EXAM #3: ACUTE ABDOMEN

Question 1

How is the nine quadrant view of the abdominal anatomy organized?

Answer 1

Around the neurovascular supply

Question 2

What type of sensation is associated with the midline of the abdomen?

Answer 2

Visceral

Question 3

What type of sensation is associated with the lateral regions of the abdomen?

Answer 3

Somatic

Question 4

What organs are supplied by the celiac trunk?

Answer 4

Distal esophagus to Ligament of Treitz

Question 5

What organs are supplied by the IMA?

Answer 5

Mid-transverse colon to rectum

Question 6

What artery supplies the organs between the Ligament of Treitz and mid-transverse colon?

Answer 6

SMA

Question 7

What organs are supplied by the celiac plexus?

Answer 7

Distal esophagus to Ligament of Treitz

Question 8

What organs are supplied by the inferior mesenteric plexus?

Answer 8

Mid-transverse colon to rectum

Question 9

What organs are supplied by the superior mesenteric plexus?

Answer 9

Distal esophagus to Ligament of Treitz

Question 10

Are peritoneal signs somatic or visceral?

Answer 10

Somatic

Question 11

For a patient with appendicitis, what is the utility of a WBC count?

Answer 11

• 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

Question 12

How do you manage a patient with acute appendicitis in the ED prior to surgery?

Answer 12

1) Fluids
2) Pain meds
3) NPO

Question 13

What should be high on your differential for a female with RLQ pain?

Answer 13

Ectopic pregnancy

Question 14

What is the normal relationship between the psoas and the appendix?

Answer 14

Appendix just just over the right psoas muscle–> positive psoas sign

Question 15

Why is acute appendicitis pain normally periumbilical initially?

Answer 15

Superior mesenteric plexus visceral pain

Question 16

How would you describe a patient that is thrashing on the bed with abdominal pain?

Answer 16

Colic–> indicates obstruction

Question 17

What is a sign that a child is doing well with medical GI complaint in the ED?

Answer 17

Tolerating PO fluids

Question 18

What is the hallmark of ischemic colitis?

Answer 18

Pain out of proportion to exam

Question 19

What do most patients who develop ischemic colitis have?

Answer 19

Underlying vascular disease

Question 20

What is a classic symptom with ischemic colitis?

Answer 20

Pain worsened by eating

Question 21

How do you treat ischemic colitis?

Answer 21

1) Bowel rest
2) Analgesia
3) Fluids
4) NPO

Question 22

Why is BUN elevated in excess of creatinine in SBO?

Answer 22

Dehydration

Question 23

Why would you NOT give Ketorlac in SBO?

Answer 23

Decreases renal perfusion

Question 24

What is the treatment for a SBO?

Answer 24

1) Fluids- LR
2) Analgesia (morphine)
3) Antiemetic–prochloperazine
4) NG tube
5) Admit to surgery