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ER Part 2 > ABDOMINAL PAIN > Flashcards

ABDOMINAL PAIN Flashcards

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1
Q

If a 63 patient has a distended bowel with tympany – what do you think?

A

Bowel obstruction

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2
Q

If you get a WBC on a patient you think has a bowel obstruction and her white count is high, and a really high anion gap, so you decide to get a CT scan – what might you see?

A

Ischemic bowel

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3
Q

What is afib associated with in the bowel?

A

Ischemic bowel

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4
Q

If a bicarb is 8 (extremely high) with vomiting and a blood glucose of 12,000 – what diagnosis?

A

DKA

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5
Q

If a patient have RLQ pain with rebound tenderness, what other diagnosis should you think of besides appendicitis?

A

Kidney stone

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6
Q

What is a positive murphy’s sign?

A

That take a breath in while you push in and they suddenly stop their breath – almost always gallbladder

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7
Q

What is a positive psoas sign?

A

Side lying, while extending the leg, with pain in the LQ (something would cause peritoneal pain- ovarian, appendix, or perforation)

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8
Q

What is a positive obturator sign?

A

flex the hip and rotate in and out

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9
Q

What is a positive rovsings sign?

A

Pushing on the LLQ & suddenly lifts off causing rebound pain the RLQ

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10
Q

What is a positive heel strike?

A

Strike the feel and causes jiggling in the belly (can also ask about the car ride in)

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11
Q

If any of those 5 signs (heel strike, rovings sign, obturator sign, posts sign, and murphy’s sign) are positive – what does that mean?

A

They need to be worked up now (don’t send them to their PCP or the surgeon)

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12
Q

When would you order an xray?

A

Bowel obstruction, perf, kidney stone, toxic megacolon, FB, constipation

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13
Q

Is an xray good enough to diagnose a bowel obstruction?

A

Nope… especially if they had any abdominal surgery

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14
Q

What is a KUB?

A

Kidney, uterine, bladder – xray

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15
Q

Why would we utilize an ultrasound for abdominal pain?

A

Ovaries, gallbladder, appendix (30% success rate), pregnancy, torsion, testicles, enlarged kidney

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16
Q

What is a FAST exam?

A

Looking for free fluid around an organ after trauma as performed by an U/S

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17
Q

When would we use an MRI in the setting of abdominal pain?

A

Preggo women! (especially 1st tri)

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18
Q

When would we order a CT without contrast for the abdomen?

A

Kidney stones, post-surgery abscess, you can see fluid → but you can’t see where it’s coming from (you need contrast)

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19
Q

When would you need a CT with contrast?

A

Ischemic bowel, traumatic injuries, when you need to see flow, pancreatitis

Oral contrast = when we need to see plumbing (apple core)

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20
Q

If a patient has a contrast allergy – can you still perform oral or IV contrast?

A

IV = no

Oral = Yes! (it just takes 2 hours to be absorbed)

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21
Q

What should you document every time for an abdominal exam?

A

Presence or absence of peritoneal signs

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22
Q

If a patient is over the age of 70 and they present with abdominal pain – what should be on our DDx?

A

Acute cholecystitis, malignancy, ileus, ulcer, diverticulitis, hernia, acute pancreatitis, appendicitis

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23
Q

If we have a neonate with nonbilious vomiting – what should we keep on our ddx?

A

GERD, hypertrophic pyloric stenosis

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24
Q

If we have a neonate with bilious vomiting – what should we keep on our ddx?

A

Malrotation, volvulus, Hirschsprung’s, hernias, meningitis, and sepsis

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25
Q

If you see a neonate with an abdominal mass – what should we keep on our ddx?

A

Renal (Wilm’s) or neuroblastoma

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26
Q

What should you think of with 2 year old that’s happy and then brings their knees to their chest while crying – what diagnosis?

A

Intussusception (along with currant-jelly stools & U/S showing target sign or bulls eye)

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27
Q

If a patient is 6-7 years old with persistent lateralization of pain – what should we think of?

A

Appendicitis

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28
Q

What’s often the most common cause of abdominal pain in children?

A

Constipation

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29
Q

What’s the best approach to working with a patient with acute abdomen?

A

Vitals, careful HPI, location of pain, diagnostics

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30
Q

If a patient has severe explosive pain – what do you think of?

A

perforation of hollow viscus

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31
Q

If a patient has progressive severe pain or cramping pain in a crescendo-decrescendo pattern – what do you think of?

A

ischemic necrosis

32
Q

What might we need to consider in the upper quadrants on our DDx that are often forgotten?

A

PE, lower lobe pneumonia, and kidney stones

33
Q

What might have referred pain to the low back?

A

Salpingitis or cystitis

34
Q

What might have referred pain to the mid-back?

A

Pancreatitis, ulcer, and cholecystitis

35
Q

What might have referred pain to the shoulder?

A

Diaphragmatic irritation

36
Q

What do you look for on PE of the abdomen during gross inspection & on palpation?

A

Distended abd, ecchymosis, obvious hernia

Rebound, guarding, rigidity, absence of bowel sounds

37
Q

What special tests can you do on abdominal exams?

A

Heel strike, obturator, iliopsoas, murphy’s, Rovsings

38
Q

What is Borhaave’s syndrome?

A

When they tear the esophagus from the stomach – after continuous vomiting with acute onset of pain

May have pneumomediastinum (air underneath)

39
Q

What type of history questions should we consider with a gastric ulcer?

A

NSAID use, ASA, ETOH, and smoking

Might awaken them at night

Worse or better with food

40
Q

If a patient has been continuously vomiting and cough with chest pain. And then they start having hematemesis after vomiting – what do you think of?

A

Mallory-Weiss Tear

41
Q

What should we rule out with a Mallory Weiss tear?

A

CXR to r/o free air/pneumomediastinum

42
Q

Where does cholelithiasis radiate to? When is it often exacerbated?

A

Radiates to the chest and right shoulder

Pain worse after a fatty meal

43
Q

What can you control the symptoms of cholelithiasis with?

A

Toradol, morphine, and Zofran

44
Q

Do the stones of cholelithiasis always cause pain?

A

Nope… (so if you find the stones it can be an incidental finding)

45
Q

If you see a gallbladder with thickening or fluid around the gallbladder on U/S – what does that indicate?

A

It’s not cholelithiasis it’s cholecystitis

46
Q

If a patient presents with RUQ pain along with fever, chills, and vomiting – what do you think of?

A

Acute cholecystitis & choledocolithiasis

47
Q

What does a patient with acute cholecystitis need?

A

Surgery

48
Q

If a patient is jaundiced with RUQ pain – what do you think of?

A

Choledocolithiasis

49
Q

What does a patient need with acute choledocolithiasis?

A

ERCP & consult surgery STAT

50
Q

Where is a stone in choledocolithiasis?

A

Common bile duct

51
Q

What diagnosis presents with severe, unrelenting pain that radiates to the back and epigastric area. Pain is worse with laying down and better if slumped over?

A

Pancreatitis

52
Q

Turner’s and Cullen’s signs are associated with what?

A

Pancreatitis & sometimes AAA

53
Q

What labs do you definitely want to do to help you rule in/out pancreatitis, what would you see?

A

Lipase! It would be 3x normal

ALT 3x normal

54
Q

How do you treat pancreatitis?

A

IV hydration (LOTS of fluids) & IV pain meds

55
Q

If a patient is old and has back pain – what do we need to keep on our differential until proven otherwise?

A

AAA!!!

56
Q

What do you need to check for on PE for a AAA?

A

Palpable, pulsatile, non-tender mass. May hear a bruit

57
Q

If a patient has periumbilical pain that is out of proportion with exam, and they have a history of afib and is on warfarin – what diagnosis should you think of?

A

Ischemic bowel

58
Q

What labs would you see with ischemic bowel?

A

Increased WBC, lactic acid, and LDH

59
Q

What imaging should you order for definitive diagnosis of ischemic bowel?

A

CT with oral & IV contrast

60
Q

How do we treat ischemic bowel?

A

Surgical consult

Broad spectrum Abx (Zosyn), NPO, and NG tube

61
Q

What else can present with periumbilical pain that is generally seen in children & young adults?

A

Mesenteric Adenitis

62
Q

What is often causing appendicitis?

A

Bacterial overgrowth by E. coli

63
Q

Where does appendicitis pain typically start?

A

periumbilical and then migrates to the RLQ

64
Q

In a female, what else should you consider besides appendicitis?

A

UTI, kidney stone, ovarian abcess/torsion, PID, ectopic

65
Q

What types of labs and imaging do you order for appendicitis?

A

CBC, UA, HCG, coag

Imaging = Ultrasound and/or CT scan with PO/IV contrast

66
Q

What diagnosis do you typically think of with LLQ pain that presents with constant pain, fever, and constipation?

A

Diverticulitis

67
Q

What causes diverticulitis?

A

fecolith in diverticulum causing invasion of bacteria

68
Q

How do we diagnose diverticulitis?

A

Elevated WBC’s & CT scan with PO or IV contrast

69
Q

How do we treat diverticulitis?

A

Cipro + flagyl

70
Q

What does a CBC tell you?

A

Infection (but you can have an appendicitis and have a normal WBC), anemia

71
Q

If a patient is going into surgery for their abdomen – do you give them pain meds?

A

Yes! (just not a ton, and do it IV)

72
Q

What does a lactate level tell you?

A

Sepsis!

73
Q

If a female has lower abdominal pain – what must we do?

A

Pelvic Exam – it’s standard of care!!!

Consider STD studies

74
Q

If a patient has cramping abdominal pain, with N/V, and pencil stools. The abdomen is distended, tympani, and they’re diffusely tender – what diagnosis?

A

Small Bowel Obstruction

75
Q

What diagnostic test would we do for a small bowel obstruction?

A

KUB with upright abdomen (air fluid level), CT if needed, surgery consult

76
Q

If a patient has painless rectal bleeding with blood/mucous diarrhea are present in what?

A

UC

77
Q

What’s the most common suit involving medical emergencies?

A

Appendicitis

ER Part 2 (7 decks)

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