Abdominal Topics 1

Question 1

Findings and imaging for appendicitis

Answer 1

Labs: leukocytosis with left shift

Abdomen CT with IV/PO contrast shows > 7 mm appendix

Question 2

Abx for appendectomy

Answer 2

Cefotoxin

or Cefazolin + Metronidazole

Question 3

When should asx gallstones be removed?

Answer 3

If immunosuppressed or has DM

Question 4

What will you see on imaging for acute cholecystitis?

Answer 4

US: gallbladder wall thickening, peri-cholescystic fluid

Positive HIDA scan

Question 5

Gallbladder polyp sizes

Answer 5

< 5 mm benign
6-9 mm: multiple = benign, solitary = neoplastic
1-2 cm: high malignancy potential
2+ cm: malignant 
*anything 1+ cm = cholecystectomy

Question 6

How to dx biliary dyskinesia

Answer 6

HIDA w/ CCK provocation replicates sx or EF < 35% of bile

Question 7

Charcot’s triad of cholangitis

Answer 7

Fever, abdominal pain, jaundice

Question 8

Tx for cholangitis

Answer 8

Like sepsis --
Fluid resuscitation 
Abx (Zosyn or meropenem)
Blood cultures
ICU - can progress quickly!

Question 9

Findings for esophageal perforation

Answer 9

Chest pain, SQ emphysema, tachycardia/tachypnea, pneumomediastinum

Question 10

Tx for esophageal perforation

Answer 10

IV hydration
NPO/NG tube
IV abx
IR drainage 
Chest tubes

Question 11

Causes of SBO

Answer 11

70% Intra-abdominal adhesions (kinks, rotations)
20% Tumors: usually a metastasis
10% Hernias

Question 12

Risk factors for SBO

Answer 12

Surgery, hernia, intestinal inflammation, neoplasm hx, IR, hx of foreign body ingestion

Question 13

Best imaging for free air in a SBO?

Answer 13

upright CXR

Question 14

What do you see on abdominal CT in SBO?

Answer 14

Physical point of obstruction
Dilated bowel (proximally) gives way to non-dilated bowel (distally) --> transition point

Question 15

Tx for uncomplicated acute diverticulitis

Answer 15

Oral levo/ciprofloxacin + metronidazole

Question 16

Typical pain for appendicitis

Answer 16

Periumbilical that radiates/migrates to RLQ

Question 17

Diagnostics for appendicitis

Answer 17

Usually clinical
Lab: leukocytosis with left shift
Image: helpful if uncertain - CT with IV/PO contrast shows > 7 mm

Question 18

Typical acute cholecystitis pain

Answer 18

RUQ

Question 19

Diagnostics for acute cholecystitis

Answer 19

RUQ ultrasound shows thickened gallbladder wall

HIDA scan will be positive (functional exam, gallbladder not visualized)

Question 20

Murphy’s sign

Answer 20

Inspiration arrest during deep palpation of RUQ

Pathognomonic for acute cholecystitis

Question 21

Dx for cholangitis

Answer 21

RUQ ultrasound followed by cholangiography

Question 22

Dx for uncomplicated SBO and complicated SBO

Answer 22

Uncomplicated: abdomen xray
Comp: CT w/ IV contrast

Question 23

Tx for SBO

Answer 23

IV hydration
NG tube decompression
Bowel rest
Abx (Cefoxitin or Cefazolin/Metro)

Question 24

Most common location for pain in acute diverticulitis

Answer 24

LLQ > RLQ (cecum)

Question 25

What should you do after acute diverticulitis?

Answer 25

High fiber diet, exercise, probiotics

Colonoscopy to r/o cancer b/c similar CT findings