Answer 36

Typically worse in a supine position, relieved sitting up with trunk flexed and knees drawn to the chest.

Question 37

Tx for pancreatitis?

Answer 37

Supportive | Correction of electrolyte imbalances: hypocalcemia and hypoalbuminemia

Question 38

MC stone in renal colic?

Answer 38

Calcium oxalate, present in the urinary tract

Question 39

PE/clinical presentation of renal colic?

Answer 39

Constantly pacing Flank pain N/V Referred pain to testes

Question 40

Risk factors/MOI of a ruptured spleen?

Answer 40

Domestic violence MVA Infectious: mono, lymphoma, malaria Blunt trauma: trampolines, contact sports, bicucle accidents

Question 41

PE/clinical presentation of a ruptured spleen?

Answer 41

L abdominal pain | L shoulder pain: Kehrs sign