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Multisystem > Acute Abdominal Pain > Flashcards

Acute Abdominal Pain Flashcards

1
Q

Is involuntary guarding concerning and what does it suggest?

A
  • Yes it is concerning

- Suggest peritonitis

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2
Q

How do you perform a psoas sign?

A

Roll onto left side, extend leg back

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3
Q

How do you perform a obturator sign?

A

Flex and externally rotate right leg

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4
Q

How do you perform a Rovsing’s sign?

A

Push in LLQ, pain in RLQ

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5
Q

How do you perform a Reverse Rovsing’s? and what diagnosis do we think when this test is positive?

A
  • Push in RLQ, pain in LLQ

- Diverticulitis

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6
Q

How do you perform a Murphy’s sign? What diagnosis do we think if this test is positive?

A
  • Pt takes a deep breath, push in RUQ, positive if pt stops inhaling due to pain
  • Cholecystitis
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7
Q

What exam should be done in all males?

A

Testicular test - do not want to miss a testicular torsion

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8
Q

What lab test should you get on every female?

A

UA/HCG for females

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9
Q

Why do you get a CBC?

A
  • Consultants want them, up to 30% of appys have normal WBC
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10
Q

What do you look at when getting a CMP?

A
  • Liver Enzymes
  • Renal fxn: Creatine for CT
  • Electrolytes: hypokalemia can cause an ileus
  • Low bicarb = acidosis
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11
Q

What COAGs do you want to order? and why do you order COAGS?

A
  • INR/PTT
  • Standard pre-op lab
  • Liver disease elevates coags before LFTs
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12
Q

What lab do you order to see pancreatic function?

A
  • Lipase to look for pancreatitis

- Amylase is unnecessary- not sensitive or specific

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13
Q

What type of pts do you order VBG + Lactate? what does the high lactate indaicte?

A
  • Older patients

- High lactate = mesenteric ischemia

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14
Q

Why is a CRP useful?

A
  • Will be increased with appy, helps to differentiate esp. if CBC is normal
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15
Q

What medication is a good option for pain control?

A

Morphine

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16
Q

What is the average loading dose of Morphine?

A

0.1 mg/kg

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17
Q

What dose of morphine do you generally want to start with?

A

4 mg IV

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18
Q

What medication and dose is typically given with Morphine to help with nausea?

A

4 mg IV of Zofran

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19
Q

What is the max dose of morphine in older pts?

A

4mg

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20
Q

What medication and dose can be given if pt is experiencing itching from the Morphine medication?

A

12.5 - 25 mg IV Benadryl

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21
Q

What are considered true allergic rxns to Morphine?

A
  • Swelling of lips, tongue and SOB
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22
Q

What imaging is effective for LUQ pain? and what are you looking for?

A

Rarely requires imaging unless you have a:
- Rigid abdomen
OR
- Suspect a bowel obstruction

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23
Q

What imaging is effective for epiastric pain? and what are you looking for?

A

Rarely requires imaging.

  • May get it for pancreatitis to check for pseudocyst
  • If you find pancreatitis, check a RUQ US for gallstone pancreatitis
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24
Q

What imaging is effective for RUQ pain? and what are you looking for?

A
  • RUQ US

- Cholecystitis

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25
Q

What imaging is effective for RLQ pain? and what are you looking for?

A

CT w/ contrast or US

- Appendicitis.

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26
Q

What imaging is effective for LLQ pain? and what are you looking for?

A

CT w/ contrast

- Diverticulitis

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27
Q

What imaging is effective for flank pain? and what are you looking for?

A

CT without contrast

- kidney stones

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28
Q

What diagnosis should be written on the chart instead of gastritis or gastroenteritis?

A
  • Abdominal pain
    OR
  • Vomiting/diarrhea
29
Q

What do you need to have in order to diagnose a pt with gastroenteritis?

A

Need vomiting AND diarrhea.

30
Q

What causes mesenteric ischemia?

A
  • Clot thrown into mesentery or low flow state

- Classically an older patient with a-fib and pain out of proportion

31
Q

What imaging is needed for mesenteric ischemia?

A
  • CT w/ contrast
  • Angiogram
  • MRI
32
Q

You should be suspicious of a bowel obstruction in a pt with what?

A
  • Multiple abdominal surgeries
  • Diffuse abdominal pain
  • Vomiting
33
Q

What imaging is needed for a bowel obstruction?

A

CT w/contrast and PO contrast

34
Q

What imaging is needed for a AAA?

A
  • US (>5cm = surgery)

- CT w/ angio (Test of choice)

35
Q

What is the mortality of a STEMI vs mortality of an elderly pt with abdominal pain?

A
  • STEMI: 8%

- Elderly pt w/ abdominal pain: 10%

36
Q

What should you document in d/c instructions in a pt w/ abdominal pain?

A
  • Return precautions
  • Document a repeat abdominal exam before discharge
  • Pt response to meds and f/u with specialist or PCP
37
Q

What should you be sure to ask a female pt in regards to her OB history?

A
  • How many Gs: pregnancies

- How many Ps: live births

38
Q

Pain above the iliac crest indicates what?

A

Abdominal cause of pain

39
Q

Pain lower towards inguinal ligament indicates what?

A

Pelvic pathology

40
Q

What labs do you run after performing a pelvic exam?

A
  • Wet-prep
  • KOH
  • G/C
41
Q

What are the main steps for a pelvic exam?

A
  • Insert the speculum
  • Observe for d/c
  • Examine cervix for lesions
  • Chaperone should always be present
42
Q

When palpating the cervix and the pt seems uncomfortable/in distress what does this indicate and what should you check?

A
  • Cervical motion tenderness (CMT)

- Adnexa

43
Q

What diagnoses would you suspect that would cause you to order a Transvaginal Pelvic ultrasound?

A
  • Ectopic pregnancy

- Threatened abortion/miscarriage

44
Q

What are S/Sxs of an ovarian torsion?

A
  • Sudden onset of sharp stabbing pain in lower abdomen

- N/V

45
Q

What would a negative pelvic US tell you if you were suspicious of ovarian torsion?

A
  • A negative pelvic US DOES NOT rule out torsion.
  • Intermittent torsion is possible
  • Time sensitive diagnosis- ovary salvage rate greatly declines after 4 hours
46
Q

If the US is negative but you have a high suspicion that the pt has ovarian torsion what do you do?

A
  • OB/GYN consult and admission serial abdominal exams

- Most torsions have large cysts but not all

47
Q

What two STDs should you always treat together?

A

ALWAYS treat for gonorrhea and chlamydia

48
Q

What are the medications and dose for cervicitis? and what are the medications/dose for pts w/ a PCN or cephalosporin allergy?

A
  • Ceftriaxone 125mg IM and 1 gram of azithromycin PO x1 dose

- Allergy: 2 grams azithromycin PO x1 + Zofran

49
Q

Do pts with cervicitis have CMT?

A

Negative CMT but + swab or suspicion

50
Q

What are the medications and dose for PID?

A
  • Ceftriaxone 250mg IM

- Doxycycline 100mg PO BID for 14 days

51
Q

Do pts with PID have CMT?

A

Positive CMT

52
Q

What is Fitz-Hugh Curtis?

A

a PID infxn that has spread to the liver capsule and has caused peri-hepatitis

53
Q

What are the S/Sxs of Fitz-Hugh Curtis? and what are the lab findings

A
  • RUQ pain
  • R shoulder pain
  • Labs: elevated LFTs
54
Q

What is the tx plan for a pt with Fitz-Hugh Curtis?

A

Treat PID and consult OBGYN

55
Q

What are common historical findings in a pt presenting with Tubo-ovarian abscess (TOA)?

A
  • Hx of STDs
  • Severe or recurrent PID
  • Usually untreated PID that has formed an abscess.
56
Q

What imaging and tx plan would you get for a pt with TOA?

A
  • Diagnosed with transvaginal US
  • Tx w/ IV abx
  • OBGYN consult
  • Poss surgical drainage
57
Q

What are S/Sxs of Trichomonas?

A
  • Itching
  • D/c
  • Dysuria
  • Dyspaurenia
58
Q

What is seen on the wet prep in a pt w/ Trichomonas?

A

Motile organism

59
Q

What is a very common PE finding in a pt with Trichomonas?

A

Strawberry cervix

60
Q

What is the tx for a pt with Trichomonas?

A

Flagyl (metronidazole): 2 grams PO x1

- Treat partner as well: men are often asymptomatic

61
Q

What is a potential SE of Flagyl?

A

Disulfaram reaction = vomiting

- avoid alcohol

62
Q

What is a common sx of bacterial vaginosis?

A

Malodorous d/c

63
Q

What is seen on the wet prep in a pt with bacterial vaginosis?

A

Clue cells

64
Q

What causes bacterial vaginosis?

A

Imbalance/overgrowth of Gardanella Vaginalis

65
Q

Who should you treat in pts with bacterial vaginosis? and what is the medication and dose?

A
  • Tx all symptomatic pts AND pregnant pts

- Flagyl (metronidazole) 2 grams PO x1

66
Q

What are s/sx of candidiasis and what is it usually caused by?

A
  • Itching, burning, d/c

- caused by antibiotics

67
Q

What is seen on the wet prep in a pt w/candidiasis?

A

Fungal elements

68
Q

What are the medications/dose for a pt w/candidiasis?

A
  • Fluconazole- 150mg PO x1
  • Topical for short term
  • Others: Clotrimazole and Miconazole takes x7 days

Multisystem (6 decks)

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