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EM quiz readings > Abdominal pain in the ER > Flashcards

Abdominal pain in the ER Flashcards

1
Q

What are the three types of abdominal pain and how to they present? what causes each of these?

A
  1. Visceral - poorly localized and 2/2 stretching of unmyelinated fibers
  2. Parietal (somatic) - localized and 2/2 irritation of myelinated fibers of the parietal pleura covering peritoneum
  3. Referred - pain felt at a location distant to underlying cause. MC on ipsilateral side.
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2
Q

which type of pain begins as tenderness and guarding and progresses to rigidity and rebound tenderness.

A

parietal (somatic)

remember 2/2 myelinated fibers of parietal pleura.

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3
Q

what are the MC extra-abdominal etiologies

A
  • DKA
  • Alcoholic ketoacidosis
  • Pneumonia
  • PE
  • Herpes Zoster
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4
Q

is genitourinary considered extra-abdominal or intraabdominal?

A

extra-abdominal

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5
Q

who is more likely to have less severe or atypical presentations of abdominal pain?

A

elderly population.

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6
Q

How much is mortality increased for abdominal complaints in elderly

A

6-8 fold

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7
Q

what etiologies should you consider for elderly population who have abdominal pain

A
  • ischemic heart disease
  • vasculopathies
  • coagulopathies
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8
Q

pain with maximal intensity at onset is a red flag for what diagnoses

A
  • ischemia
  • dissection
  • perforation
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9
Q

a gradual onset of abdominal pain is more suggestive of what types of diagnoses

A
  • inflammatory
  • infectious
  • obstructive
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10
Q

if pain is constant or worsening over 6 hours what type of etiology is it likely

A

surgical

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11
Q

What diagnosis relates to each of the following aggravating/alleviating factor?:

  1. pain improves after meals
  2. pain worse after meals
  3. pain improves when upright and worse when supine
  4. pain worse with sudden movements and improves with stillness
A
  1. PUD
  2. Biliary Colic
  3. pancreatitis
  4. peritonitis
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12
Q

Vomiting AFTER the onset of pain suggests what type of etiology

A

surgical

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13
Q

bilious vomiting suggests what etiology

A

obstruction distal to pylorus

note: Vomitus is considered bilious if it has a green or bright yellow color, indicating larger amounts of bile in the stomach

from google^ just cuz idk what bilious meant.

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14
Q

coffee-ground or hematemesis suggests what etiologies

A
  • PUD
  • Varices
  • aortoenteric fistula in pts with aortic aneurysm repair.
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15
Q

What etiologies are associated with the following diarrheal types:
1. loose/watery
2. mucoid
3. bloody
4. small scant amounts

A
  1. loose/watery - infectious or diverticulitis
  2. mucoid - infectious or inflammatory
  3. bloody - mesenteric ischemia or infectious
  4. small scant amounts - bowel obstruction
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16
Q

what may suggest infectious etiology in elderly and neonatal populations

A

lower body temperature

17
Q

what do the following auscultations suggest:
* absence
* periodic high-pitched
* hyperactive medium pitch
* bruit

A
  • absence - peritonitis or bowel obstruction
  • periodic high-pitched - bowel obstruction
  • hyperactive medium pitch - blood or inflammation within the GI tract
  • bruit - abdominal aortic aneurysm
18
Q

What tests peritoneal pain and who are these tests not reliable in?

A
  • rebound
  • heel tap
  • jumping
  • not reliable in elderly or pregnant population
19
Q

what do the following signs indicate?

  1. Carnett’s sign¹
  2. Murphy’s sign²
  3. Psoas sign³
  4. Obturators sign⁴
  5. Rovsing sign⁵
  6. CVA percussion
A
  1. Carnett’s sign¹ - indicates abdominal wall pathology
  2. Murphy’s sign² - indicative of cholecystitis
  3. Psoas sign³ - indicative of a retrocecal appendicitis
  4. Obturators sign⁴ - indicative of appendicitis
  5. Rovsing sign⁵ - indicative of appendicitis
  6. CVA percussion - indicative of pyelonephritis
20
Q

who has physiologic leukocytosis?

A

pregnant people (elevated WBC = normal)

21
Q

what can be visualized with an ultrasound

A
  • GB
  • pancreas
  • kidneys
  • ureters
  • urinary bladder volume
  • uterus/fallopian tubes
  • aortic dimensions
22
Q

What is the preferred study for undifferentiated abdominal pain

A

CT scan

23
Q

what are indications for NON contrast CT’s

A
  • nephrolithiasis
  • trauma
  • hemoperitoneum
  • bowel obstruction
24
Q

what are indications for oral vs IV contrast for CT abdomen

A
25
Q

what are CI to IV contrast

A
  • serum Cr >1.5
  • GFR <60 (unless life threatening)
  • Caution w metformin
26
Q

when is angiography indicated for abdominal pain?

A

mesenteric ischemia and massive lower GI bleeds!

27
Q

if there is any concern for bleeding in an abdominal pain complaint, what labs must you get?

A
  • Type and screen
  • crossmatch
28
Q

If there is evidence of shock in abdominal complaints, what lab should you order

A

ABG

29
Q

Slides 21-25 is literally a huge flow chart. maybe glance at that

A

okie dokie

30
Q

what is initial management for patients with abdominal pain?

A
  • NPO!
  • Hypotensive = Rapid infusions of IV crystalloids (NS/LR) 1 L bolus over 10-20 min.
  • Normotensive = IV cyrstalloids 75-125ml/hour
31
Q

what are go to antiemetics?

A
  • ondansetron
  • Metoclopramide
32
Q

what might be co-administered w metoclopamide

A
  • diphenhydramine (benadryl) to avoid extrapyramidal SE
  • avoid if hx of akathisia or dystonic rxns.
33
Q

what are pain goals for patients with abdominal pain?

A
  • improve pain to a tolerable level (not to eliminate it!)
  • improve pt cooperation (no gaurding)
34
Q

what agents might we use as pain management

A
  • morphine
  • fentanyl
  • ketorolac (toradol) - great for renal colic, avoid in peritonitis
35
Q

what are indications for NG tube placement

A
  • intractable emesis
  • confirm upper GI bleed
  • add light suction to decompress GI tract in a bowel obstruction
  • consider in peritonitis and severe ileus
36
Q

what are indications for a foley catheter

A
  • bladder obstruction
  • closely monitor I&O’s
  • assess renal perfusion
37
Q

what are the empiric antibiotics for suspected sepsis and peritonitis

A
  • option 1 - pip/taz IV
  • option 2 - gentamicin + metronidazole IV
  • vary based on individual and ddx
38
Q

according to the “when to order Contrast” article, when is IV contrast indicated

A
  • Infection
  • inflammation
  • masses/malignancies
  • vascular abnormalities
39
Q

if a pt is known to have mild allergy to contrast, what do you give them

A

solumedrol 125 mg IV 1 hour prior to procedure and Benadryl 50 mg IV 15 minutes before procedure in all allergies except clear anaphylaxis

EM quiz readings (43 decks)

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