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SD- ER pt 2 > Acute Abdomen Lecture > Flashcards

Acute Abdomen Lecture Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Esophageal perforation
PUD/gastritis
Mallor-Weiss

..will all present with pain where?

A

Epigastric pain

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2
Q

Associated with high mortality rate

MC type= iatrogenic (50-60%)

Other causes:
Boerhaave’s Syndrome
Trauma
Foreign body ingestion

A

Esophageal perforation

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3
Q

A full thickness perforation of the esophagus after a sudden rise in the intraesophageal pressure, often due to forceful emesis

*usually associated with alcohol

A

Boerhaave’s Syndrome

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4
Q

Acute, severe unrelenting and diffuse pain in chest, neck and abdomen

swallowing exacerbates pain
tachypnea, tachycardia

Abrupt onset, usually preceded by violent emesis
Mediastinal (sub Q) emphysema can be seen (but takes time to develop)

A

Esophageal perforation

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5
Q

A finding caused by air in the mediastinum being moved by the beating heart, can sometimes be ausculated

A

Hammon’s crunch

(seen with esophageal perforation)

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6
Q

Pleural effusions happen in about ____% of pts with intrathoracic perforations

A

50%

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7
Q

Diagnosis of esophageal perforation

A

CXR will suggest
CT confirms

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8
Q

Related to NSAIDs and H Pylori

dyspepsia= continuous or recurrent upper abdominal pain or discomfort +/- associated symptoms

must consider with heavy NSAID, ASA, ETOH and smoking use

A

PUD, gastritis

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9
Q

H pylori is present in about…

____% of duodenal ulcers
____% gastric ulcers

A

95% duodenal ulcers

70% gastric ulcers

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10
Q

Burning epigastric pain that is relieved with food, milk or antacids

recurs at night as stomach empties

EPIGASTRIC TENDERNESS on exam

A

PUD

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11
Q

Gold standard dx of PUD

A

Upper GI endoscopy

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12
Q

Partial thickness tear of esophogeal-gastric junction

Hematemesis after vomiting, CP, coughing

CXR to R/O free air/pneumomediastinum

A

Mallory Weiss Tear

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13
Q

gall stones

often found incidentally (asymptomatic)
**pain ususally after fatty meal (may radiate to chest, R shoulder or scapula)

A

Cholelithiasis

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14
Q

Highest risk= women age 30-80 yo

Usually gallstone obstructing cystic duct
Fever, chills, vomiting, severe pain (often post prandial)

positive murphy’s sign

A

Acute cholecystitis

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15
Q

Gallstone in common bile duct

pain radiating to middle of back and epigastric tenderness
may be jaundiced

*can produce sepsis, pancreatitis, obstructive jaundice

A

Choledocholithasis

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16
Q

Bacterial infection of biliary tree as a result of obstruction

A

Cholangitis

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17
Q

Top 2 causes of acute pancreatitis

A
  1. ETOH abuse
  2. cholelithasis
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18
Q

A central cause of pancreatitis is intracellular activation of..

A

trypsin

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19
Q

Nausea, vomiting, epigastric pain
May localize to R or L UQ or radiate to back
Usually begins abruptly and lasts for days
Epigastric tenderness
Bowel sounds may be decreased
+ Cullen or Turner sign in SEVERE cases
May have guarding on exam

Pain worse when lying down, better when leaning forward

A

Pancreatitis

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20
Q

What 2 labs will be elevated in pancreatitis?

A

Lipase (3x norm; nearly 100% sensitive and specific)

ALT (3x norm; nearly 95% predictive value for biliary pancreatitis)

21
Q

Age >55
WBC >16,000
Glucose >200
LDH >350
ALT >250

A

Ranson’s criteria for Pancreatitis Admission

22
Q

Pain and nausea control
Hydration
Bowel rest

..mainstay tx for?

A

acute pancreatitis

23
Q

MC abdominal surgical emergency

A

Appendicitis

24
Q

Develops from obstruction of appendiceal lumen

Increased luminal pressure leads to vascular compromise, bacterial invasion, inflammatory response and resultant tissue necrosis with possible perforation and peritoneal contamination

pain from periumbilical area to the RLQ

A

Appendicitis

25
Q

MC ages 10-40
VERY rare in kids under 5

bacterial overgrowth by E. Coli occurs in 80%

Rosvings
Heel Strike
Obturator Sign
Psoas Sign
Guarding

A

Appendicitis

26
Q

After the onset of vague abdominal pain, the classic triad of symptoms in appendicitis are:

1.
2.
3.

A
  1. anorexia
  2. nausea
  3. vomiting
27
Q

What is the most reliable sign for appendicitis in kids?

A

Guarding

28
Q

Is fever an early or late sign of appendicitis?

A

Late

29
Q

Dx of appendicitis is

A

most are diagnosed clinically

*but, image of choice = CT scan!

30
Q

90% occur in sigmoid colon (LLQ pain)
generally in >50 yo

results from high colonic pressures, resulting in erosion and microperforation of the diverticular wall, leading to inflammation of the pericolonic tissue

A

Diverticulitis

31
Q

Image of choice for diverticulitis?

A

CT scan

32
Q

Flagyl + Cipro = DOC for?

A

Diverticulitis

33
Q

Most pts >60
Males
HTN
Family history
Marfan’s Syndrome, smoking, hyperlipidemia, diabetes

A

AAA

34
Q

Thinning of the media of the aorta with a reduction in elastic, collagen and fibromellar units results in a decrease in tensile wall strength

as the aorta dilates, the force on the aortic wall increases, causing further aortic dilation

*on avg, can grown 0.25 cm to 0.5 cm a year

A

AAA

35
Q

For a AAA, those larger than _____cm are at risk of rupture

A

5 cm

36
Q

Classically older males with severe back or abdominal pain who presents with syncope or hypotension

“tearing” or “ripping” pain

Often complain of unilateral flank or groin pain, hip pain or abdominal pain localized to a specific quadrant

A

AAA

37
Q

Retroperitoneal hemorrhage on periumbilical

A

Cullen’s sign

AAA

38
Q

What is the Grey-Turner sign that can be seen with a AAA?

A

Flank ecchymosis

39
Q

Image of choice for AAA

A

CT scan

(but if pt is really unstable, can do a bedside ultrasound)

40
Q

Asymmetric femoral pulses can be seen with….

A

AAA

41
Q

Periumbilical pain out of proportion to exam

often seen in pts with a fib, hypercoagulable conditions, vasculitis, sickle cell

A

Ischemic bowel

(usually occurs at: splenic flexure, rectosigmoid jxn, ascending colon)

42
Q

Inflammation of mesenteric lymph nodes (usually RLQ)

A

Mesenteric Adenitis

43
Q

What is more common, large or small bowel obstruction?

A

Small bowel obstruction

44
Q

MC cause of small bowel obstruction

A

Adhesions following surgery

45
Q

Adhesions
Incarcerated inguinal hernias
Intussusception
Lymphoma
Strictures

..all cause?

A

Small bowel obstruction

46
Q

Carcinoma
Fecal impaction
Ulcerative colitis
Volvulus
Diverticulitis
Intussception
Psuedo-obstruction

…all can cause?

A

Large bowel obstruction

(neoplasm = MC cause)

47
Q

Vomiting
Abdominal distention
Pain
Past hx of abdominal surgery or hernia

A

Bowel obstruction

48
Q

What are the bowel sounds like in a person with an obstruction?

A

Initially..hyperactive
Later, diminished/absent

SD- ER pt 2 (6 decks)

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