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Flashcards in Abdominal Pain Deck (30)
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Radiographic finding highly sensitive for mesenteric ischemia/infarction

Pneumatosis intestinalis


Metabolic abnormalities seen in alcoholic ketoacidosis

Elevated serum ketones (B-OH:AcAc ratio ~5:1, consequently nitroprusside test may only be weakly positive because it only reacts with AcAc), high anion gap and metabolic alkalosis from vomiting.


Treatment of alcoholic ketoacidosis

#1) Give thiamine to prevent Wernicke's encephalopathy. #2) D5NS or D5 1/2NS + carbohydrates to suppress counter-regulatory hormone release, decrease ketogenesis and normalize NADH/NAD+ ratio.


Calculate anion gap

Na - Cl - HCO3


Initial treatment of a patient with suspected renal calculi

IVF, anti-emetic, NSAID (decreases ureteral spasms and renal capsular pressure)


Mnemonic for causes of small bowel obstruction

ABC: Adhesions, bulges (hernia) and cancer


When should you start antibiotics for spontaneous bacterial peritonitis? Which abx are indicated?

Paracentesis shows neutrophil count > 250. Abx that cover common organisms (E. coli, Klebsiella and Streptococci) are 3rd gen cephalosporins.


Prehn sign

Physical elevation of testicle relieves pain in epididymitis, not in testicular torsion.


Which way do you spin the testicle to detorse it?

Laterally "like opening a book"


Lab findings in patients with appendicitis

WBC > 10k in 90%, may also have +LE in urine due to irritation of ureter and pyruia.


Initial test for patients with suspected ovarian torsion

Doppler ultrasound


Charcot's triad

RUQ pain, jaundice and fever indicative of cholangitis


Plain film findings in patients with AAA

Curvilinear calcification of the aortic wall or paravertebral soft tissue mass


Ranson's criteria at admission

"GA LAW": Glc > 200, Age > 55, LDH > 350, AST > 250, WBC > 16. Each + criteria gets 1 point and mortality goes up with each point. 0-2 = 2%, 3-4 = 15%, 5-6 = 40%, > 6 = 100%. BISAP score is newer and probably better


Ranson's criteria 48 hours after admission

"CHOBBS": Ca < 8, > 10% Hct drop, pO2 < 60mmHg, Base deficit (24 - HCO3) > 4, BUN increase > 4, Sequestration ( > 6L fluid requirement). Each + criteria gets 1 point and mortality goes up with each point. 0-2 = 2%, 3-4 = 15%, 5-6 = 40%, > 6 = 100%.


Causes of epididymitis

E. coli in men > 35 (prostatitis, catheterization). N. gonorrhoeae and C. trachomatis in men < 35.


Treatment of urethritis in men

50% will be due to coinfection with N. gonorrhoeae (ceftriaxone or ciprofloxacin x1) and C. trachomatis (azithromycin x 1 or erythromycin x 7d or doxy x 7d).


Diverticular abscess size that can be treated with antibiotics alone? Which abx?

5cm or less. Tx w/cipro and metronidazole


Blumberg sign

Rebound tenderness over McBurney's point


Initial management of SBO

NG decompression, IV fluids, surgical consultation and IV antibiotics if surgery is planned


Who should be admitted for treatment of PID

Pregnant, failed on outpatient abx, unstable, TOA or cannot rule out surgical condition.


How can you tell an obstruction int the small bowel from one in the large bowel?

Small bowel has valvulae convientes, which are similar to haustra of the large bowel; however, the cross the entire width of the small bowel, unlike haustra.


Next step in a patient with dislodged G-tube

Try to replace it, if you meet resistance, stop. If you don't, then advance, inject 30-50cc of water soluble contrast and take a supine plain film. If you can visualize gastric rugae, the patient may begin feeding.


Next step in patients with obstructing uretral calculus + overlying infection.

IV abx + urgent surgery. This can progress to abscess and necrosis of the kidney if not cleared.


Size of ureteral calculi and likelihood of passage without intervention

< 4mm = 90%. 4-6mm = 50%. >6mm = 10%.


Treatment of scromboid fish poisoning

Eating the dark fish meat results in histamine-like reaction in 20-30 minutes and can adequately be treated with antihistamines.


Most common cause of food outbreaks in the US.

C. perfringens from undercooked poultry and beef


Suspected etiology of mesenteric ischemia in patients with sudden onset pain vs. insidious onset pain?

Sudden = arterial embolism. Insidious = venous thrombus.


Prophylactic medications given to sexual assault victims in the ED

Ceftriaxone (gonrrhea), azithromycin (chlamydia), metronidazole (syphilis and trichomoniasis), +/- antiretrovirals for post-exposure prophy, emergent contraception, tetanus if injured and HBV if unvaccinated.


Extra-intestinal manifestations of IBD. What is one that is seen in Crohn's but not UC?

Aphthous ulcers, erythema nodosum,
iritis or episcleritis, arthritis, and gallstones. Nephrolithiasis is only seen in Crohn's due to ileal inflammation, increased oxalate absorption and formation of oxalate stones.