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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?

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
majority of small bowel obstructions are caused by?
post op adhesions
26
# condition? dx? tx? - distention, diffuse **crampy** pain, N/V, dehydration - cant pass gas or stool
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
- severly painful, tender, non-reducible mass - SBO presentation too - hematochezia - if strangulated-- gangrene, peritonitis, shock
incarcerated hernia dx: clnical, labs (leukocytosis, elevated lactate), SBO on XR, CT tx: surgery consult if incarcerated, IV abx & surgery emergency if strangulated
28
- sudden severe onset of pain - POOP when ischemic, peritoneal when necrotic - N/V - forceful bowel evacuation
acute mesenteric ischemia dx: labs (leukocytosis, elevated lactate), CTAP or CTA, tx: eary surgery consult
29
what is rovsing, obturator, iliopsoas signs
- rovsing: RLQ pain w/ palp of LLQ - obturator: pain w/ R hip Internal rotation - iliopsoas: RLQ pain w/ passive R hip extension
30
imaging for appendicitis (3)
CTAP most sensive US in kids & pregnant MRI in pregnant
31
- LLQ pain/tenderness, N/V/D - hematochezia - h.o diverticulosis on colonscopy
acute diverticulitis complications: absecess, perforation labs: leukocytosis, CTAP admit w/ IV abx if complicated; discharge, bowel rest & abx if uncomplicated
32
perforation through wall of hollow organs (bowels) PUD, complicated appy, diverc, SBO sick, septic shock, abdominal distention
ruptured hollow viscus labs: leukocytosis, elevated lactate XR: pneumoperitoneum-- rigler sign; air crescent CT tx: surgery
33
- ripping/tearing abdominal or flank pain, hypotension, pulsatile abd. mass - hemorrhagic shock, tachy, hypotension - retroperitoneal hemorrage: cullens & grey turners
ruptured AAA US if known AAA; CT if stable decreased h/h, elevated lactate surgery
34
- colicky pain following ureter trajectory - pacing, vomiting, v painful - typically in 20s to 50s - UA shows blood, infection - **CT non con**, US if pregnant
septic ureteral stones only discharge if no infection, baseline renal fxn, pain & nausea manged w/ PO; other wise admit and surgery
35
red swollen testicle w unilateral absent cremasteric reflex
testicular tosion emergent urology consult; color US if unsure
36
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**
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
- ascites fluid infetion w/o apperent intraabdominal treatable source - large volume ascites, fever, AMS, diffuse abd pain/ttp/peritoneal signs - paracentesis w/ fluid analysis
spontaneous bacterial peritonitis abx, consider albumin infusion, ICU admit

EM 3 (4 decks)

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