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Cam's Cards COPY > Evaluating Abd Pain > Flashcards

Evaluating Abd Pain Flashcards

1
Q

What is the most sensitive physical exam finding for cholecystitis?

A

Murphy’s sign

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2
Q

A patient with RUQ pain has a RUQ US + for gal stones and normal labs. What should you do?

A

Watch and wait. Cholelithiasis is not emergent, but if it becomes cholecystitis, the patient will need surgery.

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3
Q

A patient with RUQ pain has a + RUQ US and abnormal labs. What should you do next?

A

Send to ER if not at the ER, general surgery consult.

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4
Q

What labs should be included in your cholecystitis work up?

A

CBC, CMP (lipase)

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5
Q

Do most patients with cholecystitis have fever?

A

No, only 35%.

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6
Q

What is on your differential diagnosis for epigastric pain?

A

PUD, GERD, esophagitis, gastric/esophageal cancer, biliary disease, gastritis, pancreatitis, medication SE, ACS, AAA.

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7
Q

What are the most common causes of dyspepsia?

A

GERD and PUD make up 40% of cases.

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8
Q

Is the pain from a duodenal ulcer relieved or exacerbated by eating?

A

Relieved

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9
Q

Is the pain from a gastric ulcer relieved or exacerbated by eating?

A

Exacerbated.

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10
Q

What signal nodes may be found on physical exam in gastric cancer?

A

Virchow’s nodes

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11
Q

What signal nodes my be found on physical exam in pancreatic cancer?

A

Sister Mary Joseph nodes

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12
Q

What physical exam finding commonly associated with diabetes can also be a sign of malignancy?

A

Acanthosis nigricans

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13
Q

What is the gold standard test for H. pylori?

A

Urea breath test

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14
Q

What medications must be discontinued prior to H. pylori testing?

A

PPIs for 1-2 weeks prior to testing
Bismuth 4 weeks prior to testing
Antibiotics 4 weeks prior to testing

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15
Q

What is the triple therapy for H. pylori? How effective is it?

A

PPI + clarithromycin 500mg BID x 14 days + amoxicillin 1gm BID x 14 days

It is 75% effective

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16
Q

What is the quadruple therapy for H. pylori?

A

Bismuth + tetracycline 500mg QID + metronidazole 500mg TID + prilosec 20mg BID

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17
Q

How long does it take for most duodenal ulcers to heal?

A

4 weeks

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18
Q

How long does it take for most gastric ulcers to heal?

A

8 weeks

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19
Q

What is the most common cause of prancreatitis?

A

Cholelithiasis (40% of cases)

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20
Q

What lab findings would you expect to see in prancreatitis?

A

Lipase 3x nl
Amylase 3x nl
Leukocytosis 15-20k is not unusual

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21
Q

If a patient has chronic/recurrent pancreatitis, can they be treated at home?

A

If VSS, tolerating PO’s, and pain is controlled, they can go home.

22
Q

Do you need to get a CT on every patient you suspect pancreatitis in?

A

Only if it is their first episode, if concerned for complications.

23
Q

What does outpatient treatment of pancreatitis consist of?

A

Clear liquid diet, pain control.

24
Q

What diagnosis should be considered in all patients with RLQ pain?

A

Appendicitis

25
Q

What diagnosis should be considered in all patients with LLQ pain?

A

Diverticulitis

26
Q

What are the two main concerns of diverticulitis?

A

Abscess and perforation

27
Q

What is the treatment for diverticulitis?

A

Clear liquid, high fiber diet.
Metronidazole 500mg TID x 7-10 days + one of the following: Cipro 500mg BID, levofloxacin 750mg QD, Bactrim DS BID.
Pain control

28
Q

What diagnostic criteria can be used for irritable bowel disease?

A

ROME III or Manning criteria

29
Q

What are the most common complaints in irritable bowel disease?

A

Sensation of incomplete emptying - 70%

Mucous stools - 40%

30
Q

What are the ROME III criteria?

A
  1. Abdominal pain or discomfort accompanied by at least two of the following symptoms 25% of the time.
    a. Improvement of defecation
    b. Onset assoicated with change in frequency of stools.
    c. Onset associated with a change in form of stools.
  2. No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the symptoms.
31
Q

What lab abnormalities are present in irritable bowel disease?

A

None

32
Q

What is the risk of reoccurrence after 1 episode of nephrolithiasis?

A

50% to have another episode. 10% have >3 episodes.

33
Q

What is the gold standard for diagnosis of nephrolithiais?

A

CT abd/pelvis without contrast

34
Q

What percentage of stones can be identified on KUB XR?

A

60%

35
Q

What medications are indicated for pain control for nephrolithiasis?

A

NSAID’s, Toradol IM (CHECK RENAL FUNCTION BEFORE GIVING TORADOL)

36
Q

What must you rule out in a patient with kidney stones?

A

UTI (Infected stone)

37
Q

What size of stones will not pass?

A

> 10mm

38
Q

What medication can help pass stones?

A

Alpha blocker (flomax/tamsulosin)

39
Q

What medication can help pass stones?

A

Alpha blocker (flomax/tamsulosin)

40
Q

What is the most common cause of small bowel obstructions?

A

Adhesions

41
Q

What would be found on percussion of the abdomen in a small bowel obstruction?

A

Tympany

42
Q

What would be found on percussion of the abdomen in a small bowel obstruction?

A

Tympany

43
Q

What are bowel sounds like initially in a small bowel obstruction?
What are they like late in a small bowel obstruction?

A

Initially: High pitched, hyperactive
Late: Hypoactive or absent

44
Q

What are bowel sounds like initially in a small bowel obstruction?
What are they like late in a small bowel obstruction?

A

Initially: High pitched, hyperactive
Late: Hypoactive or absent

45
Q

What imaging is most sensitive for small bowel obstruction?

A

CT abd/pel with contrast

46
Q

If you suspect small bowel obstruction in a patient who has mild symptoms and stable vital signs, what imaging would you order?

A

KUB

47
Q

What is the treatment for a small bowel obstruction?

A

NPO
NG tube for decompression
Surgery

48
Q

What is the treatment for a small bowel obstruction?

A

NPO
NG tube for decompression
Surgery

49
Q

How far along into gestation do symptoms of ectopic pregnancy start?

A

Around 7 weeks gestation

50
Q

What imaging should be ordered if ectopic pregnancy is considered?

A

Transvaginal US

51
Q

What are bowel sounds like initially in a small bowel obstruction?
What are they like late in a small bowel obstruction?

A

Initially: High pitched, hyperactive
Late: Hypoactive or absent

Cam's Cards COPY (93 decks)

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