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Disciplines (Emergency) > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

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1
Q

Acute abdominal pain: definition

A

abdominal pain less than one week in duration

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2
Q

“Acute abdomen”

A

in reference to severe abdominal pain du eto an intra-abdominal process

(often requiring surgery)

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3
Q

Visceral pain: etiology

A
  • Stretching of nerve fibers surround viscus
  • Ischemia
  • Inflammation
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4
Q

Describe Visceral Pain

A
  • Cramping
  • Colicky (unable to find comfortable position)**
  • Ill defined*
  • Diffuse
  • Vague
  • Intermittent
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5
Q

Intestinal obstruction, early appendicitis or renal colic are examples of what type of pain?

A

Visceral pain

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6
Q

Parietal (aka somatic pain): pain description

A
  • sharp
  • precise
  • constant

-Able to lie still and motionless

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7
Q

Appendicitis (late) pain is what type of pain?

A

parietal (somatic)

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8
Q

Give 3 examples of referred pain

A
  1. right scapular pain with biliary disease
  2. Ipsilateral testicle/labia pain with renal colic
  3. Left neck/jaw/shoulder/arm pain with myocardial ischemia
  4. Back - pancreatitis
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9
Q

Name 3 causes of toxicologic extra-abdominal pain

A
  1. Strep pharyngitis
  2. Black widow spider
  3. Cocaine
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10
Q

What is the difference between intra-abdominal and extra-abdominal pain?

A

Both cause abdominal pain but intra or extra refers to the source of the pain in the abdomen.

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11
Q

Name a neurogenic extra-abdominal pain source?

A

herpes zoster

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12
Q

Name a metabolic extra-abdominal pain source?

A

DKA

Adrenal crisis

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13
Q

Guarding

A

voluntary contraction of musculature

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14
Q

Rigidity

A

involuntary contraction of musculature

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15
Q

What is the name for bruising around the umbilicus (retroperitoneal hemorrhage)?

A

Cullen’s Sign

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16
Q

What is the name for bruising on a patient’s lower posterior flank (retroperitoneal hemorrhage)?

A

Grey Turner’s Sign

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17
Q

Differential Diagnosis for RUQ pain

A
  • Cholecystitis
  • Biliary colic
  • Hepatic Abscess
  • Perforated duodenal ulcer
  • Pancreatitis
  • Retrocecal appendicitis
  • Herpes Zoster
  • MI
  • RLL pneumonia
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18
Q

Differential Diagnosis for LUQ pain

A
  • gastritis
  • pancreatitis
  • splenic rupture/infarction
  • MI
  • LLL pneumonia
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19
Q

Differential Diagnosis for RLQ pain

A
  • Appendicitis (late)
  • Meckel’s Diverticulum
  • Leaking AAA
  • Ruptured ectopic
  • Ovary torsion
  • PID
  • Endometriosis
  • Urinary calculi
  • Psoas abscess
  • Hernia
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20
Q

Differential diagnosis for LLQ pain

A
  • Sigmoid diverticulitis
  • Leaking AAA
  • Rutured ectopic
  • Ovary torsion
  • PID
  • Endometriosis
  • Urinary calculi
  • Psoas abscess
  • Hernia
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21
Q

Differential diagnosis 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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22
Q

Appendicitis

A
  1. Periumbilical pain –>anorexia and N/V

2. Pain localized to the RLQ in about 24 hours

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23
Q

Rovsing’s sign

A

pain in the RLQ when palpating the LLQ

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24
Q

Iliopsas sign

A

pain when patient flexes right hip with straight leg against resistance

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25
Q

Obturator sign

A

Knee flexed 90 degrees and hip internally/externally rotated

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26
Q

An Alvarado Score of 7-8 would mean Appendicitis is ?

A

probable

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27
Q

An Alvarado score of 5-6 would mean appendicitis is?

A

possible

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28
Q

An alvarado score of >9?

A

very probable appendicitis

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29
Q

What is the treatment of choice for appendicitis?

A

appendectomy

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30
Q

Intermittent RUQ pain radiating to right shoulder with N/V associated with ingestion of fatty meal or large meal after fast. Fever/chills and increased temperature

A

Cholecystitis

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31
Q

What is the therapy of choice for diagnosing cholecystitis?

A

HIDA scan (hepatobiliary iminodiacetic acid)

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32
Q

Charcot’s Triad

A
  1. Fever
  2. Jaundice
  3. RUQ pain
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33
Q

Reynold’s Pentad

A

Charcot’s triad (Fever + Jaundice + RUQ pain) with shock and altered mental status/confusion.

34
Q

What type of organism cause cholangitis?

A

gram negative

35
Q

Cholangitis treatment

A
  1. IV fluids

2. IV antibiotics

36
Q

Mesenteric Ischemia: pain

A

-poorly localized
-intermittent pain out of proportion to examination findings***
-“intestinal angina” pain after large meal relieved with vomiting
+/- vomiting and diarrhea

37
Q

What is the most common cause of mesenteric ischemia?

A

arterial embolism to the superior mesenteric artery

38
Q

Mesenteric Ischemia: labs

A
  • Increased WBC
  • Increased amylase
  • Increased phosphate
  • metabolic acidosis (lactic acid)
39
Q

Mesenteric ischemia: Treatment

A
  1. Heparin

2. Antibiotics

40
Q

What is the best way to diagnose mesenteric ischemia?

A

arteriography

41
Q

Where is the most common location for ectopic pregnancy?

A

isthmus of fallopian tube

42
Q

What is the triad for ectopic pregnancy?

A
  1. Pain
  2. Vaginal bleeding
  3. Amenorrhea
43
Q

Gastric ulcers account for _____ of peptic ulcers

A

1/3 gastric

2/3 duodenal

44
Q

Describe the timing, location and character of gastric ulcer pain

A

Timing: less than 2 hours after meal

Location: localized to epigastrum

Character: gnawing, buring, or aching

45
Q

Gastric ulcer: treatment

A
  1. Fluid

2. H2 blockade or PPI

46
Q

What is the most common reason for small bowel obstruction?

A
  • adhesions from previous surgery

- incarcerated hernia

47
Q

Most common cause of large bowel obstruction?

A

malignancy (or vovulus)

48
Q

Small bowel obstruction: treatment

A
  1. CMP, CBC, Abdomen imaging (multi-view)
  2. Antiemetics, pain medication
  3. NG tube decompression
  4. IV fluid resuscitation
49
Q

Abdominal Aortic Aneurysm

A
  • Abdominal, back, flank or groin pain (not affected by movement)
  • Hypotension

+/- pulsatile abdominal mass, bruit

50
Q

When is there significant chance that an abdominal aortic aneurysm will spontaneously rupture?

A

> 5cm

51
Q

If an AAA is smaller than 5cm how often should it be followed by US?

A

every 6 months

52
Q

When is AAA rupture suspected?

A

-Syncope + Over 60 yrs + Abdominal or back pain

53
Q

What is Bell clapper deformity?

A

High attachment of teste to tunica vaginalis

54
Q

Which side is typically affected in testicular torsion?

A

Left

55
Q

What reflex will be abest in testicular torsion?

A

cremateric reflex

56
Q

Testicular torsion: treatment

A

manually 180 degrees at a time medial to lateral

57
Q

Testicular torsion whould be fixed within what time period?

A

6 hours

58
Q

Epididymitis: Phren’s Sign

A

Relief of pain with scrotal elevation

59
Q

What is the most common organism to give men under 35 epidiymitis?

A

Chlamydia

60
Q

What is the most common pathogen to give men over 35 epididymitis?

A

E. coli

61
Q

Treatment for man <35 with chlamydia causing epidiymitis?

A

Rocephin and doxycycline

62
Q

Treatment for man >35 with E. coli causing epididymitis?

A

Fluroquinolone

63
Q

Distinguish the pain in testicular torsion and epidiymitis

A

Testicular torsion

  • Suddent onset
  • After sleep or exercise*
  • Vomiting**
  • Unilateral
  • Not positional
  • Decreased blood flow (Doppler)

Epididymitis

  • Gradual onset
  • Fever*
  • Bilateral
  • Worse standing
  • Testicular swelling*
  • Increased blood flow (Doppler)
64
Q

What is the most common cause of acute scrotal pain to superior testicle pole in 3-13 years old.

Pathognomonic “blue dot sign”

A

Torsion of testicular appendix

65
Q

List the 4 types of urogenital tract stones from most common to least common

A
  1. Calcium
  2. Struvite (Ammoninum magnesium phosphate)
  3. Uric Acid
  4. Cystine
66
Q

Most urinary stones will pass on their own if they are what size?

A

<5mm

67
Q

Urolithiasis: treatment

A

Toradol**
Morphine
Antiemetics
IV fluids

68
Q

What are the 3 most common reasons for Pancreatitis in the US?

A
  1. Alcohol abuse
  2. Cholelithiasis
  3. Hypertriglyceridemia
69
Q

Pancreatitis: pain description

A
  • Severe and constant
  • epigastric
  • Radiates to back
  • Worse with lying down
  • Better with sitting up and leaning forward
70
Q

What two labs will be elevated in pancreatitis?

A
  1. Amylase

2. Lipase

71
Q

Abdominal Xray findings of Pancreatitis?

A
  • localized ileus
  • gallstones
  • widening duodenal sweep
72
Q

Pancreatitis: Goal of medical therapy

A

“place the bowel at rest”

  • Nothing by mouth
  • IV fluids
  • Demerol
  • Antiemetics
73
Q

What is Ranson’s criteria used for?

A

determining severity of acute pancreatitis

74
Q

Diverticulitis: Pain and lab

A
  • Abrupt pain in LLQ
  • Fever
  • Leukocytosis with left shift
75
Q

What is the best imaging for diverticultitis?

A

CT with contrast

76
Q

What is the treatment for diverticulitis?

A
  • Levaquin
  • Flagyl (metronidazole)
  • Zosyn (tazobactam-pipercillin)
77
Q

DKA definition

A
  1. Blood glucose >250mg/dl
  2. Arterial pH <7.3
  3. Serum bicarb <15
  4. Ketones in the urine
78
Q

What are the most common precipitating factors for DKA

A
  1. Forgetting to take insulin
  2. Infection (ex. PNA, UTI)
  3. MI
  4. Alcohol or drug use
  5. Pregnancy
79
Q

5 F’s risk factors for gallbladder disease

A 
Fat
Forty
Female
Flatulent
Fertile
80
Q

What US findings suggest cholecystitis

A
  • Thickened gallbladder wall >3mm

- Stones

81
Q

What diagnosis shoud be considered in a patient with pain out of proportion to examination?

A
  • Mesenteric ischemia
  • Necrotizing fasciitis
  • Compartment syndrome

Disciplines (Emergency) (5 decks)

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