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Internal Med EOR > Abdominal Pain and Acute Abdominal Disorders > Flashcards

Abdominal Pain and Acute Abdominal Disorders Flashcards

(96 cards)

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1
Q

characteristics of visceral pain

A
  • slow onset
  • poorly localized
  • dull discomfort
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2
Q

characteristics of somatic pain

A
  • sudden
  • sharp
  • well localized
  • lateralizing
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3
Q

it may be necessary to wait as long as ____ minutes to establish absence of peristalsis

A

2-3

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4
Q

Carnett sign

A

flex stomach to determine if pain is located in the abdominal wall or intraabdominally

if pain when flexed carnett is positive and pain is abdominal wall pain

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5
Q

murphy’s sign

A

patient takes a slow, deep breath in and there is an abrupt cessation in inspiration by deep palpation of the RUQ

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6
Q

what is murphy’s sign indicative of?

A

cholecystitis

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7
Q

rovsing sign

A

RLQ pain elicited by pressure applied on the lower left quadrant

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8
Q

what is rovsing sign indicative of?

A

appendicitis

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9
Q

psoas sign

A

patient flexed the thigh against the resistance of the examiner’s hand

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10
Q

what is psoas sign indicative of?

A

appendicitis

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11
Q

obturator sign

A

patient’s thigh is flexed to a right angle and gently rotated, first internally and then externally

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12
Q

what is obturator sign indicative of?

A
  • appendicitis
  • diverticulitis
  • PID
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13
Q

management of abdominal pain

A
  • stabilize
  • NPO
  • IV hydration
  • analgesics
  • antiemetics
  • consult
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14
Q

indications for admission of abdominal pain

A
  • toxic appearance
  • unclear diagnosis
  • inability to exclude serious etiology
  • intractable pain or vomiting
  • altered mental status
  • inability to follow discharge or F/U instructions
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15
Q

volvulus

A

torsion of a segment of the bowel

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16
Q

types of volvulus

A
  • MC sigmoid
  • cecal
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17
Q

t/f some volvulus may reduce spontaneousley

A

true

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18
Q

pathophys of sigmoid volvulus

A

air filled loop of the sigmoid colon twists about its mesentery

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19
Q

risk factors for sigmoid volvulus

A
  • long, redundant sigmoid colon w/ a narrow mesenteric attachment
  • chronic fecal overloading from constipation
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20
Q

clinical presentation of sigmoid volvulus

A

insidious onset of slowly progressive abdominal pain, nausea, abdominal distention, and constipation

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21
Q

vomiting in volvulus usually occurs…

A

several hours after onset

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22
Q

PE of sigmoid volvulus

A
  • abdominal distention and tympany
  • tenderness to palpation
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23
Q

diagnosis of sigmoid volvulus

A

abdominal CT showing whirl patterns and birds beak

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24
Q

imaging used for volvulus when there isnt access to CT

A

radiographs

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25
management of sigmoid volvulus
* reduce volvulus * IV fluids * endoscopic detorsion with rigid sigmoidoscope * surgical exploration with gangrene
26
cecal volvulus
torsion of a mobile cecum and ascending colon
27
in cecal volvulus, rotation occurs around the...
ileocolic blood vessels
28
risk factors for cecal volvulus
* pregnancy * tumors * exertion * violent coughing * infections * weakness of colon muscle
29
clinical findings of cecal volvulus
gradual onset of steady abdominal pain with episodic cramping due to peristalsis
30
PE of cecal volvulus
* distended and tympanic abdomen * tenderness to palpation * fever * hypotension
31
diagnosis of cecal volvulus
* initially, a plain radiograph will be done * CT is first line and confirmatory
32
results of plain radiography of cecal volvulus
* coffee bean sign * comma sign
33
results of CT with cecal volvulus
whirlwind sign
34
results of barium GI series for cecal volvulus
birds beak
35
t/f cecal volvulus can not be detorsed endoscopically
true
36
management of cecal volvulus stable without bowel compromise
open surgical detorsion, then iliocecal resection
37
management of cecal volvulus hemodynamically unstable without bowel compromise
cecopexy after detorsion
38
t/f you should detorse when the patient has bowel compromise
false
39
management of cecal volvulus stable with bowel compromise
ileocolic resection and anatamosis
40
management of cecal volvulus unstable with bowel compromise
resection of compromised bowel
41
MC cause of intestinal obstruction between 6 months and 3 years
intussesception
42
intussusception
portion of the bowel is telescoped into another segment
43
MC type of intussusception
ileocolic
44
as the intussusception develops, the mesentery is dragged into the bowel, leading to...
development of venous and lymphatic congestion with resulting edema
45
clinical presentation of intussusception
* severe pain in a perviously healthy child * currant jelly stool * sausage shaped mass in the right side of the abdomen
46
diagnosis of intussusception
US
47
what do you see on US for intussusception?
bullseye whirlwind one more thing? snails shell? idk
48
confirm diagnosis of intussusception
barium enema
49
t/f the barium enema is curative as well as diagnostic for intussusception
true
50
management of intussusception
* nonoperative reduction * surgical consult if severe
51
nonoperative reduction
hydrostatic or pneumatic pressure by enema
52
fluoroscopy
* type of medical imaging that shows a continuous xray image on monitor * can be pneumatic or hydrostatic
53
sonographic
uses US and hydrostatic technique to provide retrograde pressure
54
what type of intussusception management has higher success rates?
pneumatic
55
MC abdominal surgical emergency
appendicitis
56
etiology of appendicitis
fecalith causing obstruction leading to increased intraluminal pressure
57
clinical presentation of appendicitis
* vague, colicky, abdominal pain * RLQ
58
PE of appendicitis
* localized tenderness with guarding in RLQ * mcburneys point tenderness * rovsing sign * psoas sign * obturator sign * heel slap sign
59
McBurney's point tenderness
tenderness to palpation in the mid-point of the right lower quadrant (RLQ) which can indicate appendicitis
60
diagnosis of appendicitis
CT (US in pregnant or child)
61
management of appendicitis
* laparoscopic appendectomy * hydrate with IV fluids * antibiotics (cefotixin or cefotetan for surgical. metro+rocephin if non surgical.
62
etiology of toxic megacolon
lethal complication of inflammatory bowel disease or infectious colitis
63
toxic megacolon is a nonobstructive colonic dilation of at least ...... + .......
6cm and systemic toxicity
64
what inflammatory bowel disease is toxic megacolon related to?
chrons
65
hallmark of toxic megacolon
* severe inflammation extending into the smooth muscle layer * paralyzing the colonic smooth muscle and leading to dilation
66
clinical findings of toxic megacolon
* s/s of colitis resistant to therapy * severe bloody diarrhea * malaise * abdominal pain and distention
67
PE of toxic megacolon
* altered mental status * fever * tachycardia * lower abdominal pain and tenderness
68
diagnosis of toxic megacolon
CT
69
criteria for toxic megacolon diagnosis
* radiographic evidence * at least 3 of the following (fever, HR>120, elevated neutrophils, and anemia) * at least one of the following (dehydration, altered mental status, electrolyte disturbances, hypotension)
70
what part of the colon is most dilated in toxic megacolon?
transverse or right
71
treatment of toxic megacolon
* complete bowel rest * NG tube * IV fluids * IV steroids * surgical consult
72
Acute mesenteric ischemia
sudden onset of small intestine hypoperfusion
73
MC artery affected by acute mesenteric ischemia
superior mesenteric artery
74
clinical features of acute mesenteric ischemia
abdominal pain out of proportion to PE
75
PE of acute mesenteric ischemia
* abdominal distention * absent bowel sounds * occult blood in stool * feculent odor to breath
76
labs for acute mesenteric ischemia
metabolic acidosis
77
imaging for acute mesenteric ischemia
* CT/MRI performed first * definitive mesenteric arteriography
78
what does the mesenteric arteriography show in acute mesenteric ischemia ?
* narrowing/spasming of mesenteric arteries * reduced filling * irregularity of arterial branches
79
treatment of acute mesenteric ischemia
* pain control * hemodynamic support * anticoagulation * vasodialtor
80
Upper GI bleed
originating proximal to the ligament of treitz
81
MC cause of upper GI bleed
PUD
82
lower GI bleed
Distal to the ligament of Treitz
83
MC cause of lower GI bleed
diverticulosis
84
what do each of the following indicate? * hematemesis * melena * hematochezia
* hematemesis: source is proximal to the right colon * melena: upper GI bleed * hematochezia: coming from the colon/rectum
85
emergency stabilization of GI bleed
* ABCs * fluids * NG tube
86
hernia
protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it
87
how are hernias typically classified?
location or etiology
88
cause of umbilical hernia
increased intra-abdominal pressure
89
risk factors for umbilical hernias
* multiple pregnancies * ascites * obesity * large intra-abdominal tumor
90
indications for emergent repair for an umbilical hernia
incarceration and strangulation
91
treatment of umbilical hernia
* surgical repair * open repair * mesh laparoscopic
92
incisional hernia
herniation through a previous surgical wound
93
risks for incisional hernia
* poor surgical technique * obesity * age * post-op wound infection
94
t/f hernias can cause bowel obstruction
true
95
concerning clinical features for strangulation
* firm, incarcerated hernia * severe tenderness on exam * redness and other discoloration of the overlying skin
96
if the patient.... then the symptoms can be controlled by an abdominal binder
* doesn't require emergency surgery * unwilling to undergo surgery * poor surgical risk

Internal Med EOR (18 decks)

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