abdominal pain

Question 1

Pain in the RUQ you should think what 9 things?

Answer 1

Biliary colic
Cholecystitis
Hepatitis
MI
Pancreatitis
PUD
Pneumonia
P.E.
Renal stones

Question 2

Pain in the LUQ you should think what 10 things?

Answer 2

Gastritis
Gastric ulcer
MI
Pancreatitis
Pyelonephritis
Renal stones
Splenomegaly
Splenic rupture or abscess
Pneumonia
P.E.

Question 3

Pain in the RLQ you should think what 9 things?

Answer 3

Appendicitis
Ovarian cyst
Renal stone
Torsion
Epididymitis
Ectopic pregnancy
IBD
AAA
UTI

Question 4

Pain in the LLQ you should think what 9 things

Answer 4

Diverticulitis
Epididymitis
Ectopic pregnancy
Ovarian cyst
IBD
Renal stone
Torsion
UTI
AAA

Question 5

abdominal pain is typically derived from what 3 things

Answer 5

visceral– poorly localized
somatic
referred

Question 6

what is visceral pain most commonly caused by?

Answer 6

caused by abdominal distention, contraction, or stretching of hollow & solid organs
Often the earliest manifestation of particular disease process

Question 7

somatic/parietal pain results from what?

Answer 7

ischemia, inflammation, or stretching of the parietal peritoneum
Localized to the affected area
Typically sharp, knife like pain that is worse with cough or movement

Question 8

4 instances of referred pain?

Answer 8

Patients with pneumonia can present with abdominal pain
Patients having MI’s can have epigastric pain
Patients with cholecystitis can have right infrascapular pain
Patients with a ruptured spleen can have shoulder pain

Question 9

what is gastritis

Answer 9

Inflammatory changes in the gastric mucosa with disruption of the mucosal barrier

Question 10

what is PUD

Answer 10

Mucosal defect in portions of the GI tract that are exposed to acid & pepsin secretion

Question 11

leading cause of gastritis and PUD

Answer 11

H-pylori

Question 12

what is Phlegmonous gastritis

Answer 12

gangrene of the stomach
Severe abdominal pain accompanied by nausea and vomiting of potentially purulent gastric contents can be the presenting symptoms
Fever, chills

Question 13

Upper GI bleed

Answer 13

bleeding derived from a source proximal to the ligament of Treitz.
Sites include esophagus, stomach, duodenal bulb, 2nd/3rd portion of duodenum
Multiple causes include mucosal tears, varices, gastritis, esophagitis, CA

Question 14

Lower GI bleed

Answer 14

bleeding derived from a source distal to the ligament of Treitz
Sites include small bowel & colon
Multiple causes includes diverticular, cancer or polyps, AVM, ischemic or infectious colitis, IBD, hemorrhoids, anal fissure

Question 15

Management of GI bleed in ED

Answer 15

ABC’s
Two (2) large bore IV’s – 16 g or larger
IV fluids – crystalloids are best (NS or LR)
NG tube if vomiting blood
Foley catheter
Supplemental O2
Consult GI & surgery if needed

Question 16

Hemorrhoids

Answer 16

Dilated internal or external veins of the hemorrhoid plexus located in the lower rectum
Internal usually painless unless prolapsed
External painful may be thrombosed

Question 17

what are hemorrhoids caused by

Answer 17

Caused by cirrhosis/portal hypertension, obstruction, pregnancy

Question 18

treatment of hemorrhoids

Answer 18

Stool softeners – Colace
Supportive care with sitz baths
Anti-inflammatory preparations – Anusol, Preparation H, Analapram HC, Proctofoam HC
NSAID’s
surgical referral
Dietary changes – increase fiber, fluids, fruits, & vegetables

Question 19

Acute cholecystitis

Answer 19

Inflammation of the gallbladder most commonly from obstruction of the cystic duct from cholelithiasis
90% caused by gallstones

Question 20

treatment for acute cholecystitis?

Answer 20

ABC’s
IV fluids – NS 100-200 mL/hr
Pain meds – Ketorolac or Hydromorphone
Do not use Morphine as it can cause spasm

Question 21

what is Cholangitis

Answer 21

Infection of the biliary tract with the potential to cause significant morbidity and mortality
Many patients respond to antibiotic therapy

Question 22

Cholangitis triad

Answer 22

Triad of fever, jaundice, and right upper quadrant pain

Question 23

treatment for cholangitis

Answer 23

Assess ABC’s
Monitor, Pulse ox, & EKGIV fluids (NS or LR)
Broad-spectrum intravenous antibiotics

Question 24

what is pancreatitis

Answer 24

Inflammatory process in which pancreatic enzymes auto digest the gland

Question 25

common causes of pancreatitis

Answer 25

cholelithiasis, alcohol, iatrogenic, trauma/surgery, viral infection, metabolic disorders, untreated hypertriglycerides

Question 26

signs of acute pancreatitis

Answer 26

Sudden onset of dull, boring, and steady abdominal pain that gradually becomes more severe until reaching a constant ache
Most often located in the upper abdomen
cullens sign
gray turner sign

Question 27

Bowel Obstructions

Answer 27

90% are SBO

Leading cause of SBO is postop adhesions (60%), followed by malignancy, Crohn disease, and hernias

Question 28

what are 4 types of hernias

Answer 28

Incisional Hernia
Reducible Hernia
Incarcerated/Irreducible Hernia
Strangulated Hernia

Question 29

what is a strangulated hernia

Answer 29

vascular compromise of herniated contents

Question 30

what is incarcerated/ irreducible hernia

Answer 30

tissue cannot be reduced back into place

Question 31

what is incisional hernia

Answer 31

protrudes through a surgical incision site

Question 32

what is diverticulitis

Answer 32

Herniations of the mucosa & submucosa or entire wall thickness through the muscularis
Most common in the sigmoid colon

Question 33

Crohns disease

Answer 33

Chronic inflammatory disease of the GI tract
Can involve any part from the mouth to the anus
Skip lesions of the GI tract are seen
Transmural inflammation

Question 34

Ulcerative colitis

Answer 34

Chronic inflammatory disease of the colon
Etiology is unclear
Involves the mucosa & submucosa
Inflammation is more severe proximal to the distal colon
Rectum is usually involved
Involves intermittent attacks with remission