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GI Exam 3 > ER: abdominal pain > Flashcards

ER: abdominal pain Flashcards

1
Q

What is mid-epigastric pain radiating to the back?

A

Pancreatitis

until ruled out

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2
Q

What is RUQ pain that radiates to the right shoulder?

A

Gallbladder

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3
Q

What is RLQ pain that radiates to the right shoulder?

A

Appendicitis or Ectopic pregnancy

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4
Q

What is LLQ pain that radiates to the left shoulder?

A

Diverticulitis

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5
Q

What two common ER conditions have improved symptoms when lying flat?

A
  1. Appendicitis

2. Peritonitis

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6
Q

What condition in the ER does not show any improvement regardless of positioning?

A

Testicular torsion, orchitis

really anything wrong down there is very uncomfortable

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7
Q

What is a common finding on PE for aortic dissection?

A

Unequal femoral pulses

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8
Q

What is suspected when there is “pain out of proportion to the exam”?

A

Mesenteric Ischemia

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9
Q

Necrosis during appendicitis allows these two organisms to grow.

A
  1. Bacteroides f.

2. E. coli

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10
Q

Diagnostic procedure of choice for appendicitis.

A

CT scan

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11
Q

Triad associated with acute cholecystitis.

A

Fat
Fertile
Forty

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12
Q

What are the characteristics of black vs. brown gall stones?

A

Black: hemolysis, in gallbladder
Brown: infection, in ducts

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13
Q

Two best tests to diagnose cholecystitis.

A
  1. CT

2. Ultrasound

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14
Q

Two most common causes of small bowel obstruction.

A
  1. Adhesions (scar tissue from previous surgery)

2. Hernias

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15
Q

Leading cause of large bowel obstruction.

A

Carcinoma

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16
Q

How does large bowel obstruction appear on X-ray?

A

Dilated bowel with flat lines indicating air-fluid levels within the colon

17
Q

What is Ogilvie Syndrome?

A

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.

18
Q

How does a low fiber diet lead to diverticulosis?

A

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”.

19
Q

In patients suspected to have diverticulitis, what is important to avoid?

A

Barium enema and colonoscopy due to risk of perforation.

20
Q

Red current jelly stool.

Sausage-shaped mass on palpation

A

Intussusception

21
Q

Best diagnostic tool for intussusception and treatment.

A

Ultrasound

Treatment: barium enema, water enema, air enema
Surgery if recurrence happens

22
Q

Bacteria associated with MALT B lymphomas

A

H. pylori

23
Q

What can indicate a perforated peptic ulcer on X-ray.

A

Air under the diaphragm

although 40% do not show this

24
Q

What is Cullen Sign and Grey Turner sign?

A

CS: umbilical ecchymosis (small bruises)
GTS: flank ecchymosis

Both indicate acute pancreatitis

25
Q

Most common cause of pancreatitis

A

Alcohol

gall stones is #2

26
Q

Name and describe the worst complication of acute pancreatitis.

A

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

27
Q 
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
A 
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
28
Q

Name and describe the two types of mesenteric ischemia/infarction.

A

Arterial:

  1. occlusive - embolus or thrombus occluding SMA
  2. Non-occlusive - low flow state

Venous:
Mesenteric venous thrombus

29
Q

Most common situation when patients present with Mesenteric ischemia.

A

2-3 hrs. after a triple bypass heart surgery.

30
Q

Name and describe the 3 phases of Mesenteric Ischemia.

A
  1. Hyperactive: increased bowel sounds, bloody stool, abdominal pain
  2. Paralytic: absent bowel sounds, increased abdominal pain
  3. Shock: fluids leak thru damaged colon lining, acidosis, dehydration, confusion, hypotension, tachycardia

GI Exam 3 (11 decks)

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