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Clinical Disciplines Final (Jess) > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

How long does and pain have to last to be considered acute?

A

less than 1 week

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2
Q

What is visceral pain caused by?

A

from stretching of anatomic nerve fibers surrounding viscus

-can also result from ischemia and inflammation

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3
Q

What organs are associated w/ visceral pain? Describe visceral pain

A

intra-peritoneal

  • cramping, colicky
  • ill-defined, diffuse, vague
  • intermittent
  • unable to find a comfortable position
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4
Q

How is parietal pain described? What is another name for it? Ex?

A
  • sharp
  • precisely located
  • constant
  • lie still and motionless

Somatic pain

late appendicitis

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5
Q

what is referred pain?

A

Pain felt at a location distant from the diseased organ

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6
Q

what is guarding vs rigidity??

A

guarding= voluntary contraction of musculature

rigidity= involuntary contraction

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7
Q

Bruising around the umbilicus is called what?

A

Cullen’s sign

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8
Q

bruising of the flank area is called what?

A

Grey Turner’s sign

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9
Q

DDX for and pain in the RUQ

A 
Cholecystitis
biliary colic
hepatic abscess
perforated duodendal ulcer
pancreatitis
retrocecal appendicitis
herpes zoster
MI
RLL pna
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10
Q

DDX for and pain in the LUQ

A 
gastritis
pancreatitis
splenic rupture
splenic infarction
MI
LLL pna
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11
Q

DDX for and pain in the RLQ

A 
appendicitis (late)
Meckler's diverticulum
leaking AAA
ruptured ectopic
ovary torsion
PID
endometriosis
urinary calculi
psoas abscess
hernia
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12
Q

DDX for and pain in the LLQ

A 
sigmoid diverticulitis
leaking AAA
ruptured ectopic
ovarian torsion
PID
endometriosis
urinary calculi
psoas abscess
hernia
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13
Q

DDX for diffuse abdominal pain

A 
peritonitis
pancreatitis
sickle cell crisis
early appendicitis
DKA
mesenteric thrombosis
gastroenteritis
aortic dissection
ruptured AAA
intestinal obstruction
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14
Q

Describe sx of Appendicitis? Only what pt would complain of

A

periumbilical pain
Anorexia and N/V

Pain localizes to RLQ over 24 hrs

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15
Q

Explain Rovsing’s sign, Iliopsoas sign, and Obturator sign

A

Rovsing’s= pain in RLQ when palpating LLQ

Illiopsoas= elicited by having supine pt keep R knee extended and flex R hip while examiner resists

Obturator sign= elicited by having supine pt flex R knee to 90 degrees, examiner int/externally rotates hip

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16
Q

What is Alvarado score?

A

for appendicitis

7-8= probable
>9 = very probable
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17
Q

How do you treat appendicitis?

A

fluid resuscitation
Abx- Ceph

TOC= Appendectomy

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18
Q

How does cholecystitis present?

A

Intermittent RUQ pain radiating to R shoulder w/ N/V associated w/ ingestion of fatty meal or large meal after fats

fever/chills

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19
Q

What diagnostic tools can be used to see if a pt have cholecystitis?

A

US- stones, thickened CB wall, distended GB, sonographic Murphy’s sign

HIDA scan- TOC FOR DX CHOLECYSTITIS

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20
Q

What is Charcot’s triad

Reynold’s Pentad? Significance?

A

fever
jaundice
RUQ pain
(seen in 25% cholangitis)

Reynolds= +confusion and shock
-100% mortality if not tx properly

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21
Q

How does Mesenteric ischemia present?

A

poorly localized, intermittent pain out of proportion to exam findings

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22
Q

MCC of Mesenteric ischemia? Risk factors?

A

MCC= arterial embolism to SMA

Risk factors= over 60, AFib, ASVD, decreased ejection fraction, hyper coagulable states, hypotension

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23
Q

What lab values will you see in mesenteric ischemia?

How do you treat?

A

Increased WBC, amylase, phosphate, and metabolic acidosis

TOC= arteriography, heparin, abx

24
Q

Triad for ectopic pregnancy?

A

pain, vaginal bleeding, and amenorrhea

25
Q

Risk factors for ectopic pregnancy

A
  • PID
  • prior ectopic
  • women w/ IUD
  • in vitro fertilization
  • prior tubal surgery
  • smoking
  • age
26
Q

Tx for ectopic

A

fluid resuscitation
(+/- blood products)
preoperative labs
OB/GYN for OR

27
Q

What are perforated gastric ulcers and how do they MCly occur?

A

Mucosal breaks of 3 mm or larger

helicobacter pylori infection

28
Q

Risk factors for perforated gastric ulcer?

A 
steroids or aspirin
smoking
alcohol or coffee
stress
delayed gastric emptying
duedenogastric bile reflux
29
Q

Sx of perforated gastric ulcer

A

Pain occurs <2 hrs after meals

  • localized to epigastrium
  • gnawing, burning, or aching in nature

anorexia, weight loss, belching, bloating, nausea, heartburn

30
Q

Tx for perforated gastric ulcer

A

fluid resuscitation
H2 blocker or PPI
Surgery consult

31
Q

MCC of SBO?

A

adhesions from previous surgery, incarcerated hernia

32
Q

Sx of SBO

A
  • abdominal distention
  • constipation
  • bowel sounds high pitched at first then go silent
  • vomiting
33
Q

Signs and sx of AAA

A
  • abdominal, back, flank, or groin pain
  • usually not affected by movement
  • +/- pulsatile abd mass
  • hypotension

(may be asymptomatic)

34
Q

if AAA is > 5 cm then?

Smaller ones?

A

> 5 cm= significant risk of spontaneous rupture

smaller ones are followed by US every 6 months

35
Q

What deformity is common in testicular torsion?

What side is more commonly affected?

A

inappropriately high attachment to tunica vaginalis

L side

36
Q

What sign when absent, has 99% association w/ testicular torsion?

A

absent cremasteric reflex

37
Q

What is tx for testicular torsion?

A

manually detours 180 degrees at time from medial to lateral

38
Q

What is Phren’s sign and what dx is it a/w?

A

Phren’s= relief of pain w/ scrotal elevation

a/w Epididymitis

39
Q 
Testicular torsion:
avg age?
pain quality?
onset?
time to presentation?
assoc. sx?
A

neonate, 12-15 yo

sudden onset, unilateral, no positional change

onset after sleep or exercise

present < 6 hrs

vomiting (rare= fever, discharge)

40
Q 
Epididymitis:
avg age?
pain quality?
onset?
time to presentation?
assoc. sx?
A

25 yo

gradual onset, b/l, worse w/ standing

rarely after sleep

present > 24 hrs

A/s= fever, testicular swelling (rare= vomiting, discharge)

41
Q

How will UA for testicular torsion differentiate from epididymitis?

A

Torsion=
30% have WBC and bacteria
rare voiding complaints

Epididymitis= 50% normal, frequent voiding

42
Q

MCC of acute scrotal pain in 3-13 yo?

A

Torsion of testicular appendix

43
Q

sx of Torsion of testicular appendix? what sign is pathognomonic?

A

pain to superior testicular pole
N/v rare

Blue dot sign= pathognomonic

44
Q

What is the basic pathophys of urolithiasis?

A

involves supersaturation of urine w/ salt, lack of urinary inhibitors of crystalization

45
Q

MC type of Urolithiasis?

A

Calcium 70-80%

2nd = Struvite 10%

46
Q

how are the majority of urinary stones < 5 mm treated?

A

90-95% pass spontaneously

47
Q

Management of urolithiasis?

A

toradol
morphine
antiemetics
IV fluids

48
Q

MMC of pancreatitis?

A

alcoholism, cholelithiasis, and hypertriglyceridemia

49
Q

Sx of pancreatitis?

A

pain is usually severe, constant

  • located in epigastrium and radiates to back
  • worse w. lying down, better sitting up and leaning forward

fever, tachy, N/V

50
Q

What do labs and abd X-ray show in pancreatitis?

A

elevated amylase, lipase

xray= localized ileum, gallstones, widening of duodenal sweep

51
Q

Pain and sx a/w diverticulitis

A

abrupt onset (usually LLQ)
fever
Leukocytosis w/ L shift

52
Q

Dx and tx of diverticulitis?

A

CT A/P w/ IV/PO contrast

tx= Levaquin and Flagyl, zosyn

53
Q

In DKA, blood glucose is?

what about in hyperosmolar hyperglycemic state?

which one has presence of ketones?

A

DKA= > 250 mg/dl

hyper= > 600 mg/dl

DKA has ketones

54
Q

Signs and sx of DKA?

A
  • polyuria, polydipsia
  • weight loss, N/V, dry mucus membranes
  • dizziness, weakness
  • Kussmaul breathing
  • fruity odor on breath
55
Q

Tx of DKA?

A

IV fluids
Insulin
Potassium replacement
bicarbonate

check glucose and electrolytes every 1-2 hrs

Clinical Disciplines Final (Jess) (4 decks)

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