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Medical Emergencies > GI emergencies > Flashcards

GI emergencies Flashcards

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USMLE® Step 1 flashcards
1
Q

objectives

A
  • understand the anatomy of the abdomen
  • identify common and emergent causes of abdominal pain
  • develop an approach to abdominal pain
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2
Q

lower right quad pain

A

-appendix pain

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3
Q

introduction

A

-complicated anatomy
-diverse
-presentations
-what do we care about?
-abdomen contains multiple organ systems
-complicates assessment, diagnosis, and ultimately treatment
-consider life threats and to use history and assessment skills to sort through the disorders.
Introduction
-The abdomen contains multiple organ systems:
-Vascular
-Digestive
-Renal
-Reproductive
-This complicates assessment, diagnosis and ultimately treatment

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4
Q

associated symptoms

A
  • because the abdomen is so complex and often presents in conjunction with other cardinal presentations, it is often useful to direct the assessment using the following:
  • abdominal pain or discomfort with:
  • unstable vital signs
  • gastrointestinal bleeding
  • nausea and vomiting
  • diarrhea
  • jaundice
  • vaginal bleeding
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5
Q

anatomy

A
  • Anatomy can direct you to the problem.
  • Location of the pain often correlates to the involved organ.
  • Know your surface anatomy landmarks:
  • What are these landmarks indicative of?
    • ASIS (dont need to know)
    • umbilicus * -> appendix
    • costal margin
    • McBurney’s point
    • borders/names of quadrants and regions
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6
Q

abdominopelvic regions

A
  • right upper quad
  • left upper quad
  • right lower quad
  • left lower quad
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7
Q

McBurneys point

A
  • most common location for the base of the appendix

- look at picture on slides

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8
Q

clinical questions

A
  • where is the pain
  • what else is going on
  • who is the patient
  • any associated symptoms
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9
Q

referred pain

A
  • abdominal pain -> referred pain

- spleen pain -> spleen is in left upper quad BUT the pain is in left shoulder

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10
Q

spleen

A
  • well protected
  • uncommon to have splenic injury unless traumatic
  • spleen in in upper left quadrant but referred pain in the left shoulder
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11
Q

scenario 1

A
  • 40 year old female with abdominal pain
  • vomiting
  • going to bathroom
  • sick but no life threat
  • tachypnea at 24
  • 144/76
  • 110 pulse
  • sudden onset
  • pain started in epigastric area, now in right upper quadrant that radiates to the right shoulder
  • nothing makes it worse or better
  • constant
  • pregnant
  • 99 temp
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12
Q

right upper quadrant

A
  • gal bladder

- liver

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13
Q

acute cholecystitis

A
  • biliary stasis bile levels arnt being secreted properly
  • leads to wall thickening
  • common in pregnant females
  • pregnant women are at risk for developing due to biliary stasis
  • older patients are also at greater risk
  • stones
  • pain begins in the epigastric area and migrates to the right upper quad
  • pain may be crampy initially and then becomes constant
  • pain may radiate to right scapula
  • peritoneum may become irritates causing peritoneal signs and symptoms
  • positive murphy sign is present*
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14
Q

murphy sign

A
  • while palpating the right subcostal region, have the patient take a deep breath
  • if the patient stops inhaling or complains of pain during the breath, the test is positive
  • detects acute cholecystitis
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15
Q

acute cholecystitis management

A
  • support airway- have suction available, vomiting is common
  • oxygen
  • IV fluid
  • position of comfort
  • antiemetics
  • analgesics
  • sonogram at the facility
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16
Q

scenario 2

A
  • 38 year old man
  • abdominal pain intermittently for past 4 day getting progressively worse
  • 18 bpm
  • lung crackles in lower left lobe on auscultation
  • 108 pulse
  • sudden onset
  • aches
  • left upper quad pain radiates into back
  • cant eat
  • partying, alcoholism
  • 100.3 temp
  • 144/92
  • rales
  • > pancreatitis
17
Q

pancreatitis

A
  • pain usually begins in the epigastric area or upper left upper quad
  • may come on suddenly or gradually
  • pain is described as going through the body to the back, not around the body
  • abdomen is usually distended with rigidity and guarding
18
Q

pancreatitis risk factors

A
  • there is a higher frequency in african american, white, and native american males, in that order
  • history of alcoholism is the number one risk
  • onset after binge consumption is common
  • ingestion of alcohol can be recent or within several days
  • 40% of people with gallstones can have pancreatitis
  • 30% of alcoholics can have pancreatitis
19
Q

grey turner sign and Cullen sign may be present due to hemorrhagic pancreatitis

A
  • pain usually begins in the epigastric area or upper left quad
  • pain may come on suddenly or gradually
  • pain is described as going through the body to the back, not around the body
  • abdomen is usually distended with rigidity and guarding
  • grey turner sign and cullen sign may be present due to hemorrhagic pancreatitis
20
Q

ongoing management of pancreatitis

A
  • pancreatitis may be life threatening, so be prepared to support ABCs
  • support airway- have suction available as vomiting may occur
  • NPO- sometimes
  • oxygen
  • IV fluid- crystalloids or blood if hemorrhage present
  • pain medication (fentanyl or dilaudid)
21
Q

scenario 3

A
  • 60 year old female
  • abdominal pain for past couple hours
  • lower left quad
  • moderate distress
  • 14 bpm
  • 98 pulse
  • onset gradual
  • no radiation
  • diarrhea with some bright red bleeding
  • 100.4
  • 98
  • 132/82
  • respiration 14
  • 97%
  • > sigmoid diverticulitis
22
Q

sigmoid diverticulitis

A
  • inflammation of the diverticula (pouches that have developed in the bowel)
  • usually localized to the lower left quad
  • often severe, may be present for several
  • change in bowel habits
  • bleeding may be present
  • urinary symptoms (may also be present ex. pain with urination
  • fever is common due to inflammation
  • peritonitis may be present
  • a mass may be palpated if an abscess develops
  • CT may be used to confirm disease and severity
23
Q

sigmoid diverticulitis risk factors

A
  • -diverticulosis
  • NSAID use
  • lower fiber use
  • chronic constipation
  • elderly
  • most commonly presents with lower left quad pain
24
Q

summary

A
  • The abdomen contains multiple organ systems.
  • This complicates assessment, diagnosis, and ultimately treatment.
  • The key is to consider life threats and to use history and assessment skills to sort through the disorders.
25
Q

ongoing management of sigmoid diverticulitis

A
  • IV fluid- crystalloids or blood is hemorrhage is present
  • pain medication
  • antibiotics?
  • Support airway – have suction available as vomiting may occur
  • Oxygen
  • Diverticulitis is often managed with antibiotics on an outpatient status if not severe or the patient does not have comorbid conditions

Medical Emergencies (16 decks)

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