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Elaina: Emergency 2 > ED 2 Abdomen > Flashcards

ED 2 Abdomen Flashcards

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1
Q

crescendo-descrescendo crampy pain should make you think of what abdominal emergency?

A

obstruction

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2
Q

localized, then generalized severe, explosive pain should make you think of what abdominal emergency?

A

perforation

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3
Q

progressive, worsening severe pain should make you worry about what abdominal emergency?

A

ischemic necrosis

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4
Q

where will pain of cystitis or salpingitis refer to?

A

low back

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5
Q

where will pain of pancreatitis, PUD, or cholecystitis refer to?

A

mid-back

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6
Q

pain of diaphragmatic irritation will refer where?

A

shoulder

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7
Q

ABRUPT, localized, unrelieved epigastric pain preceded by violent emesis should make you think what?

A

esophageal perforation

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8
Q

what will you note on auscultation of a patient with esophageal perforation?

A

may have pneumomediastinum

will have subcutaneous emphysema (snap, crackle, pop)

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9
Q

what is the most common cause of esophageal perforation?

A

50-60 percent iatrogenic

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10
Q

what GI condition is characterized by periodic pain that awakens the patient at night, often worsened with food?

A

gastric ulcer

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11
Q

risk factors for gastric ulcer?

A

heavy NSAID, ASA, ETOH, smoking

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12
Q

gastric ulcers are usually considered benign abdomens, unless they perforate. how will they present?

A

hematochezia

epigastric tenderness

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13
Q

how do we treat gastric ulcers?

A

GI cocktail! IV PPI/H2 blocker

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14
Q

hematemesis after repetitive vomiting is often due to what?

A

mallory weiss-tear

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15
Q

what is the difference between an esophageal perforation and a mallory weiss tear?

A

esophageal perforation=rip esophagus from stomach

mallory weiss=partial thickness tear at esophogastric junction

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16
Q

how do we DX and TX a mallory weiss tear?

A

will need EGD, but not emergently

most do well with conservative TX

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17
Q

what is the term for a gallbladder stone? how do these patients typically present?

A

cholelithiasis

often asymptomatic; found incidentally…usually a benign abdomen

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18
Q

what is the best test for DX cholelithiasis?

A

ultrasound

all labs should be normal

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19
Q

if patient with cholelithiasis were symptomatic, what would they complain of? how do we TX?

A

RUQ pain esp after fatty meal, may radiate to chest or right shoulder

will NOT be sick or have fever!

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20
Q

a positive murphy’s sign should make you think of what abdominal DX?

A

cholecystitis

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21
Q

how will a patient with cholecystitis present?

A

fever, chills, vomiting, POSTPRANDIAL severe pain

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22
Q

what are complications of untreated cholecystitis?

A

empyema, gangrenous gallbladder, perforation

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23
Q

how do we manage cholecystitis in the ED?

A

keep patient NPO as you prep them for cholecystectomy

can TX symptoms with IV mefoxin, nausea meds, pain meds

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24
Q

intermittent, colicky pain in the RUQ that may radiate to the back should make you think of what? what on PE will clue you into this DX vs. cholecystitis?

A

choledocolithiasis

may be jaundiced!

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25
Q

what will labs look like in a patient with choledocolithiasis?

A

elevated hepatic function panel, bilirubin

26
Q

why must we emergently consult surgery for choledocolithiasis? what can and does it often lead to?

A

MC pancreatitis

also sepsis, obstructive jaundice

27
Q

what is the DX and TX of choice for choledocolithiasis?

A

ERCP emergently!

keep them NPO, but give IV narcotis, fluids, pain meds

28
Q

most common cause of pancreatitis?

A

alcoholism

29
Q

severe, unrelenting epigastric pain that radiates to the back and is worse when laying down should make you worry about what?

A

acute pancreatitis

30
Q

what two signs on PE can predict a very severe attack of pancreatitis?

A

grey-turner’s and cullen’s sign

31
Q

what will the abdominal exam of a patient with acute pancreatitis look/feel/sound like?

A

abdominal distension
NO rebound tenderness
guarding on exam
decreased to no bowel sounds

32
Q

which two labs are the MOST important in diagnosing acute pancreatitis?

A

1) lipase: 3x normal and 100 percent specific/sensitive

2) ALT 3x normal and 95% positive predictive value for biliary pancreatitis

33
Q

what is the name of the criteria we use for prognosis of pancreatitis?

A

ranson’s criteria

34
Q

TX of acute pancreatitis? (4)

A

1) NPO!!
2) IV hydration (LARGE amnt of fluid)
3) IV nausea meds
4) IV pain meds

35
Q

when is the only indication for ABX in treating pancreatitis?

A

if pancreas is necrotic

36
Q

old man with a history of ATHEROSCLEROSIS presents with sudden-onset severe belly pain that radiates to his back and groin…what is it until proven otherwise?

A

AAA

37
Q

what will PE of patient with an intact AAA look like?

A

1) palpable, pulsatile, non-tender mass

2) may hear a bruit

38
Q

what may PE of a patient with a ruptured AAA look like?

A

1) vital signs initially normal, then tank fast
2) grey-turners and cullen’s sign
3) femoral pulses asymmetric!

39
Q

how fast does an AAA grow per year?

A

1-1.5 cm

40
Q

if patient’s AAA is asymptomatic and less than 5 cm, what do you do?

A

wait, serial ultrasounds

41
Q

patient with abdominal pain with history of Afib or hypercoagulable conditions should make you worry about what!

A

ischemic bowel!

42
Q

what is the classic presentation of ischemic bowel?

A

periumbilical pain out of proportion to exam

also N/V, diarrhea
may have fever if perforation

43
Q

what is the definitive study for ischemic bowel done in the ED?

A

CT with oral AND IV contrast!

44
Q

how will we manage a patient with ischemic bowel in the ED?

A

1) NPO, NG tube while waiting surgery
2) ABX such as zosyn
3) GET TO SURGERYYY

45
Q

what is the term for inflamed lymph nodes in the mesentery? what else will these younger patients present with?

A

mesenteric adenitis

fever, nausea, vomiting

46
Q

who is appendicitis very rare in?

A

kids under 5

47
Q

which 4 signs will likely be positive in patient with appendicitis?

A

1) rovsings: push in LLQ, pain in RLQ on rebound
2) heel strike: lift leg, bang on heel, ow
3) obturator: flex at knee while on back, pain in RLQ
4) psoas: extend leg straight backwards while on side, pain in RLQ

48
Q

when palpating a patient with appendicitis, what will you note?

A

guarding

rebound tenderness

49
Q

how do we definitively diagnose appendicitis?

A

CT with PO and IV contrast

50
Q

how will we manage appendicitis in the ED?

A

1) NPO
2) pain and nausea meds IV
3) IV mefoxin
4) surgery

51
Q

bacterial overgrowth by ____ occurs in 80 percent of appendicitis patients?

A

e. coli

52
Q

most common sites for ischemic bowel to occur? (3)

A

watershed areas of intersecting circulation (splenic flexure, rectosigmoid junction, ascending colon)

53
Q

where do 90 percent of diverticulitis cases occur?

A

sigmoid colon

54
Q

definitive diagnosis of diverticulitis? how do we treat?

A

CT with contrast

pain and nausea meds
cipro and flagyl ABX!

55
Q

MC cause of diverticulitis?

A

fecolith in diverticulum causes invasion of colonic bacteria

56
Q

what is your typical presentation of diverticulitis?

A

older person

constant LLQ pain, fever, constipation, anorexia

57
Q

how will the abdomen appear in someone with a bowel obstruction? what will bowel sounds sound like?

A

crampy, distended, diffusely tender abdomen

hyperactive bowel sounds

58
Q

how do we diagnose a bowel obstruction?

A

KUB upright! to see air fluid levels

59
Q

management of bowel obstruction?

A

NPO
NG tube to wall suction
pain meds
surgery consult

60
Q

diarrhea and rectal bleeding with blood/mucus should make you think of what?

A

ulcerative colitis

Elaina: Emergency 2 (11 decks)

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