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Nayla clinical disciplines > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

What is appendicitis

A

luminal obstruction of appendix causing periumbilical pain, which develops into RLQ pain over 24 hr.

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2
Q

What are associated Sx of appendicitis

A

anorexia, N/V

not likely to be ruptured at time of removal

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3
Q

What will your PE findings be for appendicitis

A 
Rovsing's sign (pain in RLQ when palpating LLQ)
Iliopsoas sign (pain when flexing R hip w straight knee)
Obturator sign (pain w/ flex knee 90 and rotate hip int/ext)
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4
Q

What is the Alvarado score

A

grades Sx, signs, and labs of appendicitis (iliac fossa pain,
7-8 is probable, >9 is highly probably

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5
Q

What are possible lab findings in appendicitis

A

Leukocytosis w/ left shift

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6
Q

How do you treat appendicitis

A

TOC: Appendectomy
Fluid resuscitation
antibiotics (more intense if perforated)

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7
Q

What is Cholecystitis

A

Inflammation and infection of the gallbladder (stores bile)
Causes intermittent RUQ pain out of proportion to exam findings
-Referred pain to R scapula/shoulder

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8
Q

What are associated symptoms in cholecystitis

A

N/V after a fatty meal or large meal after fasting

fever, chills, increased temp

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9
Q

What are your PE findings in cholecystitis

A

Murphy’s sign (inspiratory arrest when palpating RUQ)

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10
Q

How should you work cholecystitis up

A

**HIDA scan to diagnose (if GB not clearly outlined in 1 hr, CD obstructed)
US to show stones, thick GB wall, pericholecystic fluid

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11
Q

How do you treat cholecystitis

A

Fluid resuscitation

Antibiotics

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12
Q

What is cholangitis and how do you treat it

A

infection of bile duct caused by gram - bacteria

100% fatal if not Tx w/ aggressive IVF, IV abx, and surgery

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13
Q

What is charcot’s triad

A

Fever + Jaundice + RUQ pain
indicative of Cholangitis
-Reynolds pentad is the above triad + confusion + shock

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14
Q

What is Mesenteric ischemia due to

A

Arterial embolism to SMA from mural thrombus, associated with MI
Causes poorly localized, intermittent pain out of proportion to exam findings

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15
Q

What are RF for mesenteric ischemia

A 
>60 
AFib
CHF
recent MI 
hypotension 
hypercoagulable
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16
Q

What symptoms are associated with Mesenteric Ischemia

A

vomiting
diarrhea
intestinal angina (pain after large meal, relief w/ vomiting)

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17
Q

Mesenteric Ischemia workup will show

A 
increased WBC, amylase, and phosphate 
Metabolic acidosis (lac>10=bad)
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18
Q

How do you treat mesenteric ischemia

A

Arteriograph
heparin
antibiotics

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19
Q

What is an ectopic pregnancy

A 
Pregnancy outside the uterus (MC isthmus of fallopian tube) 
Causes triad (Pain in RLQ/LLQ + vaginal bleeding + amenorrhea)
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20
Q

What is a common PE finding in ectopic pregnancy

A

Kern’s sign: referred left shoulder pain

US will show empty fundus and endometrial stripe

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21
Q

How do you treat ectopic pregnancy

A

Fluid resuscitation
Pre-op labs
OB/GYN for surgery

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22
Q

What is a Perforated gastric ulcer

A

mucosal break >3mm (mostly duodenal)- caused by H. Pylori

Causes burning, gnawing pain to epigastrum <2 hours after eating

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23
Q

What symptom are associated with perforated gastric ulcer

A 
anorexia
belching
bloating
nausea
heart burn
\+/- hematesis and melena
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24
Q

How do you treat a perforated gastric ulcer

A

Fluid resuscitation
H2 blocker/ppi (zantac, pepcid)
Surgery consult for repair

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25
Q

What is a small bowel obstruction due to

A

*adhesions from prior surgery/ incarcerated hernia prevent fluid from flowing into colon
Causes proximal bowel distention and edema, bacterial overgrowth in stagnant bowel, hemorrhagic necrosis, gangrene, sepsis, and death

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26
Q

What should your work up include for SBO

A

CBC
CMP
CT abdomen

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27
Q

How do you treat a SBO

A

antiemetics
pain meds
NG tube decompression
IV fluid resuscitation

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28
Q

What is the MC of large bowel obstruction

A

Malignancy or volvulus

29
Q

What is an AAA

A

If >5cm theres a significant risk for rupture (if smaller, follow on US q6 months) M>W
Causes abdominal, back, flank, or groin pain, not affected by movement.

30
Q

When should you suspect AAA rupture

A

Syncope, >60, with abdominal or back pain

Triad of rupture: Abdominal pain + Pulsatile mass + Hypotension

31
Q

What should be in your AAA workup

A

US

US will show trace blood

32
Q

How do you treat AAA

A

IV fluids/blood

Vascualr surgery

33
Q

What abdominal imaging finding is indicative of a AAA

A

Calcification of aorta left of midline

34
Q

What can cause testicular torsion

A

Bell clapper deformity (inappropriately high attachment to tunica vaginalis= elevated testicle w/ horizontal lie)
MC in left testicle

35
Q

What are symptoms of testicular torsion

A

Sudden onset unilateral testicular pain and swelling, common s/p sleep or exercise
Vomiting, +/- fever
(NO discharge)

36
Q

What are findings of testicular torsion on exam

A

Absent cremaster reflex

US w/ decreased flow (doesn’t r/o if normal)

37
Q

How do you treat testicular torsion

A

Manually detorse 180 degrees (Medial to Lateral)
If 1/in 4-6 hours, 80-100% salvageable
If >24 hours, 20%

38
Q

What is MCC of acute scrotal pain in 3-13 y/o

A

Torsion of testicular appendix, should resolve spontaneously

Pain superior to testicle pole and BLUE DOT SIGN

39
Q

What are common causes of epididymitis

A

<35: Chlamydia, gonorrhea

>35, E. coli, pseudomonas

40
Q

What are symptoms of epididymitis

A

Gradual onset bilateral pain, worse with standing
swelling +/- discharge
painful prostate

41
Q

What will you find on exam for epididymitis

A

Phren’s sign (pain relief with scrotal elevation)

Increased flow on doppler

42
Q

How do you treat epididymitis

A

<35: Rocephin IM + Doxy

>35: Cipro or Levo

43
Q

What is urolithiasis

A

Supersaturation of urine w/ salt, lack of urinary inhibitors of crystallization. Can be calcium (MC), struvite (ammonium, Mg, phosphate), uric acid, or cystine (MC in M, white)
Causes sudden onset pain (referred), urgency, N/V, hematuria

44
Q

What will you see on urolithiasis workup

A

US showing hydronephrosis of kidney

Can also check CT or XR

45
Q

How do you treat urolithiasis

A 
<5cm pas spontaneously 
Toradol (onset in 30-45 min) 
Morphine (until toradol works) 
anti emetics 
IV fluids
Admit, abx if concurrent infection
46
Q

What are struvite stones associated with

A

Urea splitting organisms, proteus klebsiella and staph

contain ammonium, mg, phosphate

47
Q

What is pancreatitis

A

Inappropriate autodigestion of pancreas by proteolytic enzymes, caused by 6-8 years heavy alcoholism

48
Q

What are Sx of pancreatitis

A

Hemorrhage and edema cause pain
Severe, constant, epigastric pain radiating to back; worse lying, better standing and leaning forward
Fever, tachycardia, N/V

49
Q

What will Pancreatitis work up show

A 
Elevated lipase (MC) and amylase (amylase also elevated in mesenteric ischemia) 
Abd XR: localized ileus, gallstones, wide duodenal sweep)
50
Q

How do you treat pancreatitis

A 
Rest the bowel, NPO
IVF 
demerol (less ampulla spasms) 
anti-emetics 
\+/- NG tube
51
Q

What is diverticulitis

A

Pressure gradient between colon lumen and serosa is jacked causing herniation of diverticula (descending and sigmoid have narrow lumens and higher pressure), sometimes due to eating seeds and nuts
Causes abrupt onset LLQ pain and fever

52
Q

What symptoms are associated with diverticulitis

A

If they say they went to the bathroom and “blood gushed out” think bleeding diverticulum

53
Q

What will you find on diverticulitis workup

A

Leukocytosis with left shift (also finding in appendicitis)

Do a CT AP with contrast

54
Q

How do you treat diverticulitis

A

Levaquin and flagyl or zosyn + vancomycin if severe

If abscess is seen on CT, drain it

55
Q

What helps relieve pressure causing diverticulitis

A

Eating fiber, it widens the intestine

56
Q

What is DKA

A

With less insulin, glucose builds up. High glucagon, catecholamines, cortisol, and GH also further increase glucose
Excess glucose is converted to ketones (“Keto”)
Tg synthesis is inhibited, causing lipolysis (“acidosis)

57
Q

What gives you a hyperosmolar state (diuresis)

A

Hyperglycemia + Ketoacidosis

58
Q

What are symptoms of DKA

A

Polyuria, polydipsia, weight loss, urinary frequency

N/V, DMM, dizzy, weak, Kussmaul breathing, fruity breath

59
Q

What PE findings are associated with DKA

A

BG >250 (check glucometer q1-2 hrs)
pH <7.3 and bicarb <15 (met acidosis)
Ketonuria (check UA)

60
Q

How do you treat DKA

A

IVF (1L 1hr, then 500cc for 4 hr, then 25 cc for 4 hr)
Insulin infusion to reverse ketogenesis (keep until ketones not in urine// goal decrease glucose 75-100 x hr)
Potassium replacement (when urine output begins)

61
Q

Hyperosmolar and hyperglycemic state cause BG to be

A

> 600

62
Q

What are the different kinds of pain

A

Visceral: cramping, colicky, ill defined, intermittent
Parietal: sharp, precise, constant

63
Q

What are types of referred pain

A

Biliary disease= Right scap/shoulder
Renal colic= ipsilateral testicle/labia pain
MI= L neck, jaw, shoulder, arm

64
Q

What pain is felt in RUQ

A 
cholecystitis
biliary colic
hepatic abscess
perforated duodenal ulcer pancreatitis
retrocecal appendicitis
herpes zoster
MI
RLL PNA
65
Q

What pain is felt in LUQ

A 
Gastritis
Pancreatitis
Splenic rupture/infarct
MI 
LLL PNA
66
Q

What pain is felt in both lower quadrants

A 
Leaky AAA
Ruptured ectopic
ovaro torsion
PID
Endometriosis
Urinary calculi 
Psoas abscess
Hernia
67
Q

What pain is felt in RLQ

A

Late appendicitis

Meckel’s diverticulum

68
Q

What psin is felt in LLQ

A

Sigmoid diverticulitis

Nayla clinical disciplines (8 decks)

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