GI case

Question 1

carnett sign

Answer 1

-differentiate abdominal pain from pain in ab wall from ab viscera; contract abd wall

Question 2

cough test

Answer 2

-used to check for peritonitis/inguinal hernia; increase in pain with cough

Question 3

closed eye sign

Answer 3

-pts w/ true abd path tend to have their eyes open and watch the docs hands at palpation

Question 4

murphy’s sign

Answer 4

check for cholecystitis; painful arrest of inspiration w/ palpation

Question 5

psoas sign

Answer 5

check for retrocecal appendicitis; hyperextend the hip

Question 6

obturator sign

Answer 6

check for retrocecal appendicitis; internally rotate hip, ankle turned out

Question 7

rovsing sign

Answer 7

check for appendicitis, press on LLQ and look for pain in RLQ

Question 8

prevalence of abdominal pain in ER

Answer 8

• 7% of ER visits (btwn 5-10%)

- leading reason for ER visits across all age groups

Question 9

life threatening abdominal emergencies

Answer 9

-AAA rupture, perforated GI, volvulus, acute bowel obstruction, mesenteric ischemia, ectopic pregnancy, abruption, MI, splenic rupture

Question 10

common clinical conditions causing abdominal pain

Answer 10

-Constipation, gastroenteritis, GERD, IBS, kidney stones, flu, rota/nora virus, food allergies, lactose intolerance, menstrual cramps, pancreatitis, sickle cell anemia (spleen rupture), pregnancy

Question 11

labs

Answer 11

-bHCG, LFTs, Amylase/Lipase, CBC

Question 12

abdominal imaging

Answer 12

• CT test of choice for abdominal pain (don’t pick MRI!!, not cost effective)
• US for obstetric problems; initial study of choice for AAA & GB disease, stones, appendix, easy, quick, cheap (; not good for free air/perforation or retroperitoneal bleed

Question 13

ER drugs–racism?

Answer 13

• race plays a role in ER distribution of pain meds

- whites are 1.8x more likely to receive opioids in the ER compared to blacks

Question 14

acute abdomen

Answer 14

• acute severe abdominal pain demonstrating rebound and guarding w/ abnormal vitals, often elevated HR, abnormal BP, and fever
• surgical emergency

Question 15

Acute Nonspecific Abdominal Pain (NSAP)

Answer 15

• early lap did not show clear benefit in women w/ NSAP
• led to reduction of recurrences in 3 mo but not by 1 year
  
  • no significant difference in cost

Question 16

adhesions

Answer 16

• Fibrous bands that form between tissues and organs often in response to damage (surgical, inflammation, etc.) Can often adhere typically unconnected tissues to one another