Chapter 71: Acute Abdominal Pain

Question 1

Obstruction, ischemia, or inflammation can cause stretching of unmyelinated fibers that innervate the walls or capsules of organs

Answer 1

Visceral pain

Question 2

Why visceral pain is initially felt midline?

Answer 2

Because intraperitoneal organs are bilaterally innervated, stimuli are sent to both sides of the spinal cord, causing intraperitoneal visceral pain to be felt in the midline

Question 3

Usually perceived on the same side as the involved organ, because it is not mediated by fibers that provide bilateral innervation to the cord. It is felt in the midline only if the pathologic process is also located in the midline

Answer 3

Referred pain

Question 4

Shock that develops rapidly after the onset of acute abdominal pain is usually the consequence of?

Answer 4

Intra-abdominal hemorrhage

Question 5

A useful parameter for the assessment of volume depletion, but its absence does not exclude blood/fluid loss

Answer 5

Tachycardia

Question 6

What are the visceral pain features?

Answer 6

Foregut - stomach to second part of duodenum
Midgut - 3rd part of duodenum to proximal 2/3 of transverse colon
Hindgut - distal 1/3 of transverse colon to rectum and GU orgasn

Question 7

Patients with CD4 counts over ____ are much less likely to have opportunistic infections

Answer 7

Patients with CD4 counts over 200/mm3 are much less likely to have opportunistic infections

Question 8

Hyperactive bowel sound may be noted in?
A. ileus
B. mesenteric infarction
C. peritonitis
D. small bowel obstruction

Answer 8

D. small bowel obstruction

Question 9

Regarded as the sine qua non for peritonitis

Answer 9

Rebound tenderness

Question 10

Evaluate the abdominal aorta, particularly in patients ____ years of age with acute abdominal, flank, or low back pain

Answer 10

Evaluate the abdominal aorta, particularly in patients >50 years of age with acute abdominal, flank, or low back pain

Question 11

Pain medications that can be given to abdominal pain that does not obscure abdominal findings?

Answer 11

Opioid analgesia

Question 12

IV dose of Ondansetron?

Answer 12

4 or 8 mg (0.45mg/kg/day) to maximum of 32mg

Question 13

If patient was given metoclopromide and develop extrapyramidal side effects. What drug can be given?

Answer 13

Dipenhydramine IV 25-50mg prophylaxis for dystonia

Question 14

The use of plain abdominal radiographs should be limited to screening for

Answer 14

• Severe constipation
• Obstruction
• Sigmoid volvulus
• Perforation

Question 15

If patient has cholecystitis has normal ultrasound what is recommended?

Answer 15

Cholescintigraphy

Question 16

Noncontrast abdominopelvic CT has about 97% specificity for the diagnosis of acute appendicitis, with the possible exception of what?

Answer 16

Noncontrast abdominopelvic CT has about 97% specificity for the diagnosis of acute appendicitis, with the possible exception of patients with a low body mass index (<25 kg/m2)

Question 17

The preferrred imaging modality for the diagnosis of kidney and ureteral stones

Answer 17

Noncontrast CT

Question 18

Imaging modality of choice in many institutions for suspected GI abscess, perforation and fistula

Answer 18

PO contrast CT

Question 19

It is the initial test of choice for suspected abdominal aortic aneurysm rupture or mesenteric ischemia

Answer 19

IV contrast CT

Question 20

What level of creatinine should you not order CT with contrast?

Answer 20

Serum creatinine is >1.5 milligrams/dL or the glomerular filtration rate is <60 mL/min/1.733 m2

Question 21

Patients with an unclear diagnosis at discharge, even if the CT scan is “negative” (or for whom response to treatment is a concern), should be asked to return to the ED or their primary care physician for re- evaluation within how many hours?

Answer 21

Patients with an unclear diagnosis at discharge, even if the CT scan is “negative” (or for whom response to treatment is a concern), should be asked to return to the ED or their primary care physician for re- evaluation within 12 hours

Question 22

Leading cause of pregnancy-related maternal death in the first trimester

Answer 22

Ectopic pregnancy

Question 23

The most common surgical entity in elderly patients with abdominal pai

Answer 23

Cholecystitis

Question 24

The most common early complications of bariatric surgery?

Answer 24

leakage, stenosis and bleeding

Question 25

Increased during the period of rapid weight loss after bariatric surgery

Answer 25

Gallstone formation

Question 26

Difference of early vs late dumping syndrome?

Answer 26

Early - 30min to. 1 hour

Late - 1 to 3 hours

Question 27

Severe cases of dumping syndrome is treated with

Answer 27

Octreotide

Question 28

Initial management for dumping syndrome?

Answer 28

Dietary modifications

Question 29

How many epiploic appendages each person has?

Answer 29

50-100 most commonly located at sigmoid and cecum

Question 30

What is the cardinal sign of epiploic appendagitis?
A. vomiting
B. abdominal pain
C. nausea
D. constipation

Answer 30

B. abdominal pain

Question 31

After surgery when is the normal bowel function returns?

Answer 31

2-3 days

Question 32

True or False
Proximal obstruction is usually associated with early emesis and less abdominal distention, distal obstruction with later (sometimes bilious or feculent) emesis, and significant abdominal distention

Answer 32

True
Proximal obstruction is usually associated with early emesis and less abdominal distention, distal obstruction with later (sometimes bilious or feculent) emesis, and significant abdominal distention

Question 33

Intra-abdominal hypertension is defined as persistent intra-abdominal pressure above what?

Answer 33

Intra-abdominal hypertension is defined as persistent intra-abdominal pressure above 12 mm Hg

Question 34

Abdominal compartment syndrome occurs as increased intra-abdominal pressure, often above what?

Answer 34

Abdominal compartment syndrome occurs as increased intra-abdominal pressure, often above 20 mm Hg