GI Emergencies- Ross

Question 1

Every elderly patient with abdominal pain needs what test?

Answer 1

EKG

Question 2

7 wks after her last menses, a 32 y/o woman presents with abd pain and vaginal bleeding. in addition to bhcg, which of the following is the preferred test to dx ectopic pregnancy?

a. MRI of pelvis
b. culdocentesis
c. abdominal u/s
d. transvaginal u/s

Answer 2

d. transvaginal u/s

Question 3

Rectal pain is referred from where?

Answer 3

Referred from the appendix

Question 4

Left shoulder pain is referred from where?

Answer 4

pancreatitis

Question 5

Right shoulder pain is referred from where?

Answer 5

duodenal ulcer

Question 6

What are peritoneal signs?

Answer 6

Irritation of the peritoneum

• rebound
• guarding
• rigidity
• referred rebound

Question 7

Women of child bearing age need what type of exam?

Answer 7

pelvic

Question 8

A patient with back pain and syncope and signs of shock may have this emergent condition?

Answer 8

AAA

Abdominal aorta will be >5cm

Question 9

What lab level will be elevated in mesenteric ischemia?

Answer 9

Lactate

Question 10

What is the TOC for mesenteric ischemia?

Answer 10

Surgical resection

Question 11

Folks with peritoneal sings, abnormal vitals and the elderly all need what type of imaging?

Answer 11

CT scan

Question 12

Name bugs that cause bloody diarrhea?

Answer 12

• Salmonella
• Shigella
• Yersinia
• C. Diff
• Enterohemorrhagic E. coli
• Campylobacter
• Listeria and vibro species

Question 13

Classic presentation of this disease is umbilical pain that migrates to RLQ over a time period of hours.

Answer 13

acute appendicitis

Question 14

Pain that precedes vomiting typically requires _______

Answer 14

surgery

Question 15

If you suspect acute appendicitis, what is the best choice of imaging in adults?

Answer 15

CT

Question 16

If you suspect acute appendicitis, what is the best choice of imaging in peds?

Answer 16

U/S of RLQ

Question 17

What are physical exam findings you can try to use to dx appendicitis?

Answer 17

• Psoas sign
• obturator sign
• Rovsing sign

Question 18

How do you dx mesentary ischemia?

Answer 18

Abdominal CT

Question 19

Labs for mesenteric ischemia show __________ and ________

Answer 19

leukocytosis and metabolic acidosis (need lactate levels)

Question 20

How should you treat mesenteric ischemia?

Answer 20

with aggressive resuscitation with fluids and antibiotics and early surgical evaluation.

Question 21

Ileus is the mc cause for what?

Answer 21

Small bowel obstruction

Question 22

Abdominal exam of ileus will have _________ bowel sounds and mild tenderness

Answer 22

hypoactive

Question 23

Patients have diffuse abdominal pain, distention and sometimes vomiting. There is decreased peristaltic motion and there are hyperactive bowel tinkling sounds

Answer 23

mechanical obstruction of bowel

Question 24

How to dx mechanical bowel obstruction?

Answer 24

CT

Question 25

How do you treat a mechanical bowel obstruction?

Answer 25

Replace electrolytes, fluids and decompress stomach with gastric tube (debatable). All will need admission with a surgical consult.

Question 26

A slow onset of pain for 1-2 days. It is diffuse and non-specific but will eventually go to LLQ.

Answer 26

Diverticulitis

Question 27

Mc area for diverticulitis?

Answer 27

descending and sigmoid colon

Question 28

What is the dx procedure of choice for diverticulitis?

Answer 28

A CT scan with IV contrast is the diagnostic procedure of choice especially with a first presentation.

Question 29

If you suspect diverticulitis in a patient who has already had a negative CT a month ago for the same thing, do you need to re-CT?

Answer 29

No, do not need repeat ct for every bout of diverticulitis. Obtain when you suspect a perforation or abscess.

Question 30

Treatment for diverticulitis?

Answer 30

abx and pain management

Question 31

The __________ __ ______ defines upper and lower bleeds?

Answer 31

Ligament of Treitz

Question 32

What type of blood would be in an upper GI bleed (vomit)?

Answer 32

vomiting blood or coffee ground is called hematemesis

Question 33

If melanotic, stools consider bleeding from _______ GI source. What dx should you consider?

Answer 33

upper, pud w/ perforation or esophageal varices

Question 34

If you are unsure if pt is bleeding or a mallory weiss tears, what tests should you run?

Answer 34

consider cbc, and orthostatic vitals as well as a stool guaiac and NG tube.

Question 35

If patients are actively vomiting blood, have abnormal vitals, what tests should you consider?

Answer 35

Consider 2 IV’s and fluid resuscitation, may need blood transfusion as well.

Question 36

what color blood do lower GI bleeds have?

Answer 36

bright red or hematochezia

Question 37

If you suspect a lower GI bleed, what should you do on physical exam?

Answer 37

. On physical exam you should directly visualize the anus to look for hemorrhoids, consider anoscopy.

Question 38

If you suspect a lower GI bleed, what should you do on physical exam?

Answer 38

On physical exam you should directly visualize the anus to look for hemorrhoids, consider anoscopy.

Question 39

Internal and external hemorrhoids both present as what?

Answer 39

BRBPR

Question 40

What lab test are we looking for elevation in in pancreatitis?

Answer 40

Lipase elevated x 2-3 times

Question 41

For acute pancreatitis, what treatment do most patients need?

Answer 41

pt need CT with IV contrast as well as aggressive fluid resuscitation.

Question 42

What are cullen's and grey turner's signs?

Answer 42

signs are manifestation of severe panreatitis (hemorrhagic) They are superficial edema and bruising around the umbilicus

Question 43

What should you AVOID in children with bloody diarrhea bc increased risk of HUS?

Answer 43

avoid antibiotics

Question 44

What is a sign when a patient states that cold things feel hot and hot things feel cold?

Answer 44

Could be a ciguatera toxin from coral fish Supportive tx, no therapy needed

Question 45

What is Ranson's criteria?

Answer 45

Decide if the patient has gallstone pancreatitis and determine the mortality - WBC > 16k. Yes. +1. - Age > 55. Yes. +1. - Glucose >200 mg/dL (>10 mmol/L) Yes. +1. - AST > 250. Yes. +1. - LDH > 350. Yes. +1. Anything greater than 3 = pancreatitis likely

Question 46

Initial treatment for pancreatitis?

Answer 46

Fluid hydration

Question 47

What are two physical exam findings of appendicitis?

Answer 47

rovsing and mcburney sign

Question 48

For an impacted food bolus, what two things can you try?

Answer 48

glucagon and nitrates

Question 49

Patients who have impaction and drooling need what ASAP?

Answer 49

Endoscopy

Question 50

Does a reducible hernia need any type of management?

Answer 50

little to no management except for pain. Consider outpatient referral to surgery if it impacts the person’s lifestyle. If you are unsure you can obtain a US.

Question 51

Is a strangulated hernia reducible?

Answer 51

A strangulated hernia is not reducible, has no further blood supply and is necrotic, must be taken out.

Question 52

What labs should you order when trying to decide between strangulated or no strangulated hernia?

Answer 52

Consider ordering labs; cbc, lactate (very high when there is necrotic tissue) and cmp to assist in that determination. Either disease process will need a CT of the abdomen with IV contrast and a surgical consult.

Question 53

When there is necrotic tissue, _______ will be high

Answer 53

lactate

Question 54

This condition is common in children and is usually post viral infection and due to swollen lymph tissue (peyer’s patches)

Answer 54

Intussusception

Question 55

A typical presentation of currant jelly stool leads you to what dx?

Answer 55

Intussusception

Question 56

What is the diagnosis and treatment of Intussusception

Answer 56

Diagnosis and treatment are the same barium air enema.