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EM 3 > ABDOMINAL PAIN > Flashcards

ABDOMINAL PAIN Flashcards

1
Q

3 situations where you should worry about abdominal pain

A

extremes of age
abnormal vital signs
sudden onset of severe abdominal pain

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2
Q

which antiemetic prolongs QT

A

zofran

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3
Q

3 populations that should definitely be admitted

A

needs IV meds or special consult or surgery
unstable
cant tolerate PO

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4
Q

describe visceral peritoneal pain

A

dull, poorly localized from inflammation/stretching of visceral peritoneum

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5
Q

describe parietal peritoneal pain

A

localized & distinct pain from parietal peritoneum inflammation

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6
Q

describe referral pain

A

pain felt away from source

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7
Q
  • sharp= risk of perforation
  • large= risk of ischemia, aspiration, tracheal encroachment
  • button batteries = risk of erosion/perf; thermal burn or alkaline injury; fistula formation
A

esophageal obstruction

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8
Q

what is the condition? first thing to do if suspecting this?

  • drooling/refusing PO
  • dysphagia
  • tracheal involvement= stridor/dyspnea
A

esophageal obstruction
first get CXR, if not radio-opaque then CT or EGD or gastrograffin swallow study

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9
Q

how is esophageal obstruction managed?

A
  • emergent EGD esp if button battery or sharp or airway compromise
  • output xray 24 hrs– no emergent indication, no pain, tolerating po
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10
Q

effort rupture: ++ vomiting, abdominal trauma, defecating

A

boerhaaves syndromes– can cause esophageal perforation

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11
Q

condition? imaging? tx(4)?

hx of ETOHism, bulimia, recent EGD
severe restrosternal/upper abdominal pain
odynophagia

A
  • esophageal perforation
  • imaging: CXR showing mediastinal or free peritoneal air but CT is preferred; gastrograffin esophagram
  • tx: NPO, IVF, broad spectrum abx, surgery
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12
Q

what is this? how is it treated (3)?

  • risk factors = ETOH use, liver disease
  • enlarged veins d/t portal HTN
  • upper GI bleed
A

esophageal varices
tx: ocreotide, intubate, EGD/banding

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13
Q

what is a complication of PUD?

A

deep ulceration causing upper GI bleed or perforation

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14
Q

2 general signs of upper GI bleed? one specific sign that its d/t PUD?

A
  • hematemesis or melena
  • tachycardia, hypotension, LH/syncope, shock
  • PUD: abdominal pain/rigidity
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15
Q

what is this? how is it treated (2) ?

  • upper GI bleed sx
  • abdominal pain/rigidity
  • xray shows free air or CT (if stable) shows air, defect
  • decreased h/h, increased BUN
A

PUD induced GI bleed
tx: PPI IV, surgery cautery/omental patching

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16
Q

how are upper GI bleeds generally treated (3)?

A
  • IV
  • blood match +/- transfusion
  • prophylactic abx
17
Q

what imaging do you do if the cause of the post-prandial RUQ pain is unclear?

A

CT

18
Q

inflammation in the absence of stones; critically ill, long term TPN, elderly

A

acalculous cholecystitis

19
Q

choledocholithiasis vs cholangitis

A
  • choledocholithiasis: stone in CBD +/- jaundice
  • cholangitis: inflammation/infection of the CBD; SICK
20
Q

what is charcots triad & reynolds pentad? what condition is it associated with?

A

RUQ pain, fever/rigors, jaundice, hypotension, altered mental status
associated with cholangitis

21
Q

dilation of CBD + pneumobilia is seen on US with what condition

A

cholangitis

22
Q

choledocholithiasis treatment (4)

A
  • IVF
  • pain & nausea tx
  • NPO
  • ERCP
23
Q

cholangitis treatment (7)

A
  • IVF
  • pain and nausea tx
  • NPO
  • blood cultures
  • IV abx
  • ICU
  • biliary drainage: ERCP, TR drain placement, surgical drainage
24
Q

when can you discharge someone with acute pancreatitis (3)

A

passed PO challenge
pain managed
no stone

25
Q

majority of small bowel obstructions are caused by?

A

post op adhesions

26
Q

condition? dx? tx?

  • distention, diffuse crampy pain, N/V, dehydration
  • cant pass gas or stool
A

SBO
dx: CT, XR
if partial, admit; if high grade then surgery consult; if closed loop then its a surgical emergency

+ IVF, NPO, NG tube

27
Q
  • severly painful, tender, non-reducible mass
  • SBO presentation too
  • hematochezia
  • if strangulated– gangrene, peritonitis, shock
A

incarcerated hernia
dx: clnical, labs (leukocytosis, elevated lactate), SBO on XR, CT
tx: surgery consult if incarcerated, IV abx & surgery emergency if strangulated

28
Q
  • sudden severe onset of pain
  • POOP when ischemic, peritoneal when necrotic
  • N/V
  • forceful bowel evacuation
A

acute mesenteric ischemia
dx: labs (leukocytosis, elevated lactate), CTAP or CTA,
tx: eary surgery consult

29
Q

what is rovsing, obturator, iliopsoas signs

A
  • rovsing: RLQ pain w/ palp of LLQ
  • obturator: pain w/ R hip Internal rotation
  • iliopsoas: RLQ pain w/ passive R hip extension
30
Q

imaging for appendicitis (3)

A

CTAP most sensive
US in kids & pregnant
MRI in pregnant

31
Q
  • LLQ pain/tenderness, N/V/D
  • hematochezia
  • h.o diverticulosis on colonscopy
A

acute diverticulitis
complications: absecess, perforation
labs: leukocytosis,
CTAP
admit w/ IV abx if complicated; discharge, bowel rest & abx if uncomplicated

32
Q

perforation through wall of hollow organs (bowels)
PUD, complicated appy, diverc, SBO
sick, septic shock, abdominal distention

A

ruptured hollow viscus
labs: leukocytosis, elevated lactate
XR: pneumoperitoneum– rigler sign; air crescent
CT
tx: surgery

33
Q
  • ripping/tearing abdominal or flank pain, hypotension, pulsatile abd. mass
  • hemorrhagic shock, tachy, hypotension
  • retroperitoneal hemorrage: cullens & grey turners
A

ruptured AAA
US if known AAA; CT if stable
decreased h/h, elevated lactate
surgery

34
Q
  • colicky pain following ureter trajectory
  • pacing, vomiting, v painful
  • typically in 20s to 50s
  • UA shows blood, infection
  • CT non con, US if pregnant
A

septic ureteral stones
only discharge if no infection, baseline renal fxn, pain & nausea manged w/ PO; other wise admit and surgery

35
Q

red swollen testicle w unilateral absent cremasteric reflex

A

testicular tosion
emergent urology consult; color US if unsure

36
Q

severe hepatocellular injury in normal liver; can be toxin or viral induced
AMS, belly pain, jaundice, RUQ tenderness, anorexia
elevated LFT (v high AST, ALT) & prolonged INR

A

fulminant hepatic failure or acetaminophen OD
- activated charcoal w/in 4 hrs
- N-acetylcysteine to prevent APA metabolites from further damaging cells
- rumack matthew Nomogram
- ICU +/- care at liver transplant facility

37
Q
  • ascites fluid infetion w/o apperent intraabdominal treatable source
  • large volume ascites, fever, AMS, diffuse abd pain/ttp/peritoneal signs
  • paracentesis w/ fluid analysis
A

spontaneous bacterial peritonitis
abx, consider albumin infusion, ICU admit

EM 3 (4 decks)

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