EXAM #3: ACUTE ABDOMEN Flashcards
How is the nine quadrant view of the abdominal anatomy organized?
Around the neurovascular supply
What type of sensation is associated with the midline of the abdomen?
Visceral
What type of sensation is associated with the lateral regions of the abdomen?
Somatic
What organs are supplied by the celiac trunk?
Distal esophagus to Ligament of Treitz
What organs are supplied by the IMA?
Mid-transverse colon to rectum
What artery supplies the organs between the Ligament of Treitz and mid-transverse colon?
SMA
What organs are supplied by the celiac plexus?
Distal esophagus to Ligament of Treitz
What organs are supplied by the inferior mesenteric plexus?
Mid-transverse colon to rectum
What organs are supplied by the superior mesenteric plexus?
Distal esophagus to Ligament of Treitz
Are peritoneal signs somatic or visceral?
Somatic
For a patient with appendicitis, what is the utility of a WBC count?
- Mild leukocytosis (with a left shift) is common in acute appendicitis
- It is uncommon to have a normal white count in appendicitis, except in early appendicitis
*Note that this is NOT a perfect test
How do you manage a patient with acute appendicitis in the ED prior to surgery?
1) Fluids
2) Pain meds
3) NPO
What should be high on your differential for a female with RLQ pain?
Ectopic pregnancy
What is the normal relationship between the psoas and the appendix?
Appendix just just over the right psoas muscle–> positive psoas sign
Why is acute appendicitis pain normally periumbilical initially?
Superior mesenteric plexus visceral pain
How would you describe a patient that is thrashing on the bed with abdominal pain?
Colic–> indicates obstruction
What is a sign that a child is doing well with medical GI complaint in the ED?
Tolerating PO fluids
What is the hallmark of ischemic colitis?
Pain out of proportion to exam
What do most patients who develop ischemic colitis have?
Underlying vascular disease
What is a classic symptom with ischemic colitis?
Pain worsened by eating
How do you treat ischemic colitis?
1) Bowel rest
2) Analgesia
3) Fluids
4) NPO
Why is BUN elevated in excess of creatinine in SBO?
Dehydration
Why would you NOT give Ketorlac in SBO?
Decreases renal perfusion
What is the treatment for a SBO?
1) Fluids- LR
2) Analgesia (morphine)
3) Antiemetic–prochloperazine
4) NG tube
5) Admit to surgery
