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clin med > GI emergencies/acute abdomen > Flashcards

GI emergencies/acute abdomen Flashcards

1
Q

GI emergencies can either be _____ or ______

A

bleeding or pain

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2
Q

important causes of acute abdomen are ____ or _____, both of which are potentially life threatening!

A

perforation, obstruction

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3
Q

what is the most frequently mentioned reason for patients visiting the ED?

A

abdominal pain

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4
Q

ER patient with abdominal pain: ___% will need a surgical procedure

A

15-30%

higher if elderly

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5
Q

when thinking through a patient with belly pain, one major consideration is what?

A

the anatomy!

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6
Q

always consider ____ for any pain waist to chin

A

MI

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7
Q

what things may cause abd. pain radiating to the back?

A

this pain is near the peritoneum..

diaphragmatic irritiation, cholecystitis, pancreatitis, gastritis/PUD, painful reflux

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8
Q

itussusception happens to pt at what age?

A

children under 2 years old

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9
Q

boy, <2yo with BAD intermittent abdominal pain, likely has?

A

intussusception

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10
Q

intussusception causes what characteristic symptoms?

A

bad intermittent abd pain, screaming, abd distension, vomitting, current jelly stools

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11
Q

intussesception pain may be what type of pain?

A

ischemic or from obstruction

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12
Q

what causes intusesception?

A

worms (parasites), idiopathic

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13
Q

what is intussesception?

A

telescoping of part of the gut into another part- often ileum into the cecum

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14
Q

what four things must you consider in post-pubertal girls with abd pain?

A

ruptured ectopic, twisted ovary, PID (pelvic inflammatory disease), endometriosis

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15
Q

nonspecific abdominal pain with benign exam, what could be a common cause? what if its cyclic in a female? recurrent but doesn’t come with eating?

A

common: IBS
cyclic: endometriosis
recurrent but not with eating: occult cholecystitis

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16
Q

most common surgical Dx for adults with abd pain

A

appendicitis, cholecystitis, bowel obst., perforated ulcer, pancreatitis

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17
Q

at what age ranges do people generally get appendicitis?

A

adolescent and adult (younger than 50)

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18
Q

how does appendicitis present?

A

epigastric pain migrating to RLQ, anorexia, SIGNS OF PERITONEAL IRRITATION (rebound tenderness, referred tenderness)

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19
Q

rebound tenderness and referred tenderness are signs of what?

A

peritoneal irritation

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20
Q

cough pain is a sensitive way to note _____ without putting the patient through testing.

A

rebound tenderness

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21
Q

appendicitis is a ____ Dx but …

A

clinical Dx but most surgeons will want imaging before surgery.

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22
Q

nonoperative txt option increasingly for ______ appendices

A

non-perforated

*perforated will ALWAYS need surgery

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23
Q

positive CT finding of appendicitis shows…

A

thickened appendix and cecum wall

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24
Q

peptic ulcer- how does it present?

A

eipgastric pain that comes and goes, night pain awakening, melena

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25
Q

peptic ulcer: if its perforated what will that cause? What txt will this need?

A

unrelenting pain that radiates to back, free air under diaphragm.
txt: surgery and Abx for anaerobes

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26
Q

what are the 5 Fs for? what are they?

A

Cholelithiasis (biliary tract disease)

fat, forty, female, fertile, flatulent

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27
Q

Dx for cholelithiasis

A

US

28
Q

cholelithiasis: emergent when…

A

fully obstructing or severe cholecystitis

* will require surgery

29
Q

what is pain with biliary tract disease like?

A

crampy/colicky, RUQ, triggered with eating

30
Q

acute pancreatitis is usually caused by ____ for males and ____ for females?

A

alcohol- males

gallstones- females

31
Q

labs for acute pancreatitis show what?

A

elevated lipase and amylase (lipase more indicative)

32
Q

txt for acute pancreatitis

A

these patients are VERY SICK.
NPO, pain control
- surgery generally avoided

33
Q

ureteral colic presents in who? what symptoms?

A

middle-aged men, acute onset FLANK PAIN, radiates to groin, cant lie still- writhing in pain.

34
Q

acute pancreatitis pt vs ureteral colic pt

A

ureteral colic: writhing in pain

acute pancreatitis: in pain, can’t move

35
Q

perforated viscus is usually from what? what are the risk factors? what is perforated viscus?

A

peritonitis (inflammation of peritoneum)
risk factors: PUD, diverticulitis, mesenteric ischemia
it is direct spillage of luminal contents into peritoneum

36
Q

symptoms of perforated viscus

A

tachycardia, diffuse guarding, rebound–> board like rigid abdomen.

37
Q

perforated viscus is most dangerous if…

A

air under the diaphragm! send to OR!

38
Q

what is an intestinal obstruction? what is it usually a consequence of?

A

failure of passage of intestinal contents, usually from mechanical obstruction or adynamic ileus (when gut stops contracting)

39
Q

1 cause of obstruction

A

adhesions from surgery

40
Q

tumors, intussusception and volvulus can all cause?

A

obstruction

41
Q

what is a volvulus? who does this usually happen to?

A

generally referring to a sigmoid volvulus (most common)- sigmoid gets tangled up. usually happens in older people b/c the sigmoid elongates with age.

42
Q

proximal volvulus vs distal volvulus: what are the symptoms?

A

proximal- vomiting

distal- distention and pain

43
Q

intestinal obstructions happen to what age groups?

A

infants (intussusception) and elderly (volvulus)

44
Q

obstructions with adhesions, hernias, masses, abscesses in the elderly… what should you think about?

A

cancer!

45
Q

obstruction xray imaging will show what?

A

xray: air/fluid levels and bowel loops

46
Q

what can you txt a volvulus with?

A

barium enema- it helps unwrap it. ( a shorterm fix)

surgery (a longterm fix)

47
Q

“beaked” appearance of rectosigmoid junction on a barium enema indicates what?

A

sigmoid volvulus

48
Q

symptoms of volvulus

A

crampy abd pain that comes and goes, constipation high-pitched bowel sounds
vomiting or distention (depending on proximal vs distal location)

49
Q

intestinal ischemia from volvulus can lead to … (Weeds)

A

intestinal ischemia leading to edema, petechial hemorrhages, necrosis, gangrene, perforation.

50
Q

best imaging for volvulus? what do you see?

A

CT- shows mural edema, necrosis as obstruction persists (bowel wall thickening- means ischemia)
if theres a perf you see free air

51
Q

xray of obstruction/volvulus may show what kind of pattern?

A

“stair-step” of gas-filled loops

52
Q

what do you need for Dx of obstruction?

A

symptoms plus suggestive imaging

53
Q

small bowel is responsible for ___% of ___ Abs. why is this significant for obstructions?

A

90% of H2O abs.

why small bowel obstruction can be HIGHLY lethal

54
Q

stretching of the small intestine wall reduces _____ and ______ into the bloodstream

A

reduces flux of water and ions into the bloodstream.

less absorbption

55
Q

txt for small bowel obstruction

A
  • volume and electrolyte replacement (monitored closely)
  • decompression with N/G tube
  • close observation
  • probably surgery
56
Q

who presents with leaking AAA (abd. aortic aneurysm)

A

med with CVD risk

57
Q

how does leaking AAA present?

A

asymptomatic till rupture then TEARING bad pain, can radiate all over trunk. on exam you can usually feel the pulsatile mass

58
Q

Dx for leaking AAA

A

US imaging

59
Q

significant belly pain in the ____ is rarely benign

A

ELDERLY!

60
Q

how does mesenteric ischemia present?

A

SEVERE pain, otherwise unimpressive PE

normally elderly maybe with atherosclerotic disease

61
Q

pain out of proportion to the exam in an older person is ____ until proven otherwise

A

VASCULAR- (MI or mesenteric ischemia)

62
Q

what is diverticulitis?

A

pouches off the colon that can become infected, inflamed and bleed

63
Q

painless rectal bleeding? think…

A

diverticulitis!

64
Q

fever, even if low, could mean bad things like…

A

appendicitis or cholecystitis

- fever can be deceiving especially in older pts

65
Q

lipase labs for what?

A

pancreas issues

66
Q

best imaging for abd pain

A

US
(Xray, CT, other radiology are only good if other things are positive)
CT good for appendicitis Dx and pre-surgery

67
Q

_____ has reduced surgeries on normal appendices

A

CT scan

clin med (88 decks)

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