040315 abd pain

Question 1

Murphy’s sign

Answer 1

having pt breathe in (place hand under costal margin)

positive in cholecystitis

Question 2

differential for upper abdominal pain

Answer 2

choledocholithiasis
acute pancreatitis
peptic ulcer
GERD
pyeloneprhitis
ascending cholangitis
MI
cancer
hepatitis
aortic dissec
bowel obstruction

Question 3

what diagnostic tests could you get for upper abd pain?

Answer 3

CBC
lipase (pancreatitis?)
UA

EGD

EKG

US
XR of abdomen for free air (perforated ulcer)

Question 4

cholelithiasis

Answer 4

stones in gallbladder

Question 5

cholangitis

Answer 5

stone at ampulla of Vater

Question 6

choledocholithiasis

Answer 6

stone in common bile duct

Question 7

cholecystitis

Answer 7

stone in cystic duct

Question 8

biliary colic

Answer 8

when gallstone blocks cystic duct-gallbladder contraction induces pain

Question 9

intestinal tract has sympathetic supplies (for pain) at what levels?

Answer 9

T8-L2

Question 10

kidney has sympathetic supplies (for pain) at what leveL?

Answer 10

T10-L1

Question 11

L1 is what body part?

Answer 11

groin

Question 12

T10 is what body part?

Answer 12

umbilicus

Question 13

small intestine has sympathetic supplies (for pain) at what level?

Answer 13

T8-T10

Question 14

lactate test can be used to assess

Answer 14

shock? ischemia?

Question 15

gallbladder and biliary tree-imaging modality of choice

Answer 15

US (CT and MRI can be used though to eval for complications)

Question 16

XR can look for

Answer 16

air, or obstruction in abdomen

Question 17

when should you NOT do a CT of abdomen or pelvis with contrast

Answer 17

when creatinine is elevated

Question 18

air in bowel wall is called

Answer 18

pneumotosis (due to ischemia)

Question 19

sudden onset pain in medicine is usually due to

Answer 19

something got blocked or perforated

Question 20

abd pain and unexplained hypotension-differential?

Answer 20

intra abdominal hemorrhage (aortic aneurysm, ectopic pregnancy, splenic rupture)

sepsis (acute mesenteric ischemia, appendicitis, etc)

other (adrenal insufficiency, diabetic ketoacidosis, MI)

Question 21

pain out of proportion to examination

Answer 21

acute mesenteric ischemia

Question 22

what laboratory tests can you do to diagnose acute mesenteric ischemia

Answer 22

lactate

WBC

Question 23

what imaging tests can you do to diagnose acute mesenteric ischemia

Answer 23

CT (insensitive)
CT angiography (highly sensitive, specific)
catheter angiography (gold standard)

Question 24

tx for acute mesenteric ischemia

Answer 24

embolectomy if early or bowel removal

Question 25

appendix can be imaged via

Answer 25

US

Question 26

supine films are sensitive or insensitive for free air

Answer 26

insensitive (need instead an upright or decubitus)

Question 27

in female pt presenting w abd pain, what imaging is best?

Answer 27

US (in case there's preg)

Question 28

imaging-black bubbles?

Answer 28

colon diverticula--air filled

Question 29

imaging for appendicitis

Answer 29

US for children and preg women | otherwise CT for adults

Question 30

imaging for ovarian torsion

Answer 30

US