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Internal Med EOR > Abdominal Pain and Acute Abdominal Disorders > Flashcards

Abdominal Pain and Acute Abdominal Disorders Flashcards

1
Q

characteristics of visceral pain

A
  • slow onset
  • poorly localized
  • dull discomfort
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2
Q

characteristics of somatic pain

A
  • sudden
  • sharp
  • well localized
  • lateralizing
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3
Q

it may be necessary to wait as long as ____ minutes to establish absence of peristalsis

A

2-3

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4
Q

Carnett sign

A

flex stomach to determine if pain is located in the abdominal wall or intraabdominally

if pain when flexed carnett is positive and pain is abdominal wall pain

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5
Q

murphy’s sign

A

patient takes a slow, deep breath in and there is an abrupt cessation in inspiration by deep palpation of the RUQ

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6
Q

what is murphy’s sign indicative of?

A

cholecystitis

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7
Q

rovsing sign

A

RLQ pain elicited by pressure applied on the lower left quadrant

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8
Q

what is rovsing sign indicative of?

A

appendicitis

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9
Q

psoas sign

A

patient flexed the thigh against the resistance of the examiner’s hand

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10
Q

what is psoas sign indicative of?

A

appendicitis

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11
Q

obturator sign

A

patient’s thigh is flexed to a right angle and gently rotated, first internally and then externally

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12
Q

what is obturator sign indicative of?

A
  • appendicitis
  • diverticulitis
  • PID
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13
Q

management of abdominal pain

A
  • stabilize
  • NPO
  • IV hydration
  • analgesics
  • antiemetics
  • consult
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14
Q

indications for admission of abdominal pain

A
  • toxic appearance
  • unclear diagnosis
  • inability to exclude serious etiology
  • intractable pain or vomiting
  • altered mental status
  • inability to follow discharge or F/U instructions
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15
Q

volvulus

A

torsion of a segment of the bowel

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16
Q

types of volvulus

A
  • MC sigmoid
  • cecal
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17
Q

t/f some volvulus may reduce spontaneousley

A

true

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18
Q

pathophys of sigmoid volvulus

A

air filled loop of the sigmoid colon twists about its mesentery

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19
Q

risk factors for sigmoid volvulus

A
  • long, redundant sigmoid colon w/ a narrow mesenteric attachment
  • chronic fecal overloading from constipation
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20
Q

clinical presentation of sigmoid volvulus

A

insidious onset of slowly progressive abdominal pain, nausea, abdominal distention, and constipation

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21
Q

vomiting in volvulus usually occurs…

A

several hours after onset

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22
Q

PE of sigmoid volvulus

A
  • abdominal distention and tympany
  • tenderness to palpation
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23
Q

diagnosis of sigmoid volvulus

A

abdominal CT showing whirl patterns and birds beak

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24
Q

imaging used for volvulus when there isnt access to CT

A

radiographs

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25
Q

management of sigmoid volvulus

A
  • reduce volvulus
  • IV fluids
  • endoscopic detorsion with rigid sigmoidoscope
  • surgical exploration with gangrene
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26
Q

cecal volvulus

A

torsion of a mobile cecum and ascending colon

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27
Q

in cecal volvulus, rotation occurs around the…

A

ileocolic blood vessels

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28
Q

risk factors for cecal volvulus

A
  • pregnancy
  • tumors
  • exertion
  • violent coughing
  • infections
  • weakness of colon muscle
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29
Q

clinical findings of cecal volvulus

A

gradual onset of steady abdominal pain with episodic cramping due to peristalsis

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30
Q

PE of cecal volvulus

A
  • distended and tympanic abdomen
  • tenderness to palpation
  • fever
  • hypotension
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31
Q

diagnosis of cecal volvulus

A
  • initially, a plain radiograph will be done
  • CT is first line and confirmatory
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32
Q

results of plain radiography of cecal volvulus

A
  • coffee bean sign
  • comma sign
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33
Q

results of CT with cecal volvulus

A

whirlwind sign

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34
Q

results of barium GI series for cecal volvulus

A

birds beak

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35
Q

t/f cecal volvulus can not be detorsed endoscopically

A

true

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36
Q

management of cecal volvulus stable without bowel compromise

A

open surgical detorsion, then iliocecal resection

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37
Q

management of cecal volvulus hemodynamically unstable without bowel compromise

A

cecopexy after detorsion

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38
Q

t/f you should detorse when the patient has bowel compromise

A

false

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39
Q

management of cecal volvulus stable with bowel compromise

A

ileocolic resection and anatamosis

40
Q

management of cecal volvulus unstable with bowel compromise

A

resection of compromised bowel

41
Q

MC cause of intestinal obstruction between 6 months and 3 years

A

intussesception

42
Q

intussusception

A

portion of the bowel is telescoped into another segment

43
Q

MC type of intussusception

A

ileocolic

44
Q

as the intussusception develops, the mesentery is dragged into the bowel, leading to…

A

development of venous and lymphatic congestion with resulting edema

45
Q

clinical presentation of intussusception

A
  • severe pain in a perviously healthy child
  • currant jelly stool
  • sausage shaped mass in the right side of the abdomen
46
Q

diagnosis of intussusception

A

US

47
Q

what do you see on US for intussusception?

A

bullseye
whirlwind
one more thing? snails shell? idk

48
Q

confirm diagnosis of intussusception

A

barium enema

49
Q

t/f the barium enema is curative as well as diagnostic for intussusception

A

true

50
Q

management of intussusception

A
  • nonoperative reduction
  • surgical consult if severe
51
Q

nonoperative reduction

A

hydrostatic or pneumatic pressure by enema

52
Q

fluoroscopy

A
  • type of medical imaging that shows a continuous xray image on monitor
  • can be pneumatic or hydrostatic
53
Q

sonographic

A

uses US and hydrostatic technique to provide retrograde pressure

54
Q

what type of intussusception management has higher success rates?

A

pneumatic

55
Q

MC abdominal surgical emergency

A

appendicitis

56
Q

etiology of appendicitis

A

fecalith causing obstruction leading to increased intraluminal pressure

57
Q

clinical presentation of appendicitis

A
  • vague, colicky, abdominal pain
  • RLQ
58
Q

PE of appendicitis

A
  • localized tenderness with guarding in RLQ
  • mcburneys point tenderness
  • rovsing sign
  • psoas sign
  • obturator sign
  • heel slap sign
59
Q

McBurney’s point tenderness

A

tenderness to palpation in the mid-point of the right lower quadrant (RLQ) which can indicate appendicitis

60
Q

diagnosis of appendicitis

A

CT

(US in pregnant or child)

61
Q

management of appendicitis

A
  • laparoscopic appendectomy
  • hydrate with IV fluids
  • antibiotics (cefotixin or cefotetan for surgical. metro+rocephin if non surgical.
62
Q

etiology of toxic megacolon

A

lethal complication of inflammatory bowel disease or infectious colitis

63
Q

toxic megacolon is a nonobstructive colonic dilation of at least …… + …….

A

6cm and systemic toxicity

64
Q

what inflammatory bowel disease is toxic megacolon related to?

A

chrons

65
Q

hallmark of toxic megacolon

A
  • severe inflammation extending into the smooth muscle layer
  • paralyzing the colonic smooth muscle and leading to dilation
66
Q

clinical findings of toxic megacolon

A
  • s/s of colitis resistant to therapy
  • severe bloody diarrhea
  • malaise
  • abdominal pain and distention
67
Q

PE of toxic megacolon

A
  • altered mental status
  • fever
  • tachycardia
  • lower abdominal pain and tenderness
68
Q

diagnosis of toxic megacolon

A

CT

69
Q

criteria for toxic megacolon diagnosis

A
  • radiographic evidence
  • at least 3 of the following (fever, HR>120, elevated neutrophils, and anemia)
  • at least one of the following (dehydration, altered mental status, electrolyte disturbances, hypotension)
70
Q

what part of the colon is most dilated in toxic megacolon?

A

transverse or right

71
Q

treatment of toxic megacolon

A
  • complete bowel rest
  • NG tube
  • IV fluids
  • IV steroids
  • surgical consult
72
Q

Acute mesenteric ischemia

A

sudden onset of small intestine hypoperfusion

73
Q

MC artery affected by acute mesenteric ischemia

A

superior mesenteric artery

74
Q

clinical features of acute mesenteric ischemia

A

abdominal pain out of proportion to PE

75
Q

PE of acute mesenteric ischemia

A
  • abdominal distention
  • absent bowel sounds
  • occult blood in stool
  • feculent odor to breath
76
Q

labs for acute mesenteric ischemia

A

metabolic acidosis

77
Q

imaging for acute mesenteric ischemia

A
  • CT/MRI performed first
  • definitive mesenteric arteriography
78
Q

what does the mesenteric arteriography show in acute mesenteric ischemia ?

A
  • narrowing/spasming of mesenteric arteries
  • reduced filling
  • irregularity of arterial branches
79
Q

treatment of acute mesenteric ischemia

A
  • pain control
  • hemodynamic support
  • anticoagulation
  • vasodialtor
80
Q

Upper GI bleed

A

originating proximal to the ligament of treitz

81
Q

MC cause of upper GI bleed

A

PUD

82
Q

lower GI bleed

A

Distal to the ligament of Treitz

83
Q

MC cause of lower GI bleed

A

diverticulosis

84
Q

what do each of the following indicate?
* hematemesis
* melena
* hematochezia

A
  • hematemesis: source is proximal to the right colon
  • melena: upper GI bleed
  • hematochezia: coming from the colon/rectum
85
Q

emergency stabilization of GI bleed

A
  • ABCs
  • fluids
  • NG tube
86
Q

hernia

A

protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it

87
Q

how are hernias typically classified?

A

location or etiology

88
Q

cause of umbilical hernia

A

increased intra-abdominal pressure

89
Q

risk factors for umbilical hernias

A
  • multiple pregnancies
  • ascites
  • obesity
  • large intra-abdominal tumor
90
Q

indications for emergent repair for an umbilical hernia

A

incarceration and strangulation

91
Q

treatment of umbilical hernia

A
  • surgical repair
  • open repair
  • mesh laparoscopic
92
Q

incisional hernia

A

herniation through a previous surgical wound

93
Q

risks for incisional hernia

A
  • poor surgical technique
  • obesity
  • age
  • post-op wound infection
94
Q

t/f hernias can cause bowel obstruction

A

true

95
Q

concerning clinical features for strangulation

A
  • firm, incarcerated hernia
  • severe tenderness on exam
  • redness and other discoloration of the overlying skin
96
Q

if the patient…. then the symptoms can be controlled by an abdominal binder

A
  • doesn’t require emergency surgery
  • unwilling to undergo surgery
  • poor surgical risk

Internal Med EOR (18 decks)

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