Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > Abdominal Pain in the ER > Flashcards

Abdominal Pain in the ER Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

What does visceral abdominal pain feel like?

A

Poorly localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes visceral abdominal pain?

A

Stretching of the unmyelinated fibers of the walls/capsules of organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does parietal abdominal pain feel like?

A
  • Localized pain
  • Progresses from tenderness and guarding to rigidity and rebound tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes parietal pain?

A

Irritation of the myelinated fibers of the parietal pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is referred pain?

A
  • Pain at location distant from cause
  • Often percieved on ipsilateral side due to anatomically contiguous segmental innervations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are intra-abdominal causes of abdominal pain?

A
  • Organ infection/inflammation
  • Peritonitis
  • Bowel obstruction
  • Vascular disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MC extra-abdominal causes of abdominal pain?

A
  • DKA
  • Alcoholic ketoacidosis
  • Pneumonia
  • PE
  • Herpes zoster
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should be considered with older patients who have abdominal pain?

A
  • Often less severe or atypical
  • 6-8 fold increase in mortality compared to younger patients
  • Consider ischemic heart disease, vasculopathies, coagulopathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do you need to consider regarding female patients with abdominal pain?

A
  • Pregnancy status
  • Etiologies related to respective sex organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 2 biggest historical factors to consider regarding abdominal pain?

A
  • Location
  • Onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A patient has abdominal pain that is maximal intensity at onset. What is this a red flag for?

A
  • Ischemia
  • Dissection
  • Perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A patient has abdominal pain with a gradual onset. What etiologies should you consider?

A
  • Inflammatory
  • Infectious
  • Obstructive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If abdominal pain is constant or worsening over 6 hours, what sort of etiology is more likely?

A

Surgical etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If a patient has pain that improves after meals, what condition do you consider?

A
  • PUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If a patient has pain that is worse after meals, what condition should be considered?

A

Biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If a patient has pain that improves when upright and is worse when supine, what condition should be considered?

A

Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If a patient has abdominal pain that is worse with sudden movements and improves with stillness, what should be considered?

A

Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If vomiting occurs after the onset of abdominal pain, what is the abdominal pain more likely to be?

A

Surgical etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If a patient has bilious vomiting, what does that mean?

A

Obstruction distal to pylorus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If a patient has coffee-ground or hematemesis, what condition should be considered?

A
  • PUD
  • Varices
  • Aortoenteric fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If a patient has loose/watery diarrhea, what etiologies are considered?

A
  • Infectious
  • Diverticulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If a patient has mucoid diarrhea, what conditions are considered?

A
  • Infectious
  • Inflammatory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If a patient has bloody diarrhea, what conditions are considered?

A
  • Mesenteric ischemia
  • Infectious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If a patient has small scant amounts of diarrhea, what etiology should be considered?

A

Bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If a patient has associated cardiorespiratory symptoms with abdominal pain such as cough, dyspnea, or chest pain, what differentials should be considered?

A
  • Pneumonia
  • PE
  • MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

A patient has dysuria or hematuria. What conditions should be considered?

A
  • UTI
  • Pyelonephritis
  • Nephrolithiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A patient has vaginal bleeding or discharge, recent changes in menstruation, or dyspareunia, which conditions should be considered?

A
  • Vaginitis
  • PID
  • Tubo-ovarian abscess
  • Fitz-Hugh Curtis syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If a male patient has penile discharge, scrotal pain/swelling, or recent trauma what conditions should be considered?

A
  • Urethritis
  • Testicular torsion
  • Inguinal hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

If a patient has CV/PAD disease, a.fib, or heart failure and abdominal pain, what conditions should be considered?

A
  • AAA
  • Mesenteric ischemia
  • Atypical MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

If a patient is immunocompromised, what abdominal etiology should be considered?

A

Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If a patient has previous abdominal surgery, what abdominal pain etiology should be considered?

A

Bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

If a patient is taking NSAIDs with abdominal pain, what etiology should be considered?

A
  • Gastritis
  • Gastric ulcer/perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

If a patient has recent antibiotic use in their history and abdominal pain, what should be considered?

A
  • Masked infection
  • C. diff
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

If a patient is taking a new medication with abdominal pain, what etiology should be considered?

A

Medication SE/Complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What social history can impact abdominal pain?

A
  • Heavy ETOH use (thins blood, liver disease)
  • Opiate drug use (constipation, may have run out)
  • Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

If a patient has an elevated temperature with abdominal pain, what are you thinking? Low?

A
  • Infection (high)
  • Infectious etiology in the elderly and neonates (low)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

If respiratory rate is high with abdominal pain, what etiology should you consider?

A

Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Absence of bowel sounds in a patient with abdominal pain would indicate what?

A
  • Peritonitis
  • Bowel obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Periodic high-pitched bowel sounds in a patient with abdominal pain would indicate what?

A

Bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Hyperactive medium pitched bowel sounds in a patient with abdominal pain would indicate what?

A

Blood or inflammation within the GI tract

41
Q

Abdominal bruit and abdominal pain would indicate what?

A

AAA

42
Q

What can be used for peritoneal testing?

A
  • Rebound
  • Heel tap
  • Jumping

Not reliable in the elderly population or pregnancy

43
Q

In patient >50 years of age with abdominal pain, what should be assessed?

A

Aorta

obscured in obese

44
Q

What does a positive Carnett’s sign indicate?

A

Abdominal wall pathology

45
Q

What does a positive Murphy’s sign indicate?

A

Cholecystitis

46
Q

What does a positive psoas sign indicate?

A

Retrocecal appendicitis

47
Q

What does a positive obturators sign indicate?

A

Appendicitis

48
Q

What does a positive Rovsing sign indicate?

A

Appendicitis

49
Q

What does pain on CVA percussion indicate?

A

Pyelonephritis

50
Q

If the pain is located in the lower 1/2 of the abdomen, what should be part of your physical exam?

A

Pelvic/testicular exams

51
Q

If there is a concern for GI bleed or rectal mass leading to obstruction, which physical exam should be performed?

A

Rectal exam

52
Q

What would you be looking for with heart and lungs PE in abdominal pain?

A
  • Afib (risk of mesenteric ischemia)
  • Pneumonia
53
Q

What would you be looking for with MSK exam in abdominal pain?

A

Hips- infectious and inflammatory process can radiate to lower abdomen

54
Q

What skin signs are you looking for with abdominal pain and what do they indicate?

A
  • Cullen’s
  • Grey Turner’s
  • Intra-abdominal or retroperitoneal hemorrhage
  • Ruptured/leaking AAA or hemorrhagic pancreatitis
55
Q

Why assess a fingerstick glucose for abdominal pain?

A

DKA

56
Q

Why might a CBC be helpful in abdominal pain?

A
  • H&H for signs of anemia - GI bleed
  • WBC for infection

note: physiological leukocytosis is seen in pregnancy
Immunocompromised and elderly may have normal WBC in presence of infectious etiologies

57
Q

Diagnostics for abdominal pain

`

A
  • Fingerstick glucose
  • CBC
  • CMP
  • Amylase/lipase
  • Urinalysis
  • Pregnancy test
58
Q

What would pyuria on urinalysis indicate?

A
  • Urinary tract infection
  • Non-infectious pyuria in elderly
  • Inflammatory or infectious condition adjacent to the bladder
59
Q

What would hematuria on urinalysis indicate?

A
  • UTI
  • Nephrolithiasis
  • AAA
60
Q

When would you consider adding EKG, troponin, CXR?

A
  • EKG, trop: atypical MI populations
  • CXR if lung related
61
Q

Indications for plain radiograph in abdominal pain

A

May include AP supine view, PA erect view, PA erect chest radiograph
* Bowel obstruction
* Perforation
* Sigmoid volvulus
* Radiopaque foreign body
* Incarcerated inguinal hernia
* Severe constipation

62
Q

What can you visualize on ultrasound?

A
  • Performed at bedside in emergency
  • Visualize GB
  • Pancreas
  • Kidneys
  • Ureters
  • Urinary bladder volume
  • Uterus/fallopian tubes
  • Aortic dimensions
63
Q

Indications for ultrasound

A
  • Unstable AAA
  • Cholecystitis
  • Ectopic pregnancy
  • Hemoperitoneum
  • Hydronephrosis (suspected in nephrolithiasis)
  • Pancreatitis
  • Appendicitis (only by experienced technicians/radiologists)
64
Q

What is CT scan the preferred study for?

A

Undifferentiated abdominal pain

65
Q

Non-contrasted CT indications

A
  • Nephrolithiasis
  • Trauma
  • Hemoperitoneum
  • Bowel obstruction
66
Q

Oral contast CT indications

A
  • Oral: enhances GI tract
  • BMI <23
  • GI abscess
  • Appendicitis
  • Diverticulitis
  • Perforation
  • Fistula
67
Q

IV contrast CT function

A
  • Visualize bowel mucosa
  • Visceral organ
  • Vascular structures
68
Q

Indications for IV contrast

A
  • Bowel obstruction/perforation
  • Stable AAA
69
Q

Risks of IV contrast CT

A

Nephrotoxicity
Allergic reactions

70
Q

CI and caution to IV contrast CT

A
  • Serum creatinine >1.5 or GFR <60
  • Caution: metformin use
71
Q

When is angiography indicated for abdominal pain?

A
  • Mesenteric ischemia
  • Massive lower GI bleed (if going to surgery)
72
Q

If concerned for extreme bleeding, what should be ordered in addition to CBC

A

type and crossmatch

73
Q

If evidence of shock, what should be ordered?

A

ABG

74
Q

If a patient has symptoms, signs, or risk factors suggestive of AAA, what should be done?

A
  • Surgical consultation
  • Bedside ultrasound
  • Abdominal CT
75
Q

If a patient has history, exam, or risk factors suggesting mesenteric ischemia (pain out of proportion to exam) what should be done?

A
  • Surgical consult
  • Abdominal CT
76
Q

If a patient has a bowel obstruction of perforation what are the next step?

A
  • Abdominal radiograph series

+ free air: surgical consult
+ obstruction: abdominal CT
+ free air, obstruction: abdominal CT

77
Q

If a patient has epigastric or right upper quadrant tenderness, what are next steps?

A
  • RUQ US
  • Obtain lipase
  • LFTs, chest radiograph, or others based on history and exam
78
Q

If a patient has RLQ and is female, what should be done?

A
  • Perform pelvic examination
  • Obtain US or CT based on exam findings
79
Q

If a patient has RLQ pain and is male, what should be done?

A

Palpate testicles
* Tender testicle or tender scrotal mass: urology consult and obtain US

80
Q

If RLQ in male and high suspicion for appendicits, what should be done?

A

Surgery consult

81
Q

If RLQ in male without suspicion for appendicitis, what should be done?

A

Abdominal CT vs observation with serial exam

82
Q

If LLQ, what additional study should be conducted (in addition to what is done for RLQ)

A

CT for diverticulitis

83
Q

If LUQ tenderness, what should be done?

A
  • Check for signs and symptoms of mono with splenic rupture: if present, US to assess hemoperitoneum and surgery consult if yes; if no hemo, consider abdominal CT
  • If no mono, obtain lipase, consider US biliary disease; CT, ECG, CXR
84
Q

If pregnancy with abdominal pain, what should be done?

A
  • US
  • Sterile pelvic exam
  • quantitative HCG and other laboratory tests
  • Obtain OB/GYN surgery consult
  • IUP: assess appendix with US; surgery and OB/GYN consult as indicated
  • Ectopic pregnancy: obtain OB/GYN consult
84
Q

What should be done if abdominal pain if female of childbearing age but not pregnant

A
  • Unilateral adnexal tenderness?
  • Yes: US to rule out ovarian torsion or ovarian cyst
  • No: clinical PID?
  • If clinical PID, check if toxic appearing or persistent vomiting
  • If toxic appearing: hospital admission, give IV abx, GYN consult
  • If not toxic, outpatient management and abx
84
Q

If no clinical PID in female of childbearing age with unilateral adnexal tendernes,, what should be done?

A
  • Check for predominant RLQ tenderness, if so evaluate appendix with US or CT
  • If no RLQ tenderness, consider UTI, nephrolithiasis, neoplasm, domestic violence, extraadominal causes
85
Q

Management of abdominal pain (generally)

A
  • Continuous cardiac monitoring if VS are abnormal
  • NPO (initially) and fluids: IV crystalloids
  • Antiemetics
86
Q

Treatment of abdominal pain with fluids

A
  • IV crystalloids (NS/LR)
  • Rapid infusion of 1 L bolus over 10-20 min if hypotensive or signs of dehydration are present (slower rate if hx of CHF)
  • Rate of 75-125 mL/h rate if normotensive
87
Q

What antiemetics can be used for abdominal pain?

A
  • Ondansetron 4-8 mg IV or ODT
  • Metoclopramide 10 mg slow push to avoid extrapyramidal SE, consider co-admin with diphenhydramine to avoid SE, avoid if prior hx of akathisia or dystonic reaction
88
Q

Goals of abdominal pain management

A
  • Improve pain to a tolerable level
  • Improve patient cooperation with exam
89
Q

Agents for abdominal pain management

A
  • Morphine
  • Fentanyl - shorter acting
  • Ketorolac (great for renal colic but avoid NSAIDs if concern for peritonitis)
90
Q

What can be used for additional symptomatic relief of abdominal pain?

A
  • NG tube
  • Foley catheter
91
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
92
Q

What are indications of foley catheter in abdominal pain?

A
  • Relieve bladder obstruction
  • Monitor Is &Os
  • Assess renal perfusion
93
Q

When would empiric antimicrobial therapy be used in abdominal pain?

A
  • Suspected sepsis and peritonitis
94
Q

Options for empiric antimicrobial therapy in abdominal pain

A
  • Zosyn OR
  • gentamicin + metronidazole IV
  • Vary based on individual presentation and ddx
95
Q

Disposition of abdominal pain

A
  • Reassessment critical!! VS/symptom/exam change?
  • Surgical consult early if surgical or acute abdomen highly suspected
  • Admit if at high risk
  • Patients with normal CT and unclear dx: discharge with 12 hour f/u
  • If discharged, clear instructions, diet, medications, what to watch for and where and when to return/follow up
96
Q

What patients are at high risk and should be admitted for abdominal pain?

A
  • Geriatric
  • Immunocompromised
  • Unable to communicate or cognitively impaired
  • Ill appearing
  • Intractable pain or vomiting
  • Unable to comply with discharge or f/u instructions
  • Lack of social support
97
Q

Symptoms that warrant return to ED for abdominal pain

A
  • Increased/different pain
  • Fever
  • Vomiting
  • Syncope
  • Bleeding

Emergency Medicine (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions