Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*OldSurgery > the acute abdomen, peritonitis > Flashcards

the acute abdomen, peritonitis Flashcards

1
Q

sudden onset, severe abdominal pain

A

acute abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when should you hold analgesics until w/ an acute abdomen

A

until after initial eval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

if a patient doesn’t go to the ER w/ an acute abdomen what should happen?

A

serial exams by the same provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the “policeman” of the abdomen

A

omentum- likes to clean up the mess and wall off any infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what drug should you not give someone w/ an acute abdomen because it could make it so they can’t give an accurate history?

A

promethazine (Phenergan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is visceral pain?

A

generalized

cause by stretching/ ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what mediates visceral pain?

A

autonomic nerves (sympathetic and parasympathetic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

where are receptors for vsiceral pain located?

A

mucosa or muscularis on hollow visceral and the visceral peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

location of visceral pain depends on what?

A

dermatones of the organ involves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is parietal pain?

A

more intense, acute

sharp and better localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what mediates parietal pain?

A

somatic nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what leads to more precisely localized pain?

A

Direct irritation of the parietal peritoneum by pus, bile, urine, and GI secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Visceral pain shifting to parietal pain indicates

A

extension of the underlying process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

where does referred pain usually arise from?

A

deep structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

why would a patient have pain in the shoulder after a laparoscopic surgery?

A

air under the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

if a patient has shoulder pain a week after surgery what should you consider?

A

abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

for duration of pain what should you get?

A

rate on onset and progression of pain (explosive, rapidly progressive, gradual)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

with N/V what should you ask about?

A

what came first, pain or vomiting?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

women on oral contraceptives for a long time who look shocky what should you think of?

A

hepatic adenomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what do steroids blunt?

A

inflammation and wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

individual on steroids may present how?

A

have less pain due to lack of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what should you ask a person with an acute abdomen about?

A

gallbaldder
appendix
uterus
ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

does a hx of appendectomy entirely rule out appendicitis?

A

no - can have a stump of appendix left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

does a hx of cholecystectomy rule out CBD stones?

A

no - can have common bile duct stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what family hx is important?

A

IBD
sickle cell
AAA
colon cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

for an acute abdomen what should you do for an HEENT exam?

A

lymph nodes

sclera color- yellow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

if a person has post prandial abdominal pain and you hear bruits what should you consider?

A

clots in the messenteric arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what does involuntary guarding and rebound tenderness indicate?

A

peritoneal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is Rovsing’s sign?

A

pain at McBurney’s point with palpation of LLQ

30
Q

iliopsoas sign

A

pain when hip passively extended or actively flexed against resistance
indicates inflammation on the psoas muscle
retrosecal appendix

31
Q

obturator sign

A

pain with internal rotation of the flexed thigh

one long appendix onto obturator

32
Q

what does costovertebral angle tenderness indicatie

A

pyelonephritis

33
Q

Murphy’s sign

A

Pain at RUQ with inspiration – ceases inspiration

34
Q

when would you do a CT scan?

A

appendicitis

35
Q

for trauma do you need contrast

A

yes, (IV) need to see bleeding

36
Q

to figure out an abscess what can you do with contrast ?

A

PO and IV
need PO to see intestines
IV for blood

37
Q

what type contrast do you use for suspected appendicitis?

A

PO contrast

38
Q

what does an upper endoscopy look at (EGD)?

A

esophagus
stomach
duodenum

39
Q

What is an ERCP

A

endoscopic
retrograde
coloangial
pancreatography

40
Q

what is an ERCP used for?

A

bile duct etiology

41
Q

what can you see w/ colonoscopy?

A

colon

terminal ileum

42
Q

used to identify mesentaric ischemia and to identify and possibly stop bleeding

A

angiography

43
Q

what else could upper quadrant pain present as?

A

pneumonia

44
Q

Ddx for RUQ pain

A

hepatitis
Gallbladder
pneumonia
diverticulitis

45
Q

epigastic DDx

A 
pancreatitis
cardiac
GERD
PUD
biliary 
vascular
46
Q

DDx for LUQ

A

spleen

47
Q

DDx for RLQ

A 
appendicitis
ectopic
ovarian cyst
PID
ovarian torsion 
rectus sheath hematoma
48
Q

Ddx for LLQ

A

sigmoid divericulus

49
Q

suprapubic DDx

A

bladder
colonic
gynecology

50
Q

pain onset w/i minutes think of…

A

Perforated viscera, testicular or ovarian torsion, ruptured AAA, ectopic pregnancy, pancreatitis, mesenteric ischemia

51
Q

pain onset w/i hours think of…

A

Biliary disease, appendicitis, diverticulitis, SBO, PUD

52
Q

pain onset w/i days think of…

A

IBD

53
Q

when do consult a surgeon….

A

Peritonitis
Incarcerated hernia
Tender abdomen with high fever or hypotension
Suspected ischemia

54
Q

if you suspect chronic cholecystitis what should you get before sending them to the surgeon?

A

US and LFTs

55
Q

if vomitting a lot/ distended what can you place?

A

NG tube

56
Q

well-vascularized, pliable, mobile double fold of peritoneum and fat that is involved in control of peritoneal inflammation and leaking viscus or area of infection

A

omentum

57
Q

– inflammation or suppurative response of the peritoneal lining to direct irritant

A

peritonitis

58
Q

local findings of peritonitis

A 
“Acute abdomen”
Abdominal tenderness
Rebound tenderness
Guarding
Rigidity
Distention
Diminished bowel signs
Free air
59
Q

systemic findings of peritonitis

A 
Fever
Chills
Rigors
Tachycardia
Diaphoresis 
Tachypnea
Restlessness
Dehydration
Oliguria
Disorientation
Shock
60
Q

Labs to get w/ peritonitis

A 
CBC w/ diff
cross-match
ABGs
electrolytes
BUN and creatinine
blood clotting profile
lifer and renal function tests
blood and urine cultures pre-abx
peritoneal fluid pre-abx if possible
61
Q

Can occur after perforation, inflammatory, infectious or ischemic injuries of the GI or GU systems

A

secondary peritonitis

62
Q

what are examples of secondary peritonitis

A 
Appendicitis
Perforated gastroduodenal ulcers
Acute salpingitis
Diverticulitis
Bowel perforation
Trauma
Ischemic bowel
Acute necrotizing pancreatitis
63
Q

Tx for 2ndary peritonitis

A 
IV fluids 
consider central venous cath
may need cardiovascular agents
mechanical ventilation
consider A-line (arterial line for beat by beat BP) 
ABX- broad spectrum
64
Q

how long do you continue abx w/ 2ndary periotnitis?

A

patient is afebrile w/ normal WBC

65
Q

peritonitis that occurs in the absence of GI perforation

A

primary peritonitis

66
Q

what mainly causes primary peritonitis

A

hematogenous spread

occasionally transluminal or direct bacterial invasion

67
Q

what is primary peritonitis associated w/?

A

cirrhosis
advanced liver dz
nephrotic syndrome
SLE

68
Q

will you see free air w/ primary periotnitis

A

no

69
Q

patient w/ cirrhosis, no free air but has free fluid what do you suspect?

A

primary peritonitis

70
Q

> 90% of primary peritonitis are _______- microbial infection

A

mono

71
Q

Tx for primary peritonitis

A

abx- not surgery

72
Q

tx for secondary peritonitis

A

surgery

*OldSurgery (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions