GI emergencies/acute abdomen COPY Flashcards
GI emergencies can either be _____ or ______
bleeding or pain
important causes of acute abdomen are ____ or _____, both of which are potentially life threatening!
perforation, obstruction
what is the most frequently mentioned reason for patients visiting the ED?
abdominal pain
ER patient with abdominal pain: ___% will need a surgical procedure
15-30%
higher if elderly
when thinking through a patient with belly pain, one major consideration is what?
the anatomy!
always consider ____ for any pain waist to chin
MI
what things may cause abd. pain radiating to the back?
this pain is near the peritoneum..
diaphragmatic irritiation, cholecystitis, pancreatitis, gastritis/PUD, painful reflux
itussusception happens to pt at what age?
children under 2 years old
boy, <2yo with BAD intermittent abdominal pain, likely has?
intussusception
intussusception causes what characteristic symptoms?
bad intermittent abd pain, screaming, abd distension, vomitting, current jelly stools
intussesception pain may be what type of pain?
ischemic or from obstruction
what causes intusesception?
worms (parasites), idiopathic
what is intussesception?
telescoping of part of the gut into another part- often ileum into the cecum
what four things must you consider in post-pubertal girls with abd pain?
ruptured ectopic, twisted ovary, PID (pelvic inflammatory disease), endometriosis
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?
common: IBS
cyclic: endometriosis
recurrent but not with eating: occult cholecystitis
most common surgical Dx for adults with abd pain
appendicitis, cholecystitis, bowel obst., perforated ulcer, pancreatitis
at what age ranges do people generally get appendicitis?
adolescent and adult (younger than 50)
how does appendicitis present?
epigastric pain migrating to RLQ, anorexia, SIGNS OF PERITONEAL IRRITATION (rebound tenderness, referred tenderness)
rebound tenderness and referred tenderness are signs of what?
peritoneal irritation
cough pain is a sensitive way to note _____ without putting the patient through testing.
rebound tenderness
appendicitis is a ____ Dx but …
clinical Dx but most surgeons will want imaging before surgery.
nonoperative txt option increasingly for ______ appendices
non-perforated
*perforated will ALWAYS need surgery
positive CT finding of appendicitis shows…
thickened appendix and cecum wall
peptic ulcer- how does it present?
eipgastric pain that comes and goes, night pain awakening, melena
peptic ulcer: if its perforated what will that cause? What txt will this need?
unrelenting pain that radiates to back, free air under diaphragm.
txt: surgery and Abx for anaerobes
what are the 5 Fs for? what are they?
Cholelithiasis (biliary tract disease)
fat, forty, female, fertile, flatulent
Dx for cholelithiasis
US
cholelithiasis: emergent when…
fully obstructing or severe cholecystitis
* will require surgery
what is pain with biliary tract disease like?
crampy/colicky, RUQ, triggered with eating
acute pancreatitis is usually caused by ____ for males and ____ for females?
alcohol- males
gallstones- females
labs for acute pancreatitis show what?
elevated lipase and amylase (lipase more indicative)
txt for acute pancreatitis
these patients are VERY SICK.
NPO, pain control
- surgery generally avoided
ureteral colic presents in who? what symptoms?
middle-aged men, acute onset FLANK PAIN, radiates to groin, cant lie still- writhing in pain.
acute pancreatitis pt vs ureteral colic pt
ureteral colic: writhing in pain
acute pancreatitis: in pain, can’t move
perforated viscus is usually from what? what are the risk factors? what is perforated viscus?
peritonitis (inflammation of peritoneum)
risk factors: PUD, diverticulitis, mesenteric ischemia
it is direct spillage of luminal contents into peritoneum
symptoms of perforated viscus
tachycardia, diffuse guarding, rebound–> board like rigid abdomen.
perforated viscus is most dangerous if…
air under the diaphragm! send to OR!
what is an intestinal obstruction? what is it usually a consequence of?
failure of passage of intestinal contents, usually from mechanical obstruction or adynamic ileus (when gut stops contracting)
1 cause of obstruction
adhesions from surgery
tumors, intussusception and volvulus can all cause?
obstruction
what is a volvulus? who does this usually happen to?
generally referring to a sigmoid volvulus (most common)- sigmoid gets tangled up. usually happens in older people b/c the sigmoid elongates with age.
proximal volvulus vs distal volvulus: what are the symptoms?
proximal- vomiting
distal- distention and pain
intestinal obstructions happen to what age groups?
infants (intussusception) and elderly (volvulus)
obstructions with adhesions, hernias, masses, abscesses in the elderly… what should you think about?
cancer!
obstruction xray imaging will show what?
xray: air/fluid levels and bowel loops
what can you txt a volvulus with?
barium enema- it helps unwrap it. ( a shorterm fix)
surgery (a longterm fix)
“beaked” appearance of rectosigmoid junction on a barium enema indicates what?
sigmoid volvulus
symptoms of volvulus
crampy abd pain that comes and goes, constipation high-pitched bowel sounds
vomiting or distention (depending on proximal vs distal location)
intestinal ischemia from volvulus can lead to … (Weeds)
intestinal ischemia leading to edema, petechial hemorrhages, necrosis, gangrene, perforation.
best imaging for volvulus? what do you see?
CT- shows mural edema, necrosis as obstruction persists (bowel wall thickening- means ischemia)
if theres a perf you see free air
xray of obstruction/volvulus may show what kind of pattern?
“stair-step” of gas-filled loops
what do you need for Dx of obstruction?
symptoms plus suggestive imaging
small bowel is responsible for ___% of ___ Abs. why is this significant for obstructions?
90% of H2O abs.
why small bowel obstruction can be HIGHLY lethal
stretching of the small intestine wall reduces _____ and ______ into the bloodstream
reduces flux of water and ions into the bloodstream.
less absorbption
txt for small bowel obstruction
- volume and electrolyte replacement (monitored closely)
- decompression with N/G tube
- close observation
- probably surgery
who presents with leaking AAA (abd. aortic aneurysm)
med with CVD risk
how does leaking AAA present?
asymptomatic till rupture then TEARING bad pain, can radiate all over trunk. on exam you can usually feel the pulsatile mass
Dx for leaking AAA
US imaging
significant belly pain in the ____ is rarely benign
ELDERLY!
how does mesenteric ischemia present?
SEVERE pain, otherwise unimpressive PE
normally elderly maybe with atherosclerotic disease
pain out of proportion to the exam in an older person is ____ until proven otherwise
VASCULAR- (MI or mesenteric ischemia)
what is diverticulitis?
pouches off the colon that can become infected, inflamed and bleed
painless rectal bleeding? think…
diverticulitis!
fever, even if low, could mean bad things like…
appendicitis or cholecystitis
- fever can be deceiving especially in older pts
lipase labs for what?
pancreas issues
best imaging for abd pain
US
(Xray, CT, other radiology are only good if other things are positive)
CT good for appendicitis Dx and pre-surgery
_____ has reduced surgeries on normal appendices
CT scan
