Abdomen Flashcards
(152 cards)
1
Q
location of visceral pain and often accompanied with
A
vague and midline →nausea, pallor, diaphoresis
2
Q
arises from the walls of hollow viscera and solid organs → due to abnormal stretching/distention, ischemia or inflammation
A
visceral pain
3
Q
pain that is sharp in quality and is well localized
A
somatic pain
4
Q
arises from the parietal peritoneum, mesneteric roots, and anterior abdominal wall due to chemical or bacterial inflammation
A
somatic pain
5
Q
pain due to fibers from different organs returning to CNS overlapping with pathways from cutaneous sites which had similar embryologic origin
A
referred pain
6
Q
Diaphragmatic irritation that refers pain to the shoulder via C4 due to splenic rupture/abscess, renal calculi, ruptured ectopic
A
Kehr’s Sign
7
Q
pulsatile and well localized pain
burns, lacterations, fractures, infection, inflammations
A
somatic pain
8
Q
aching and cramping, nonpulsatile, poorly localized pain or referred to distant locations
angina, hepatic distention, bowel distention, hypermobility, pancreatitis
A
visceral pain
9
Q
spontaneous, burning, lancinating or shooting pain → may be distal or proximal to site of injury
complex regional pain syndrome, sciatica
A
neuropathic pain
10
Q
stomach, 1st and 2nd parts of duodenum, liver, gallbladder, pancreas
A
epigastric area
11
Q
3rd and 4th parts of duodenum, jejunum, ileumm, cecum, appendix, ascending colon, first two thirds of transverse colon
A
periumbilical area
12
Q
last one third of transverse colon, descending colon, sigmoid, sectum, intraperitoneal GU organs
A
suprapubic area
13
Q
two big history points to hit in patient with abdominal pain
A
social hx. (IVDA, Smoke, EtOH, GU, STD, pregnancy hx)
surgical hx.
14
Q
respiratory arrest on inspiration during palpatino of RUQ [cholecystitis]
A
Murphy’s Sign
15
Q
pain referred to RLQ on palpation of LLQ [appendicitis]
A
Rovsing Sign
16
Q
Pain with internal rotation of flexed hip
A
Obturator Sign
17
Q
Pain with hyperextension of hip
A
Psoas Sign
18
Q
patients coming to ED for abdominal pain should be…
A
NPO
19
Q
where are pediatrics most likely to have foreign body entrapment in their esophagus?
A
upper esophageal sphincter
20
Q
where are adults most likely to have foreign body entrapment in their esophagus?
A
lower esophageal sphincter
21
Q
sign that esophageal foreign body has > 80% chance of passing
A
if it reaches the stomach
22
Q
MC cause of esophageal foreign body in adults
A
mechanical dysfunction
23
Q
diameters of object that will not pass through the esophagus
A
> 2.5 cm wide and > 6 cm long
24
Q
MC common GI foreign bodies in pediatrics
A
food boluses and other object (coins, toy, button battery, magnet)
25
how will esophageal foreign body present in an adult?
foreign body sensation → mild/severe pain
| can’t swallow/handle secretions, drooling, spitting, vomiting
26
issue with foreign bodies in pediatrics patients
asymptomatic or can't communicate
27
Worse cause scenario for foreign esophageal body in pediatric patient
In UES → tracheal impingement → stridor, respiratory compromise, death
28
sodium hydroxide is generated by current produced by the battery → 20 mm button batteries have higher capacitance and generate more current compared to other disc batteries
liquefaction necrosis
29
How can you differentiate button batteries from coins?
X-ray will show "double contour" of button battery
30
Time line for button battery:
liquefaction necrosis
perforation
LN → as early as 2 hours
| Perforation → 6 hours
31
methods to remove button battery
endoscopy
Foley catheter removal
Magill forceps removal
32
Even though a button battery is removed, what can continue to cause injury in the body?
residual alkali
| weakened tissues
33
You supect patient has foregin body in esophagus that you can't see on X-ray, what should you order next?
CT
34
Giving this will supposedly help move esophageal foreign body
Glucagon
35
How do you usually remove esophageal foreign body? What if that foreign body is a magnet?
endoscopy
| magnet → open exploratory laparotomy
36
which esophageal FB may pass alone?
distal smooth solitary FB
37
MC cause of esophageal perforation
iatrogenic (endoscopy and dilation)
| Boerhaave Syndrome, Mallory-Weiss tear, trauma, FB, infection, ingestion
38
why does esophageal perforation have high mortality?
gastric contents leaking into mediastinum and pleural space, etc
39
acute, severe, diffuse , unrelenting chest/neck/abdominal pain that radiates to back/shoulder
Esophageal perforation
40
What is Mackler's Triad? Indicates?
Vomiting, chest pain, SubQ emphysema
| Esophageal rupture
41
Hallmark sign for esophageal rupture
Subcutaneous emphysema → will appear usually after 1 hour of onset
42
raspy, crunchy sound heard over precordium with each heartbeat
Hammon crunch
43
signs of esophageal rupture
tachycardia
tachypnea
NO HEMATEMESIS
44
What makes the pain worse with esophageal rupture?
swallowing or laying supine
45
Chest X-ray indicators for pneumomediastinum
```
SubQ emphysema
mediastinal air fluid levels
pleural effusion
free air under the diaphragm
pneumothorax
```
46
You see pneumomediastinum on CXR, what do you order next?
```
contrast esophagogram (+ water soluble agent)
CT Chest with contrast
```
47
3 antibiotic options for esophageal rupture
piperacillin-tazobactam (Zosyn)
ceftriaxone + metronidazole (flagyl)
clindamycin
48
Esophageal rupture is a ____
emergency surgical consult
49
suspensatory muscle of duodenum, thin muscle connecting junction between duodenum, jejunum, and duodenojujenal flexure to connective tissue surrounding superior mesenteric artery and coeliac artery
Ligament of Treitz
50
MC location of GI bleed
Upper GI Bleed → proximal to ligament of treitz
| PUD, erosive gastritis/esophagitis, esophageal/gastric varices, Mallory-Weiss tear, alcoholic, ASA/NSAID use
51
MC cause of lower GI bleed
diverticular disease, anal fissue, AVM, colitis (ischemic or infetious), polyps, malignancy, anticoagulant/NSAID, hemorrhoids
52
Signs of Upper GI Bleed
hematemesis, coffee ground emesis, melena
53
why is hematochezia worrisome in Upper GI bleed?
indicates rapid transit through intestines
54
subcutaneous emphysema with history of vomiting → presenting with retrosternal CP
Boerhaave's Syndrome
55
where does Boerhaave's most likely occur?
lower 1/3 esophagus → posterolateral distal esophagusepigastric
56
severe vomiting then painless hematemesis → 90% are self-limiting
Mallory Weis tear
57
Who are Mallory Weis tears MC in
patient with Cirrhosis
58
Describe the type of tear in in Mallory Weis
incomplete → only mucosa and submucosa tear
59
These are the result of portal HTN due to cirrhosis or banding
esophageal varices
60
Signs of shock
tachycardia/hypotension
poor perfusion
AMS
61
How do you determine if red/black stool is due to blood or other cause?
Hemoccult test
62
Maroon stool indicates
LGIB from right side or small bowel
63
Bright red stool indicates
LGIB from the left side
64
Painless bleeding occurs with…
diverticular bleed
anticoag use
internal hemorrhoids
65
Fever + diarrhea + severe/crampy pain + GI bleed
UC, Crohns, C. diff
66
management for upper GI bleed
protonix
octreotide
balloon tamponade
67
this inhibits flucagon release and other hormones → reduces GI motility and gastric emptying → decreases splanchnic blood flow and portal venous pressure
Octreotide
68
who is the Balloon Tamponade for UGIB contraindicated in?
Mallory Weis tear
69
when is endoscopy for UGIB contraindicated?
perforated stomach, esophagus, instestine
70
Methods to find LGIB
colonoscopy
tagged RBC scan
angiography (SMA → IMC → celiac a.)
71
severe and sudden epigastric pain → slight movement worsens the pain → diaphoresis, pale, rebound, tachycardia, guarding, rigidity, hypotension
perforated ulcer
72
CXR of perforated ulcer reveals
free abdominal air → elevating the diaphragm
73
Treatment for perforated ulcer
open laparotomy with washout and repair
74
gallstones obstruct cystic duct for prolonged period of time → inflammation of gallbladder wall results
acute cholecystitis
75
Acute cholecystitis develops in 20% of patients with ____ if left untreated
biliary colic
76
6 F's of acute cholecystitis
```
Female
Fat
Forty
Fertile
Family history
Fair
```
77
pain begins in epigastric region and localizes to RUQ
acute cholecystitis
78
Acute cholecystitis may present with ____
positive Murphy's Sign
79
#1 diagnostic test for acute cholecystitis
Ultrasound of RUQ → pericholecystic fluid, gallbladder wall thickening (>4 mm) → best if NPO 8 hours prior
80
#2 diagnostic test for acute cholecystits
HIDA scan
81
What should you order to assess complications of cholecystitis nonspecific to US?
CT abdomen/pelvis with contrast
82
Antibiotics for acute cholecystits
piperacillin-tazobactam (zosyn)
ampicillin - sulbactam
meropenem
83
antibiotic used in severe life-threatening cases of cholecystitis
imipenem - cilastatin (primaxin)
84
MC cause of cholangitis
choledocholithiasis
| stone in cystic or common hepatic duct → obstruction
85
Charcot Triad
fever
RUQ pain
jaundice
86
malignant obstruction of gallbladder will have higher levels of what
bilirubin
87
antibiotics for cholangitis
piperacillin
ceftazadime
ampicillin
metronidazole
88
diagnostic procedure for cholangitis
MRCP → Magnetic resonance cholangiopancreatography
89
initial treatment for sever cholangitis
endoscopic or perQ biliary drainage and decompression
90
acute inflammation of pancreas where pancreatic enzymes digest the gland → obstruction of pancreatic/bile duct or direct toxicity to pancreatic cells → inflammation resulting in increased pancreatic enzyme activation
pancreatitis
91
MC cause of pancreatitis
cholelithiasis
92
ecchymosis/discoloration of umbilicus
Cullen's Sign
93
ecchymosis/discoloration of flanks
Grey Turner Sign
94
which is more specific for pancreatitis - lipase of amylase?
elevated lipase (2-3x normal)
95
Used to predict risk of mortality in pancreatitis
Randon Criteria
96
antibiotics for severe pancreatitis
Cipro + flagyl
meropenem
imipenden-cilastatin
97
which pancreattis cases get admitted
new onset → look for pseudocyst, abscess, mass, hepatits, EtOH withdrawal, gallstone
98
MC cause of spontaneous bacterial peritonitis
patient on peritoneal dialysis (PD)
99
MC organism with bacterial peritonitis
3/4 due to anaerobic Gram (-) → E. coli
100
How do you diagnose spontaneous bacterial peritonitis?
paracentesis
101
Antibiotic treatment for spontaneous bacterial peritonitis
cefotaxime
oral ofloaxacin
fluoroquinolone
102
MC cause of infectious diarrhea
norovirus
103
Treatment for infectious diarrhea
IV fluid
electrolyte replacement
antiemetic
+/- antibiotics (cipro + flagyl)
104
cause of C. dif
antibiotic use > 3 months
105
How do you diagnose C. Difficile?
stool culture + PCR
106
What must you do with your C. dif patients?
place on contact precautions → highly contagious
107
if C. dif colitis patient is healthy and stable what do you discharge them with?
metronidazole
108
Treatment for C. dif patients who need hospitalization → severe disease, fever, pain, immunocompromised
ORAL vancomycin
109
C. diff coliits with yelowish plaques of exudate replace necrotic intestinal mucosa
pseudomembranous colitis
110
Treatment for pseudomembranous colitis
metronidazole AND Oral Vanc
111
RLQ pain + N/V + rarely constipation + rectal sparing
Crohns
112
periumbilical/LLQ pain + constipation + commonly have bloody stool + always involves rectum
ulcerative colitis
113
extraintestinal manifestations of Inflammatory Bowel
arthritis
uveitis
liver disease
114
Crohn's patients typically have
perianal disease
115
why do you avoid antibiotics in UC/CD cases?
increased risk of antibiotic associated colitis
116
inflammation of diverticular from fecalith
diverticulitis
117
Where will patients with diverticulitis have abdominal pain?
LLQ is classic
118
best imaging for diverticulitis
CT Abdomen/pelvis with contrast
119
Outpatient antibiotic treatment for diverticulitis
Cipro + metronidazole (1st choice)
TMP-SMX + metronidazole
amoxicillin/clavuanic acid
120
MC type of bowel obstruction
ileus
121
MC cause of small bowel obstruction
adhesions
122
bilious vomiting may indicate
proximal bowel obstruction
123
feculent vomiting may indicate
distal bowel obstruction
124
what may small bowel obstruction progress to
bowel strangulation
125
#1 cause of larger bowel obstruction
cancer
126
large bowel obstruction in children - consider?
intussusception
127
diagnostic test for bowel obstruction
CT abdomen/pelvis with oral and IV contrast
128
How do you differentiate complete vs partial obstruction?
loop of small bowel > 2.5 cm dilated proximal to distinct transition zone of collapsed bowel < 1 cm
129
treatment for small bowel obstruction
NG tube to decompress + supportive treatment
130
MC cause of mesenteric ischemia
embolic
| mural thrombi after MI, thrombus due to mitral stenosis/Afib, vegetative endocarditis, septic emboli, AAA rescetion
131
risk factors for mesenteric ischemia
```
age
artherosclerosis
arrhythmias
hypovolemia
CHF
recent MI
valve disease
intra-abdominal malignancy
IBD
mesentary artery stenosis
cocaine use
smoking
```
132
Patient presents with disproportionate pain than what found on exam
acute mesenteric ischemia
133
two lab values used to order with mesenteric ischemia
```
Troponin
Lactic acid (sepsis vs volume depletion)
```
134
#1 diagnostic study for mesenteric ischemia in ED
CT/CTA with and without contrast
135
You just diagnose Mesenteric Ischemia → next step
emergency consult with surgery
136
Vasodilator administered to mesenteric ischemia
papaverine
137
main therapy for mesenteric vein thorbus
heparin
138
MC cause of inlammation of veriform appenix (acute appendicitis)
obstruction from facalith
139
line between umbilicus and ASIS
McBurney Point Tenderness
140
Patient presents with RLQ pain that suddenly goes away and is no longer tender
perforation
141
Female with RLQ or LLQ pain → top of Ddx?
ectopic pregnancy
142
appendicitis on CT will show…
appendiceal diameter > 6-8 mm, wall thickening >3mm, periappendiceal fat stranding, wall enhancement
143
Antibiotics for appendicitis
piperacillin-tazobactam
| PCN allery → carbapenem
144
forcal dilation of aorta causing weakness to integrity of vessel
abdominal aortic aneurysm
145
separation of layers within aortic wall → disruption of intima into media → false lumen
aortic dissection
146
Type A vs Type B aortic dissection
| management?
A → ascedning aorta → surgery
| B → beyond L subclavian → BP control
147
hypertensive, agitated, diaphoretic, anxious, tamponade, etc →
aortic dissection
148
diagnostic test for aortic dissection
CT angio chest/abdomen/pelvis with contrast
149
Goal BP for aortic dissection
systolic → 90 - 100/60-80
150
diameter for AAA
> 3 cm
151
Triad for AAA
abdominal pain
hypotension
syncope
152
medication for managing AAA BP and tachycardia exacerbations
BB
| morphine sulfate
