DSA 5: Abdominal Pain Fatigue Weight Loss DSA Flashcards
The risk of an aortic aneurysm rupture increases at around what size?
Greater than 5 cm in diameter
How does an abdominal aortic aneurysm present?
How is it usually detected?
1) Commonly asymptomatic
2) On routine examination as a palpable, pulsatile, and nontender mass
What occurs with rupture of AAA which requires an emergency operation?
What is the prior warning sign of AAA rupture?
1) Acute pain and hypotension
2) Occurs without any prior warning
What specific population is recommended for screening of AAA by abdominal ultrasound?
Men age 65–75 years who have ever smoked
Aortic dissection is caused by a circumferential or, less frequently, transverse tear of?
The pulsatile aortic flow then dissects along the elastic lamellar plates of the aorta and creates?
1) The intima
2) False lumen
How do aortic dissections present?
1) Atypical chest pain
2) Widened mediastinum
3) VS abnormalities
Appendicitis is initiated by obstruction of the appendix by?
Fecalith, inflammation, foreign body, or neoplasm
How does appendicitis present?
Begins with periumbilical or epigastric pain and within 12 hours the pain shifts to the right lower quadrant
How does appendicitis present on labs?
Moderate leukocytosis (10,000–20,000/mcL) with neutrophilia
After the appendectomy what should be given to reduce the incidence of postoperative infections?
Give broad-spectrum antibiotics with gram-negative and anaerobic coverage
What is the most common
causes of maternal death during the first trimester?
Undetected ectopic pregnancy
How does ectopic pregnancy present?
Sudden onset of severe lower quadrant pain
Along with serum beta-hCG greater than 2000 milliunits/mL, how is ectopic pregnancy diagnosed?
No intrauterine pregnancy on transvaginal ultrasound
What presents acutely and may be due to rupture, bleeding or torsion of cysts, or, much less commonly, neoplasms of the ovary, fallopian tubes, or paraovarian
areas?
Ovarian torsion
Nearly 70% of ovarian torsions occur on what side?
This is due to?
1) Right side
2) Increased length of the utero-ovarian ligament on the right and the sigmoid on the left which limits space for movement
How do ovarian torsions present?
Sudden-onset, unilateral, lower abdominal pain that may develop after episodes of exertion
An ovary greater than what size due to cyst, tumor, or edema is the most common
ultrasonographic finding associated with torsion?
4 cm
Acute colonic pseudo-obstruction (Ogilvie Syndrome) is due to?
Spontaneous massive dilation of cecum or right colon without mechanical obstruction
What is found on plain film radiograph for acute colonic pseudo-obstruction?
Colonic dilation
A cecal diameter greater than what size is associated with an increased risk of
colonic perforation?
10–12 cm
Meckel’s diverticulitis is a remnant of?
What is the most useful method of diagnosis for it?
1) Vitelline duct
2) Technetium-99m scan
What is diverticulitis?
How does it present?
What may be found on PE?
Why is endoscopy (sigmoidoscopy or colonoscopy) contraindicated during the initial stages of an acute attack?
1) Macroscopic inflammation of a diverticulum
2) LLQ pain
3) Thickened, palpable sigmoid and descending colon
4) Risk of perforation
What presents as periumbilical pain out of proportion to tenderness?
Acute mesenteric ischemia
What sign is present on abdominal XR for acute mesenteric ischemia?
Thumbprinting (submucosal edema)
What presents as abdominal angina: dull, crampy periumbilical pain 15–30 min after a meal and lasting for several hours (patient’s will have a food fear)?
Chronic mesenteric ischemia
What is the test of choice for mesenteric ischemia?
CT angiography with IV contrast
What is the most common cause of intestinal obstruction?
Peritoneal adhesions
What is seen on plain radiographs or CT scan for intestinal obstruction?
Dilated bowel and air-fluid levels
How are intestinal obstruction treated?
1) NG tube decompression and fluid resuscitation
2) Urgent laparotomy for lysis of adhesions (LOA) performed before bowel ischemia develops
What type of inflammation is a life-threatening event that is often accompanied by bacteremia and sepsis?
Peritonitis
Which form of peritonitis is most common among patients with cirrhosis?
Primary bacterial peritonitis
What are the most common etiologic agents seen with primary bacterial peritonitis?
1) Gram-negative bacilli such as Escherichia coli
OR
2) Gram-positive organisms such as streptococci, enterococci, and pneumococci
Primary bacterial peritonitis is confirmed if the peritoneal fluid is sampled and contains a PMNs/μL level of?
> 250
How does secondary peritonitis occur?
Bacteria contaminate the peritoneum as a result of spillage from an intra abdominal viscus
What does the microbiology look in secondary peritonitis?
Mixed flora of gram-negative bacilli and anaerobes
How does the patient present with secondary peritonitis?
They lie motionless, often with knees drawn up to avoid stretching the nerve fibers of the peritoneal cavity
What is a potentially lethal complication of ulcerative
colitis or C. Diff colitis?
Toxic megacolon
When should we prompt
further evaluation for unintentional weight loss in a previous healthy individual?
Loss of 5-10% of body weight over 6 months
What PEs should be done on men due to unintentional weight loss?
For women?
For both?
1) Rectal examination, including the prostate
2) Pelvic examination
3) Test stool for occult blood
What should be taken into consideration for unintentional weight loss?
Poor dentition
