ED 2 Abdomen Flashcards
crescendo-descrescendo crampy pain should make you think of what abdominal emergency?
obstruction
localized, then generalized severe, explosive pain should make you think of what abdominal emergency?
perforation
progressive, worsening severe pain should make you worry about what abdominal emergency?
ischemic necrosis
where will pain of cystitis or salpingitis refer to?
low back
where will pain of pancreatitis, PUD, or cholecystitis refer to?
mid-back
pain of diaphragmatic irritation will refer where?
shoulder
ABRUPT, localized, unrelieved epigastric pain preceded by violent emesis should make you think what?
esophageal perforation
what will you note on auscultation of a patient with esophageal perforation?
may have pneumomediastinum
will have subcutaneous emphysema (snap, crackle, pop)
what is the most common cause of esophageal perforation?
50-60 percent iatrogenic
what GI condition is characterized by periodic pain that awakens the patient at night, often worsened with food?
gastric ulcer
risk factors for gastric ulcer?
heavy NSAID, ASA, ETOH, smoking
gastric ulcers are usually considered benign abdomens, unless they perforate. how will they present?
hematochezia
epigastric tenderness
how do we treat gastric ulcers?
GI cocktail! IV PPI/H2 blocker
hematemesis after repetitive vomiting is often due to what?
mallory weiss-tear
what is the difference between an esophageal perforation and a mallory weiss tear?
esophageal perforation=rip esophagus from stomach
mallory weiss=partial thickness tear at esophogastric junction
how do we DX and TX a mallory weiss tear?
will need EGD, but not emergently
most do well with conservative TX
what is the term for a gallbladder stone? how do these patients typically present?
cholelithiasis
often asymptomatic; found incidentally…usually a benign abdomen
what is the best test for DX cholelithiasis?
ultrasound
all labs should be normal
if patient with cholelithiasis were symptomatic, what would they complain of? how do we TX?
RUQ pain esp after fatty meal, may radiate to chest or right shoulder
will NOT be sick or have fever!
a positive murphy’s sign should make you think of what abdominal DX?
cholecystitis
how will a patient with cholecystitis present?
fever, chills, vomiting, POSTPRANDIAL severe pain
what are complications of untreated cholecystitis?
empyema, gangrenous gallbladder, perforation
how do we manage cholecystitis in the ED?
keep patient NPO as you prep them for cholecystectomy
can TX symptoms with IV mefoxin, nausea meds, pain meds
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?
choledocolithiasis
may be jaundiced!
what will labs look like in a patient with choledocolithiasis?
elevated hepatic function panel, bilirubin
why must we emergently consult surgery for choledocolithiasis? what can and does it often lead to?
MC pancreatitis
also sepsis, obstructive jaundice
what is the DX and TX of choice for choledocolithiasis?
ERCP emergently!
keep them NPO, but give IV narcotis, fluids, pain meds
most common cause of pancreatitis?
alcoholism
severe, unrelenting epigastric pain that radiates to the back and is worse when laying down should make you worry about what?
acute pancreatitis
what two signs on PE can predict a very severe attack of pancreatitis?
grey-turner’s and cullen’s sign
what will the abdominal exam of a patient with acute pancreatitis look/feel/sound like?
abdominal distension
NO rebound tenderness
guarding on exam
decreased to no bowel sounds
which two labs are the MOST important in diagnosing acute pancreatitis?
1) lipase: 3x normal and 100 percent specific/sensitive
2) ALT 3x normal and 95% positive predictive value for biliary pancreatitis
what is the name of the criteria we use for prognosis of pancreatitis?
ranson’s criteria
TX of acute pancreatitis? (4)
1) NPO!!
2) IV hydration (LARGE amnt of fluid)
3) IV nausea meds
4) IV pain meds
when is the only indication for ABX in treating pancreatitis?
if pancreas is necrotic
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?
AAA
what will PE of patient with an intact AAA look like?
1) palpable, pulsatile, non-tender mass
2) may hear a bruit
what may PE of a patient with a ruptured AAA look like?
1) vital signs initially normal, then tank fast
2) grey-turners and cullen’s sign
3) femoral pulses asymmetric!
how fast does an AAA grow per year?
1-1.5 cm
if patient’s AAA is asymptomatic and less than 5 cm, what do you do?
wait, serial ultrasounds
patient with abdominal pain with history of Afib or hypercoagulable conditions should make you worry about what!
ischemic bowel!
what is the classic presentation of ischemic bowel?
periumbilical pain out of proportion to exam
also N/V, diarrhea
may have fever if perforation
what is the definitive study for ischemic bowel done in the ED?
CT with oral AND IV contrast!
how will we manage a patient with ischemic bowel in the ED?
1) NPO, NG tube while waiting surgery
2) ABX such as zosyn
3) GET TO SURGERYYY
what is the term for inflamed lymph nodes in the mesentery? what else will these younger patients present with?
mesenteric adenitis
fever, nausea, vomiting
who is appendicitis very rare in?
kids under 5
which 4 signs will likely be positive in patient with appendicitis?
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
when palpating a patient with appendicitis, what will you note?
guarding
rebound tenderness
how do we definitively diagnose appendicitis?
CT with PO and IV contrast
how will we manage appendicitis in the ED?
1) NPO
2) pain and nausea meds IV
3) IV mefoxin
4) surgery
bacterial overgrowth by ____ occurs in 80 percent of appendicitis patients?
e. coli
most common sites for ischemic bowel to occur? (3)
watershed areas of intersecting circulation (splenic flexure, rectosigmoid junction, ascending colon)
where do 90 percent of diverticulitis cases occur?
sigmoid colon
definitive diagnosis of diverticulitis? how do we treat?
CT with contrast
pain and nausea meds
cipro and flagyl ABX!
MC cause of diverticulitis?
fecolith in diverticulum causes invasion of colonic bacteria
what is your typical presentation of diverticulitis?
older person
constant LLQ pain, fever, constipation, anorexia
how will the abdomen appear in someone with a bowel obstruction? what will bowel sounds sound like?
crampy, distended, diffusely tender abdomen
hyperactive bowel sounds
how do we diagnose a bowel obstruction?
KUB upright! to see air fluid levels
management of bowel obstruction?
NPO
NG tube to wall suction
pain meds
surgery consult
diarrhea and rectal bleeding with blood/mucus should make you think of what?
ulcerative colitis
