Brainscape's Knowledge GenomeTM

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


See full index

GI 2 > Clin Med- Acute abdomen > Flashcards

Clin Med- Acute abdomen Flashcards

1
Q

Visceral Pain

  • what causes it
  • how does it related to timing of parietal pain
A
  • distention of hollow organs
  • capsular stretching of solid organs
  • typically before parietal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Visceral pain sx

A
  • intermittent
  • dull
  • crampy
  • poorly localized
  • usually midline

ex. mesenteric ischemia or early appedicitis

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

Parietal Pain

  • what causes it
  • location
  • pt rxn on PE
A
  • ischemia, inflammation, stretching of parietal peritoneum
  • specific pain - on the same side/area pain originates from
  • rebound, guarding, rigidity on exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Parietal pain

- sx

A
  • sharp
  • constant
  • worse with movement & palpation

ex. acute appendicitis

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

History

A

take a look at the slide, much like phys di information we already know

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

What is one of the most important parts of the PE??

A

VITAL SIGNS

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

What else to look for on PE

A
  • gen appearance: pallor, distress (laying still or writhing in pain)
  • inspection: distention or discoloration
  • auscultation: absent or tinkling bowel sounds, bruits
  • palpation: be gentle, localize pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Rebound tenderness

  • kid specific way to test
  • classic example of dz
A
  • jump up and down

- appendicitis

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

Guarding

- describe

A

reflex spasm of abd wall in response to palpation/peritoneal irritation

*distract pt while palpating to distinguish true guarding from purposeful

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

What must you do with every female who presents with undifferentiated abd pain?

A

pelvic exam

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

What must you do to every male who has lower abd pain?

A

GU exam to check for strangulated hernia or testicular torsion

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

Inspection of the rectum

A
  • prostate exam
  • blood
  • abscess
  • foreign body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List 5 special tests for abd exam

A
  1. Psoas
  2. Murphy’s
  3. Obturator
  4. Rovsing’s
  5. Heel Tap

*BAM we know these already!

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

Important PMH for pt with abd pain

A
  • prior surgery: obstruction from adhesions
  • questions to ascertain risk for mesenteric ischemia and AAA (CAD, HTN, a. fib)
  • ETOH abuse (pancreatitis)
  • meds: NSAIDS, abx, steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what test should be ordered if intestinal obstruction is top of ddx?

A

oral contrast (for CT?) to help surgeon delineate the obstruction point

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

Kehr Sign

A
  • pain from gallbladder or spleen radiates to shoulders or scapula due to irritation of the diaphragm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tests to order for abd pain (8)

A
  1. EKG
  2. CBC (don’t base dx on CBC!!)
  3. BMP/CMP for kidney/liver function
  4. Lipase
  5. UA/uHCG (don’t miss ectopic pregnancy!!)
  6. abd series (overused)
  7. CT
  8. US
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Appendicitis

  • cause
  • pain location
A
  • obstruction of lumen from food or adhesions

- periumbilical pain that migrates to RLQ

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

Appendicitis

  • sx
  • PE
A
  • anorexia, nausea, vomiting, fever

- guarding, rebound tenderness, +McBurney’s, Rovsings, Psoas, obturator, and heel tap

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

Appendicitis

  • what to order
  • tx
A
  • CT of abdomen pelvis pref with contrast
  • US children/pregnant
  • abx, general surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Appendicitis on CT

A
  • look at slides
  • normal is clearly delineated, smooth, air is normal
  • abnormal is stranding (inflamed), may see appendicolith
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Biliary colic, cholecystitis, ascending cholangitis

  • location of pain
  • sx
A
  • RUQ or epigastric
  • crampy, colicky pain, postprandial
  • radiates to sub scapular area
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

sx specific to cholecystitis and cholangitis

A

fever and chills

24
Q

Biliary colic, cholecystitis, ascending cholangitis

  • PE findings
  • what to order
A
    • Murphy’s
  • Charcot triad (fever, jaundice, RUQ pain)
  • US, LFTs, Lipase
25
Q

What pentad is found in severe cases of ascending cholangitis?

A

reynolds pentad:

  • charcot (fever, jaundice, RUQ pain)
  • hypotension
  • AMS
26
Q

Biliary Colic

- tx

A
  • anti-cholinergic for pain control and gallbladder relaxation
  • ex benadryl or promethazine
27
Q

Acute cholecystitis and ascending cholangitis-

- tx

A
  • hosp admission
  • broad spectrum abx
  • sx consult
28
Q

PUD

  • cause
  • sx
A
  • H. pylori, NSAIDS

- burning epigastric pain, n/v, vomit red blood, melena

29
Q

PUD

  • complications
  • TX
A
  • anemia, perforation, gastric outlet obstruction
  • PPI, dc NSAIDs, NG tube, endoscopy
    (tx volume loss, fluids, blood)
30
Q

Bowel obstruction

  • sx
  • frequent cause
A
  • diffuse crampe pain, n/v, bloating

- prior sx or obstruction

31
Q

bowel obstruction

  • PE findings
  • what to order
A
  • abd distention, tenderness
  • Acute abd series for air fluid levels
  • CT abd/pelvis with oral & IV contrast
32
Q

MCC

  • SBO
  • LBO
A
  • SBO: adhesions from previous sx

- LBO: neoplasm

33
Q

List the three radiographs in an acute abd series

A
  1. AP supine view: bowel loop width
  2. Upright abd: air fluid levels
  3. Upright chest film: free air
34
Q

Diverticulitis

  • describe
  • cause
A
  • acute inflammation of wall of a diverticulum and surrounding tissue
  • increased pressure from poor motility or obstruction causes inflammation
35
Q

Diverticulitis

  • sx
  • what to order
A
  • pain (MC), diarrhea, constipation, n/v, fever
  • Labs, UA, CT
  • AAS is little help
36
Q

Diverticulitis

- tx

A

depends on severity:

  • no systemic sx: output abx (cipro, flagyl)
  • vomiting or toxic: admission, fluids, abx
37
Q

diverticulitis two major complications

A

perforation

abscess

38
Q

Intussusception

  • describe
  • common age, sex
A
  • portion of bowel telescopes into another segment
  • 3mo to 6yr
  • M>F
39
Q

Intussusception

- sx

A
  • sudden, intermittent colicky abd pain
  • Henoch-Schonlein purpura (small vessel vasculitis)
  • blood stool-current jelly (late finding)
  • episodes of crying, drawing legs up
  • episodes usually spontaneously resolve
40
Q

Intussusception

- tests to order

A
  • air contrast enema: dx & therapeutic
41
Q

Pancreatitis

  • cause
  • sx
A
  • ETOH abuse, cholelithiasis

- severe epigastric or LUQ pain, radiation to back

42
Q

Pancreatitis

- lab test to dx

A
  • lipase: 3X upper limit normal value

- amylase is less sensitive

43
Q

Pancreatitis

  • Criteria used on admission
  • tx
A
  • Ranson criteria
  • Fluids, NPO, pain med
  • NO anticoagulation for inpts
44
Q

Mesenteric Ischemia

  • describe
  • sx
A
  • ischemia dt obstruction of mesenteric artery from embolism or thrombosis
  • gradual to acute onset, pain out of proportion to exam, soft abdomen
  • poorly localized pain
  • hypovolemia
  • low BP
  • sepsis
45
Q

Mesenteric Ischemia

- risk factors

A
  • A. fib
  • HTN
  • CAD
  • CHF
46
Q

Mesenteric Ischemia

  • dx tests
  • tx
A
  • CT abdomen/pelvis
  • angiography
  • admission, broad spectrum abx, sx
47
Q

Abdominal Aortic Aneurysm (AAA)

  • risk factors
  • cause
A
  • connective tissue disorder, family hx, atherosclerotic risk factors
  • stress on connective tissue causes dilation
48
Q

AAA

  • sx
  • dx tests
A
  • severe abd pain, flank or back pain
  • syncope, abd bruit, low BP
  • ED US, CT abd/pelvis
49
Q

what should you never skip before dx an elderly pt with renal colic

A

abd US to measure aorta for AAA

50
Q

Stable AAA

  • f/u
  • what increases risk for rupture
A
  • f/u closely, serial US

- >5 cm size increases risk of rupture

51
Q

AAA

- tx

A
  • stabilization
  • fluids? controversial
  • emergent cardiothoracic consult
52
Q

AAA

- survival rate of sx

A
  • 50% die

- those who survive likely to have multi-organ failure in ICU

53
Q

General tx of abd pain

A
  • volume repletion
  • pain relief
  • antiemetics
  • antibiotics
  • +/- NPO
  • +/- NG tube
54
Q

when get sx consult

A
  • acute abdomen
  • appendicitis
  • obstruction
  • perforated ulcer
  • acute cholecystitis
55
Q

If discharge pt with abd pain from ED, what sort of fu is recommended

A
  • 12 hr recheck
  • close fu with PCP
  • esp children high suspicion for appendicitis

GI 2 (11 decks)

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