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Emergency Medicine > surgical abdomen > Flashcards

surgical abdomen Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Sudden/rapid onset and escalation

  1. Vascular -
A

hemorrhage, ischemia

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2
Q

Sudden/rapid onset and escalation

Perforation

A

hollow viscous, ulcer/tumor erosion

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3
Q

meds that matter with a surgical abdomen

A

Steroids
coumadin

NSAID’s
Pepto Bismal
anticholenergics
CAM
 current/recent antibiotics
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4
Q

Sudden/rapid onset and escalation

A
  1. Vascular - hemorrhage, ischemia
  2. Perforation - hollow viscous, ulcer/tumor erosion
  3. Rupture - appy, ectopic pregnancy, ovarian etiology
  4. Obstruction - bowel, gallbladder, ureter
  5. Trauma
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5
Q

PMH you want to consider in a surgical abdomen

A

GI, DM, atherosclerosis, cardiac, renal, CA, Sickle Cell, HIV

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6
Q

Elderly - pain out of proportion to exam

A

Think mesenteric ischemia

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7
Q

Stimulants w/ abdominal pain (stimulants are vasoconstrictors)

A

Think mesenteric ischemia

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8
Q

Abd pain, hypotension, tachy, pale, syncope

think

A 
hemorrhagic 
AAA
Massive GI bleeds
hemorrhagic pancreatitis
eroding tumors
massive bleeding in pregnancy
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9
Q

Testicular torsion

A

Testicle pain, abd/flank pain (referred)
Doppler ULS

refer to a urologist

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10
Q

ddx for all female pelvic pain

A

i. In DDx for all female pelvic pain
ii. +/- Ovarian cyst hx
iii. Formal ULS for flow, upreg

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11
Q

Ischemic colitis - General Surgeon

A

Hx Crohn’s, ulcerative colitis

ii. Fever, WBC’s/lactate up, +/- peritoneal; CT for dx

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12
Q

incarcerated vs strangulate

A

Can’t reduce incarcerated

skin over the hernia is hot, red, and hurts to the touch, fever; WBC’s, lactate up

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13
Q

Mesenteric ischemia

can be

A

SMA or IMA

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14
Q

mesenteric ischemia presentation

A

Pain out of proportion to exam – severe tenderness but soft abd, non-peritoneal
N/V/D, bloody BM, hx pain after eating

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15
Q

labs seen with mesenteric ischemia

A

Metabolic acidosis, high WBC’s, lactic acid, amylase; hypotension, tachycardia

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16
Q

dx mesenteric ischemia

A

CT angiography for dx

IV fluids, antibiotics, surgical consult
Time to surgery predictor of survival

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17
Q

different presentation with elderly

A 
Mesenteric Ischemia
AAA
Appendicitis
Acute Cholecystitis
Perforated Peptic Ulcer

20-40% of elderly w/ abdominal pain will require surgery!

> 60yo + Abd Pain = High Risk patient

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18
Q

Small Bowel Obstruction

A

Intermittent, crampy, periumbilical
Rapid, not sudden onset - hours

Intermittent, crampy, periumbilical
Rapid, not sudden onset - hours

Distention, diffusely tender, “tinkling” bowel sounds

Dehydration, low grade temp, tachy/tachy, +/- hypotension

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19
Q

Intermittent, crampy, periumbilical
Rapid, not sudden onset - hours

first orders and second orders

A

IV fluids, pain control, antiemetic, belly labs, lactic acid, EKG, CXR-KUB

Dehydration, low grade temp, tachy/tachy, +/- hypotension

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20
Q

Bowel Obstruction

functional

A

Ileus - adynamic/paralytic; bowel stops functioning due to infection, irritation, inflammation –>
Search for the cause and fix it
Distention both large/small bowel
“Sentinal Loop” can be seen in both

21
Q

Mechanical

A

Obstruction, compression, rotation

Usually needs surgical intervention

22
Q

sentinal loops

A

is a sign seen on a radiograph that indicates localized ileus from nearby inflammation.

functional;

23
Q

MCC of LBO

A

CA

24
Q

Labs that would indicate necrosis in a pt owth LBO

A

Fever, toxic, WBC’s or high lactate = worrisome for necrosis

25
Q

Ogilvie’s Syndrome)

A

Distended large bowel but not obstructed

Think tricyclics, anticholenergic agents

in old people

26
Q

Elderly, bedridden, psych, anticholinergics
Same presentation as LBO

Elderly, bedridden, psych, anticholinergics
Same presentation as LBO

think

A

volvulus

27
Q

MC site of a volvulus

A

Sigmoid (most common)

cecal

CT AP IV contrast for dx and for location
Antibiotics, surgical consult

28
Q

Pneumoperitoneum

A

Perforated viscous: air, bowel contents escape – air rises, see it under diaphragm
Rapid onset, constant, epigastric then generalized pain
Vomiting; fever 50%; tachy/tachy

29
Q

RF for pneumoperitoneum

A

Hx PUD/gastritis, NSAIDS, steroids. CXR negative in 50%! Get CT

30
Q

51yo male, epigastric pain

A

WBC 17k,

Lactate 3.0

31
Q

Cholecystitis labs seen with

A

LFT’s: AST 95 (nl ~5-35), ALT 112 (nl ~10-40), Alk Phos 180 (nl ~40-140), T.Bili 2.2 (nl ~0.3-2.0)

32
Q

charcots triad what is it and what is it for

A

RUQ pain, fever, jaundice

Plus - shock, altered mental status

reynolds

cholangitis

33
Q

unlikely alvardo

A

5 unlikely

34
Q

possible alverado

A

5-6 possible

35
Q

probably appy alvarado

A

7-8 prob,

36
Q

probably alvarado

A

> 9 very prob

37
Q

how would retrocecal appy present

A

(flank/genital pain),

38
Q

pelvic appy sxs

A

(rectal/pelvic pain: less abd pain

39
Q

psitive psoas, obturator, rebound, Rovsings seen when

A
  1. Positive psoas, obturator, rebound, Rovsings

a. ONLY if peritoneal irritation – late signs, usually perf’ed

40
Q

presentations of appy in elderly

A

No RLQ pain in 25%, no migration of pain in 50%

UTI, kidney stone, AGE all common misdiagnoses

41
Q

story of TOA

A

a. Late progression/complication of PID
b. Low abd pain, n/v, fever, +CMT
c. Hypotensive? Sepsis if ruptures

42
Q

TOA workup

A

Endovaginal US first, then CT for extent

43
Q

Sudden unilateral pain, n/v, usually afebrile

A

d. Endovaginal US w/ doppler for flow, cysts
e. Gyn consult, admit

12-24 hr

44
Q

Sudden unilateral pain, +/- n/v

A

Transabd US for fluid, endovag US for DDx

45
Q

MCC of 1st trimester bleeding

A

Pregnancy MAY progress or ABORTION MAY follow **MC of 1st Trimester BLEEDING

NO POC expelled from Uterus

closed

46
Q

threatened picture

A

5wks - gestational sac with fetal cardiac activity

Supportive: Rest @ HOME Return to ER if SX. Persist of PASAGE of POC.
*Serial B-hCG to se if Doubling

47
Q
  • Os closed
  • +/- abd pain, no passage of POC’s
  • No fetal cardiac activity on EVUS
A

Missed abortion (fetal death <20wks)

48
Q

Septic abortion

A

• EVUS: thickened, irregular endometrium, no clear sac

  • Os open or closed
  • Abd pain, fever, + CMT, foul smelling d/c, may be peritoneal
49
Q

what do you do for a packer.

A

Go-Lytely (they will poop it all out) if stable, not obstructed

Plain KUB, CT if need surgery to remove

Emergency Medicine (28 decks)

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