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Nayla clinical disciplines > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

What is appendicitis

A

luminal obstruction of appendix causing periumbilical pain, which develops into RLQ pain over 24 hr.

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2
Q

What are associated Sx of appendicitis

A

anorexia, N/V

not likely to be ruptured at time of removal

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3
Q

What will your PE findings be for appendicitis

A 
Rovsing's sign (pain in RLQ when palpating LLQ)
Iliopsoas sign (pain when flexing R hip w straight knee)
Obturator sign (pain w/ flex knee 90 and rotate hip int/ext)
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4
Q

What is the Alvarado score

A

grades Sx, signs, and labs of appendicitis (iliac fossa pain,
7-8 is probable, >9 is highly probably

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5
Q

What are possible lab findings in appendicitis

A

Leukocytosis w/ left shift

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6
Q

How do you treat appendicitis

A

TOC: Appendectomy
Fluid resuscitation
antibiotics (more intense if perforated)

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7
Q

What is Cholecystitis

A

Inflammation and infection of the gallbladder (stores bile)
Causes intermittent RUQ pain out of proportion to exam findings
-Referred pain to R scapula/shoulder

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8
Q

What are associated symptoms in cholecystitis

A

N/V after a fatty meal or large meal after fasting

fever, chills, increased temp

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9
Q

What are your PE findings in cholecystitis

A

Murphy’s sign (inspiratory arrest when palpating RUQ)

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10
Q

How should you work cholecystitis up

A

**HIDA scan to diagnose (if GB not clearly outlined in 1 hr, CD obstructed)
US to show stones, thick GB wall, pericholecystic fluid

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11
Q

How do you treat cholecystitis

A

Fluid resuscitation

Antibiotics

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12
Q

What is cholangitis and how do you treat it

A

infection of bile duct caused by gram - bacteria

100% fatal if not Tx w/ aggressive IVF, IV abx, and surgery

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13
Q

What is charcot’s triad

A

Fever + Jaundice + RUQ pain
indicative of Cholangitis
-Reynolds pentad is the above triad + confusion + shock

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14
Q

What is Mesenteric ischemia due to

A

Arterial embolism to SMA from mural thrombus, associated with MI
Causes poorly localized, intermittent pain out of proportion to exam findings

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15
Q

What are RF for mesenteric ischemia

A 
>60 
AFib
CHF
recent MI 
hypotension 
hypercoagulable
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16
Q

What symptoms are associated with Mesenteric Ischemia

A

vomiting
diarrhea
intestinal angina (pain after large meal, relief w/ vomiting)

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17
Q

Mesenteric Ischemia workup will show

A 
increased WBC, amylase, and phosphate 
Metabolic acidosis (lac>10=bad)
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18
Q

How do you treat mesenteric ischemia

A

Arteriograph
heparin
antibiotics

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19
Q

What is an ectopic pregnancy

A 
Pregnancy outside the uterus (MC isthmus of fallopian tube) 
Causes triad (Pain in RLQ/LLQ + vaginal bleeding + amenorrhea)
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20
Q

What is a common PE finding in ectopic pregnancy

A

Kern’s sign: referred left shoulder pain

US will show empty fundus and endometrial stripe

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21
Q

How do you treat ectopic pregnancy

A

Fluid resuscitation
Pre-op labs
OB/GYN for surgery

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22
Q

What is a Perforated gastric ulcer

A

mucosal break >3mm (mostly duodenal)- caused by H. Pylori

Causes burning, gnawing pain to epigastrum <2 hours after eating

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23
Q

What symptom are associated with perforated gastric ulcer

A 
anorexia
belching
bloating
nausea
heart burn
\+/- hematesis and melena
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24
Q

How do you treat a perforated gastric ulcer

A

Fluid resuscitation
H2 blocker/ppi (zantac, pepcid)
Surgery consult for repair

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25
What is a small bowel obstruction due to
*adhesions from prior surgery/ incarcerated hernia prevent fluid from flowing into colon Causes proximal bowel distention and edema, bacterial overgrowth in stagnant bowel, hemorrhagic necrosis, gangrene, sepsis, and death
26
What should your work up include for SBO
CBC CMP CT abdomen
27
How do you treat a SBO
antiemetics pain meds NG tube decompression IV fluid resuscitation
28
What is the MC of large bowel obstruction
Malignancy or volvulus
29
What is an AAA
If >5cm theres a significant risk for rupture (if smaller, follow on US q6 months) M>W Causes abdominal, back, flank, or groin pain, not affected by movement.
30
When should you suspect AAA rupture
Syncope, >60, with abdominal or back pain | Triad of rupture: Abdominal pain + Pulsatile mass + Hypotension
31
What should be in your AAA workup
US | US will show trace blood
32
How do you treat AAA
IV fluids/blood | Vascualr surgery
33
What abdominal imaging finding is indicative of a AAA
Calcification of aorta left of midline
34
What can cause testicular torsion
Bell clapper deformity (inappropriately high attachment to tunica vaginalis= elevated testicle w/ horizontal lie) MC in left testicle
35
What are symptoms of testicular torsion
Sudden onset unilateral testicular pain and swelling, common s/p sleep or exercise Vomiting, +/- fever (NO discharge)
36
What are findings of testicular torsion on exam
Absent cremaster reflex | US w/ decreased flow (doesn't r/o if normal)
37
How do you treat testicular torsion
Manually detorse 180 degrees (Medial to Lateral) If 1/in 4-6 hours, 80-100% salvageable If >24 hours, 20%
38
What is MCC of acute scrotal pain in 3-13 y/o
Torsion of testicular appendix, should resolve spontaneously | Pain superior to testicle pole and BLUE DOT SIGN
39
What are common causes of epididymitis
<35: Chlamydia, gonorrhea | >35, E. coli, pseudomonas
40
What are symptoms of epididymitis
Gradual onset bilateral pain, worse with standing swelling +/- discharge painful prostate
41
What will you find on exam for epididymitis
Phren's sign (pain relief with scrotal elevation) | Increased flow on doppler
42
How do you treat epididymitis
<35: Rocephin IM + Doxy | >35: Cipro or Levo
43
What is urolithiasis
Supersaturation of urine w/ salt, lack of urinary inhibitors of crystallization. Can be calcium (MC), struvite (ammonium, Mg, phosphate), uric acid, or cystine (MC in M, white) Causes sudden onset pain (referred), urgency, N/V, hematuria
44
What will you see on urolithiasis workup
US showing hydronephrosis of kidney | Can also check CT or XR
45
How do you treat urolithiasis
``` <5cm pas spontaneously Toradol (onset in 30-45 min) Morphine (until toradol works) anti emetics IV fluids Admit, abx if concurrent infection ```
46
What are struvite stones associated with
Urea splitting organisms, proteus klebsiella and staph | contain ammonium, mg, phosphate
47
What is pancreatitis
Inappropriate autodigestion of pancreas by proteolytic enzymes, caused by 6-8 years heavy alcoholism
48
What are Sx of pancreatitis
Hemorrhage and edema cause pain Severe, constant, epigastric pain radiating to back; worse lying, better standing and leaning forward Fever, tachycardia, N/V
49
What will Pancreatitis work up show
``` Elevated lipase (MC) and amylase (amylase also elevated in mesenteric ischemia) Abd XR: localized ileus, gallstones, wide duodenal sweep) ```
50
How do you treat pancreatitis
``` Rest the bowel, NPO IVF demerol (less ampulla spasms) anti-emetics +/- NG tube ```
51
What is diverticulitis
Pressure gradient between colon lumen and serosa is jacked causing herniation of diverticula (descending and sigmoid have narrow lumens and higher pressure), sometimes due to eating seeds and nuts Causes abrupt onset LLQ pain and fever
52
What symptoms are associated with diverticulitis
If they say they went to the bathroom and "blood gushed out" think bleeding diverticulum
53
What will you find on diverticulitis workup
Leukocytosis with left shift (also finding in appendicitis) | Do a CT AP with contrast
54
How do you treat diverticulitis
Levaquin and flagyl or zosyn + vancomycin if severe | If abscess is seen on CT, drain it
55
What helps relieve pressure causing diverticulitis
Eating fiber, it widens the intestine
56
What is DKA
With less insulin, glucose builds up. High glucagon, catecholamines, cortisol, and GH also further increase glucose Excess glucose is converted to ketones ("Keto") Tg synthesis is inhibited, causing lipolysis ("acidosis)
57
What gives you a hyperosmolar state (diuresis)
Hyperglycemia + Ketoacidosis
58
What are symptoms of DKA
Polyuria, polydipsia, weight loss, urinary frequency | N/V, DMM, dizzy, weak, Kussmaul breathing, fruity breath
59
What PE findings are associated with DKA
BG >250 (check glucometer q1-2 hrs) pH <7.3 and bicarb <15 (met acidosis) Ketonuria (check UA)
60
How do you treat DKA
IVF (1L 1hr, then 500cc for 4 hr, then 25 cc for 4 hr) Insulin infusion to reverse ketogenesis (keep until ketones not in urine// goal decrease glucose 75-100 x hr) Potassium replacement (when urine output begins)
61
Hyperosmolar and hyperglycemic state cause BG to be
>600
62
What are the different kinds of pain
Visceral: cramping, colicky, ill defined, intermittent Parietal: sharp, precise, constant
63
What are types of referred pain
Biliary disease= Right scap/shoulder Renal colic= ipsilateral testicle/labia pain MI= L neck, jaw, shoulder, arm
64
What pain is felt in RUQ
``` cholecystitis biliary colic hepatic abscess perforated duodenal ulcer pancreatitis retrocecal appendicitis herpes zoster MI RLL PNA ```
65
What pain is felt in LUQ
``` Gastritis Pancreatitis Splenic rupture/infarct MI LLL PNA ```
66
What pain is felt in both lower quadrants
``` Leaky AAA Ruptured ectopic ovaro torsion PID Endometriosis Urinary calculi Psoas abscess Hernia ```
67
What pain is felt in RLQ
Late appendicitis | Meckel's diverticulum
68
What psin is felt in LLQ
Sigmoid diverticulitis

Nayla clinical disciplines (8 decks)

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