ER: abdominal pain Flashcards
What is mid-epigastric pain radiating to the back?
Pancreatitis
until ruled out
What is RUQ pain that radiates to the right shoulder?
Gallbladder
What is RLQ pain that radiates to the right shoulder?
Appendicitis or Ectopic pregnancy
What is LLQ pain that radiates to the left shoulder?
Diverticulitis
What two common ER conditions have improved symptoms when lying flat?
- Appendicitis
2. Peritonitis
What condition in the ER does not show any improvement regardless of positioning?
Testicular torsion, orchitis
really anything wrong down there is very uncomfortable
What is a common finding on PE for aortic dissection?
Unequal femoral pulses
What is suspected when there is “pain out of proportion to the exam”?
Mesenteric Ischemia
Necrosis during appendicitis allows these two organisms to grow.
- Bacteroides f.
2. E. coli
Diagnostic procedure of choice for appendicitis.
CT scan
Triad associated with acute cholecystitis.
Fat
Fertile
Forty
What are the characteristics of black vs. brown gall stones?
Black: hemolysis, in gallbladder
Brown: infection, in ducts
Two best tests to diagnose cholecystitis.
- CT
2. Ultrasound
Two most common causes of small bowel obstruction.
- Adhesions (scar tissue from previous surgery)
2. Hernias
Leading cause of large bowel obstruction.
Carcinoma
How does large bowel obstruction appear on X-ray?
Dilated bowel with flat lines indicating air-fluid levels within the colon
What is Ogilvie Syndrome?
Pseudo-obstruction of the large bowel most likely due to neurological malfunction. Nothing mechanical actually blocks the colon. Most commonly seen in the cecum and right colon.
How does a low fiber diet lead to diverticulosis?
Fiber aids in motility in the colon. Low fiber means that the colon has to increase its workload to move fecal material.
This increase in workload leads to an increase in the lumen pressure which causes weakened areas of the bowel to form “out-pouches”.
In patients suspected to have diverticulitis, what is important to avoid?
Barium enema and colonoscopy due to risk of perforation.
Red current jelly stool.
Sausage-shaped mass on palpation
Intussusception
Best diagnostic tool for intussusception and treatment.
Ultrasound
Treatment: barium enema, water enema, air enema
Surgery if recurrence happens
Bacteria associated with MALT B lymphomas
H. pylori
What can indicate a perforated peptic ulcer on X-ray.
Air under the diaphragm
although 40% do not show this
What is Cullen Sign and Grey Turner sign?
CS: umbilical ecchymosis (small bruises)
GTS: flank ecchymosis
Both indicate acute pancreatitis
Most common cause of pancreatitis
Alcohol
gall stones is #2
Name and describe the worst complication of acute pancreatitis.
Systemic Inflammatory Response Syndrome (SIRS)
Inflammation spreads throughout the whole body, leads to:
Temperature 38 C(100.4 F)
Fall in body temperature to < 36 C (96.8 F)
Tachycardia >90 per minute
Tachypnea > 20 per minute
Describe Ranson Criteria for diagnosing acute pancreatitis. At presentation Age WBC Glucose LDH AST
After 48 hrs. Fall in hematocrit Increase in BUN Calcium Arterial Po2 Base deficit Fluid deficit
At presentation Age >55 WBC > 16,000/mm3 Glucose >200 mg/dl LDH >350 IU/L AST >250 IU/L
After 48 hrs. Fall in hematocrit > 10% Increase in BUN >5 mg/dl Calcium 4 mg/L Fluid deficit > 6L
Name and describe the two types of mesenteric ischemia/infarction.
Arterial:
- occlusive - embolus or thrombus occluding SMA
- Non-occlusive - low flow state
Venous:
Mesenteric venous thrombus
Most common situation when patients present with Mesenteric ischemia.
2-3 hrs. after a triple bypass heart surgery.
Name and describe the 3 phases of Mesenteric Ischemia.
- Hyperactive: increased bowel sounds, bloody stool, abdominal pain
- Paralytic: absent bowel sounds, increased abdominal pain
- Shock: fluids leak thru damaged colon lining, acidosis, dehydration, confusion, hypotension, tachycardia
