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MJ- Disciplines Exam 4 > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

Is visceral pain vague or precise? What is an example?

A

Vague

(ex: crampy, colicky, etc)

Ex: Early appendicitis

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2
Q

Is parietal pain vague or precise?

A

Precise

(ex: sharp, well definied, constant)

ex= Late appendicitis

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3
Q

What referred pain is seen in biliary (gallbladder) disease?

A

Right scapular/shoulder pain

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4
Q

What is guarding vs. rigidity? Which one is involuntary vs voluntary?

A
  • Guarding- Voluntary contraction of musculature
  • Rigidity- Involuntary contraction
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5
Q

What is the name of the following physical exam sign? What does it indicate?

A

Cullens sign

Retroperitoneal hemorrhage (pancreas, kidneys, parts of intestine, aorta)

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6
Q

What is the name of the following physical exam sign? What does it indicate?

A

Grey Turner’s Sign

= Retroperitoneal hemorrhage

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7
Q

26y/o M presents with abdominal pain and N/V x24 hours. Pain initially located near umbilicus but now is at RLQ. What is the dx?

A

Appendicitis

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8
Q

What is the diagnostic test of choice in kids for appendicitis?

A

Ultrasound

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9
Q

What is Rovsing’s sign?

A

Pain in RLQ when palpating the LLQ

= Appendicitis

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10
Q

What is the iliopsoas sign?

A

elicited by having supine patient keep right knee extended and flex right hip while examiner resists

= Appendicitis

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11
Q

What is the obturator sign?

A

•elicited by having supine patient flex right knee to 90°, examiner int/externally rotates hip = Appendicitis

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12
Q

What is the treatment of choice for appendicitis?

A

Appendectomy

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13
Q

A 44y/o F comes in c/o epigastric pain after eating fried chicken that radiates to the right scapula. She has a (+) Murphy’s sign.

What is Murphy’s sign and what does this patient most likely have?

A
  • Murphy’s sign – inspiratory arrest elicited by palpating RUQ
  • Cholecystitis
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14
Q

The following is classic sxs of what condition?

•Intermittent RUQ pain radiating to right shoulder with N/V associated with ingestion of fatty meal or large meal after fast

A

Cholecystitis

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15
Q

What are the risk factors for Cholecystitis? (5 F’s)

A
  1. Fat
  2. Female
  3. Forty
  4. Flatulent
  5. Fertile

(could also include fair skinned, family and foreign)

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16
Q

What is the test of choice for diagnosing cholecystitis?

A

HIDA scan

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17
Q

What is Charcot’s Triad and what condition is this indicative of?

*** most likely a test question***

A

Charcot’s triad= Fever, Jaundice, RUQ pain

–> Cholangitis

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18
Q

What is Reynold’s Pentad?

A

Fever

Jaundice

RUQ pain

Confusion

Shock

= Cholangitis--> EMERGENCY (100% mortality if not tx properly)

(F + Jaundice + RUQ pain= Charcot’s triad)

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19
Q

A person comes in with fever, jaundice, RUQ pain, confusion and shock. How do you treat this?

A
  • This is Reynold’s triad= Cholangitis
  • The confusion and shock make this an emergency. Tx w/
    • IV fluids (aggressive)
    • IV antibiotics
    • Operating Room
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20
Q
A
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21
Q

What 3 things cause pain out of proportion to exam?

A
  1. Compartment syndrome
  2. Necrotizing Faciitis
  3. Mesenteric ischemia
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22
Q

A 73 y/o F presents c/o generalized abdominal pain that is poorly localized and is associated w/ N/V. On exam, abdomen is relatively soft but she complains of severe pain (pain out of proportion to exam).

Based on her history, physical exam findings and the attached radiographic finding, what does this patient have?

A

Mesenteric ischemia

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23
Q

What are the 6 risk factors for Mesenteric ischemia?

A
  1. >60y/o
  2. A-fib
  3. ASVD
  4. Decreased ejection fraction (CHF, recent MI)
  5. Hypercoagulable states
  6. Hypotension
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24
Q

T/F: A patient w/ Mesenteric ischemia will have a metabolica acidosis (lactic acid)

A

True

Lactate is from anaerobic metabolism

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25
Q

What is the treatment of choice for Mesenteric Ischemia?

A

Arteriography

Heparin

Antibiotics

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26
Q

What is the triad of sxs for an ectopic pregnancy?

A

1. Pelvic pain (RLQ/LLQ)

2. Amenorrhea

3. Vaginal bleeding

(on ultrasound, patient will have a normal, empty uterus with a (+) preg test)

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27
Q

What is the MC location of an ectopic pregnancy?

A

Isthmus of fallopian tube

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28
Q

The following are risk factors for what?

  • PID
  • Prior ectopic pregnancy
  • IUD
  • IVF or fertility drugs
  • Prior tubal surgery (reconstruction or tubal coagulation)
  • Cigarette smoking
  • Increasing age
A

Ectopic pregnancy

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29
Q

How do you treat an ectopic pregnancy (3 things)

A
  1. Fluid resuscitation (+/- blood products)
  2. “Preoperative labs”
  3. OB/GYN for OR
30
Q

What condition?

  • Generalized abdominal pain
  • Shallow breathing
  • Taking lots of NSAIDs
A

Perforated Gastric Ulcer

31
Q

What is more common: Duodenal ulcers or gastric ulcers? Which is worse with eating?

A
  • Duodenal ulcers are more common than gastric ulcers
  • Gastric ulcers= WORSE with eating
  • Duodenal ulcers= BETTER with eating.
32
Q

_____ infection occurs in ~75% of gastric ulcers and ~90% of duodenal ulcers

A

Helicobacter pylori

33
Q

Sxs of what?

  • gnawing, burning, aching Epigastric pain <2hrs after meals
  • Anorexia
  • Weight loss
  • Belching
  • Bloating
  • Nausea
  • +/- hematemesis/melena (may result from GI bleeding)
A

Perforated Gastric Ulcer

34
Q
A
35
Q

How do you treat a perforated Gastric ulcer? (3 things)

A
  1. Fluid resuscitation
  2. H2 blockade or PPI (Zantac, protonix, pepcid)
  3. Surgery consult for operative repair
36
Q

What is the MCC of a small bowel obstruction? MCC of a large bowel obstruction?

A
  • MCC of sm bowel obstruction: adhesions from previous surgery, incarcerated hernia
  • MCC of lrg bowel obstruction: Malignancy or volvulus
37
Q

What condition?

  • Generalized cramping abdominal pain
    • Diarrhea and nausea
  • Green vomit (billious)
  • History of prior abdominal surgeries
    *
A

Small bowel obstruction

38
Q

What condition?

  • Testicular pain
  • hematuria
A

Kidney Stone

39
Q

Presentation of what condition?

  • Abdominal/back/flank/groin pain (not affected by movement)
  • +/- Pulsatile abdominal mass
  • Hypotension
A

Abdominal Aortic Aneurysm

40
Q
  • If an abdominal aortic aneuryism is > __cm, then it has a significant risk of spontaneous rupture.
  • Smaller AAAs are followed by US every ____ months
A
  • If an abdominal aortic aneuryism is > 5cm, then it has a significant risk of spontaneous rupture.
  • Smaller AAAs are followed by US every 6 months
41
Q

Testicular Torsion:

What is the Bell clapper deformity?

A

•Bell clapper deformity – inappropriately high attachment to tunica vaginalis

42
Q

An absent _______ reflex–> 99% association w/ testicular torsion

A

Cremasteric reflex

43
Q

80-100% of testicular torsions are salvaged if fixed within ____ to ____ hours

A

4-6hrs

(~20% at 24 hrs)

44
Q

What is Phren’s sign?

A

Relief of pain with scrotal elevation = Epididymitis

(this would increase pain in testicular torsion)

45
Q

What is the MCC of Epididymitis in patients <35y/o?

A

Chlamydia

46
Q

What is the MCC of Epididymitis in patients > 35y/o? How do you tx?

A

E. Coli

Cipro x10days

47
Q

What is the average age of a pt w/ testicular torsion vs epididymitis?

A

Torsion= neonate, 12-15y/o

Epididymitis= 25y/o (19-35)

48
Q

Does the following describe pain associated w/ testicular torsion or epididymitis?

  • ______= Sudden onset, unilateral, no change with position
  • _______= Gradual onset, bilateral, worse w/ standing
    *
A
  • Testicular torsion= Sudden onset, unilateral, no change with position
  • Epididymitis= Gradual onset, bilateral, worse w/ standing
49
Q

Is vomiting common or unusual in testicular torsion? What about in epididymitis?

A
  • Common in torsion
  • Uncommon in epididymitis
50
Q

What is the diagnostic test of choice in a patient that you think might have testicular torsion?

A

ultrasound of the testicles

51
Q

What is the MCC of acute scrotal pain in 3-13y/o?

A

Torsion of testicular appendix

(20% have blue dot sign, most resolve spontaneously)

52
Q

What condition?

  • Sudden onset flank pain radiating to lower quadrant
  • Unable to urinate
  • N/V
  • M>F
  • Caucasians > AA, Asians 2:1
A

Urolithiasis

53
Q

What is the MC type of urolitiasis? (calcium, struvite, uric acid or cystine)

A

Calcium= MC

54
Q

How do you treat a patient w/ urolithiasis?

A
  1. Toradol (equally as effective as narcotics)
  2. Morphine
  3. Antiemetics
  4. IVF
  5. Presence of infection w/ obstruction requires admission, abx and drainage
55
Q

What condition?

  • Epigastric pain radiating to back
  • Pain worse w/ lying down, betting sitting up and leaning forward
  • N/V
  • Onset after binge drinking
  • Elevated amylase, lipase
A

Pancreatitis

56
Q

What is the diagnostic test of choice for pancreatitis?

A

CT

57
Q

What are the 3 MCC of pancreatitis in the US?

A

Alcoholism, cholelithiasis and hypertriglyceridemia

58
Q

What 2 physical exam signs would you see in hemorrhagic pancreatits?

A

Cullens sign and Grey Turners sign

(signs of retroperitoneal hemorrhage)

59
Q

How do you treat pancreatitis? (4)

A
  1. NPO
  2. IVF
  3. Demerol
  4. Antiemetics
60
Q

What is Ranson’s Criteria?

A

Mortality prediction for pancreatitis

61
Q

What condition?

  • abrupt onset LLQ pain
  • N/V
  • rectal bleeding
  • h/o eating “many nuts”
  • Leukocytosis w/ left shift
A

Diverticulitis

62
Q

How do you dx and tx diverticulitis?

A
  • Dx: CT A/P w/ contast
  • Tx: Levaquin and Flagyl
  • If abscess seen on CT- need drainage/resection
63
Q

What condition?

  • Generalized abdominal pain
  • Polyuria
  • Polydipsia
  • Dizziness/weakness
  • Kussmaul breathing
  • Fruity oader on breath
  • Weight loss, N/V
  • Accucheck- Hi
A

DKA

64
Q

How do you tx DKA?

A

IV insulin (May have to give D5 too)

IVF

65
Q

What is a common pain referral pattern for each of the following conditions?

  • Biliary problem?
  • MI?
  • Pancreatitis?
  • Renal colic?
A
  • Biliary problem–> right shoulder/scapula
  • MI–> Left arm/neck/jaw
  • Pancreatitis–> Back
  • Renal colic–> Groin
66
Q

What is the pathophysiologic process that leads to appendicitis?

A

Luminal obstruction of the appendix

67
Q

T/F: Appendicitis can’t be present if the WBC is normal?

A

False

68
Q

T/F: Pain meds should be withheld from patients w/ abdominal pain, as this will make the physical exam less reliable

A

False

69
Q

What ultrasound findings suggest cholecystitis?

A
  • Thickened gallbladder wall (>3mm)
    • Pericholecystic fluid
  • Stones/sludge
    • Sonographic Murphy’s sign
70
Q

What are the 5P’s of Compartment syndrome

A
  1. Pain
  2. Pallor
  3. Paresthesia
  4. Paralysis
  5. Pulseless
71
Q

T/F: since testicular torsion can be reliably distinguished from epididymitis on clinical exam, an ultrasound is not indicated

A

False

MJ- Disciplines Exam 4 (4 decks)

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