- CBC: reduced platelets and RBC - CMP: o AST/ALT will not be sig increased, BUN and Cr WNL o Decreased albumin, elevation of bilirubin - PT and PTT: can be effected?

Acute Abdomen Flashcards by Kathleen McKenzie

How to differentiate between peritoneal and visceral pain

Visceral: crampy, not localized

Peritoneal: localized pain

How well did you know this?

Not at all

Perfectly

Risk factors for severe GI bleeding

Etoh: esophageal varices
Gastritis: perforated ulcer
Bowel obstruction, etc. → perforation
Hemorrhoids
History of GI bleed
Aortoenteric fistula (Hx of AAA)
Hx diverticulosis
NSAID use
Oral anticoagulation
Liver dz
Abd surgery

How well did you know this?

Not at all

Perfectly

Cirrhosis PE findings

Diffuse abd pain and swelling, ascites
Hypoactive and distant bowel sounds
Bilateral LE edema
Telangiectasias, caput medusa
Asterixis
Weak, fatigue, ill feeling

How well did you know this?

Not at all

Perfectly

Cirrhosis Lab w/u

CBC: reduced platelets and RBC
CMP:
o AST/ALT will not be sig increased, BUN and Cr WNL
o Decreased albumin, elevation of bilirubin
PT and PTT: can be effected?

How well did you know this?

Not at all

Perfectly

Triad of sx associated tis AAA

severe abd/flank pain
hypotension
pulsatile mass

How well did you know this?

Not at all

Perfectly

Non-contrast XR

- pneumoperitoneum

Double wall sign (can see both sides of the bowel clearly)
Falciform ligament sign
Air over the liver (should look like a solid organ, not like air)
Lateral decubitus (XR or CT): air between liver and wall

How well did you know this?

Not at all

Perfectly

Non-contrast XR

- small bowel obstruction

Stacked coins
Dilated loops of bowel
“string of pearl” sign: small pockets of gas in fluid in the bowel

How well did you know this?

Not at all

Perfectly

Non-contrast XR

- large bowel obstruction

Colonic distention proximal to the obstruction, distal collapse

How well did you know this?

Not at all

Perfectly

Non-contrast XR

- intussusception

air fluid

target sign US

How well did you know this?

Not at all

Perfectly

Non-contrast XR

- Volvulus

small bowel: corkscrew configuration
cecal: distended loop of large bowel with axis from RLQ to LUQ, haustra usually preserved
sigmoid: dilated colon with loss of haustra, “coffee bean sign” with axis towards LLQ

How well did you know this?

Not at all

Perfectly

Non-constrast XR

- toxic megacolon

dilated colon

- haustra usu less visible

How well did you know this?

Not at all

Perfectly

Acute diverticulitis

- clinical presentation

Case study: BRBPR, LLQ pain, urgency before BM
Abd pain, fever, leukocytosis, gradual onset LLQ pain, constant (not colicky) pain
n/v/d/c and urinary sx can occur (sits next to bladder)

How well did you know this?

Not at all

Perfectly

Acute diverticulitis

- tx

Bowel rest and abx (metro + quinolone, metro + Bactrim, augmentin)

How well did you know this?

Not at all

Perfectly

Ischemic colitis

- clinical presentation

Abd pain
New onset diarrhea, Hematochezia, TTP
May not be severely ill-appearing
Have to CT to differentiate from diverticulitis
Fever, tachycardia, TTP, positive blood on DRE
Elevated WBC count?
Dx: colonoscopy w/o bowel prep, XR “thumbprinting”

How well did you know this?

Not at all

Perfectly

Ischemic colitis

- treatment

IV fluid
bowel rest
abx
Sx if severe

How well did you know this?

Not at all

Perfectly

Acute cholecystitis

- clinical presentation

Severe pain, RUQ but can start mid-epigastric. May also refer to right shoulder. Constant for >6 hours (vs. intermittent biliary colic)
RUQ TTP, + Murphy’s sign, guarding, rebound
Anorexia, malaise, n/v, fever
Signs of inflammation (leukocytosis, fever, etc.) and mild elevation of LFTs
US: stones, gallbladder wall thickening, pericholecystic fluid (acute sign, vs. chronic)

How well did you know this?

Not at all

Perfectly

Biliary colic

- clinical presentation

Gallbladder neck is impacted by a gallstone
No inflammatory response
Pain (sudden, dull, colicky) d/t contraction of gallbladder against occluded neck. Usually RUQ, radiation to epigastrum or back
Pain usu precipitated by consumption of fatty food
Often n/v
Might pass stone, if it gets stuck in common bile duct: pancreatitis.
Need an US

How well did you know this?

Not at all

Perfectly

What w/u is needed to differentiate biliary colic from acute cholecystitis

- US
Inc. in cholecystitis:
- alk phos
- bilirubin
- LFTs slightly elevated

How well did you know this?

Not at all

Perfectly

Choledocholithiasis

- clinical presentation

Cholecystitis but the stone is stuck in the duct and causing an obstruction
Severe epigastric pain, n/v, no blood, ill appearing, TTP in epigastric region, guarding and rebounding, no distention
Mild elevation of AST, ALT, alk phos (NOT bilirubin), elevated WBC
US: will show the stone

How well did you know this?

Not at all

Perfectly

Cholangitis

- clinical presentation

Study These Flashcards

Medical emergency
Bacteria in duodenum ascends back into common bile duct, usu dt gallstone obstruction
Charcot’s triad: abd pain, fever, jaundice (also hypotension, mental confusion)
Can rapidly progress to septic shock, multiple organ failure
Dx: +WBC and CRP (inflammation), elevated LFTS
Tx: ERCP to remove stone, IV fluids, broad spectrum abx

Acute pancreatitis

- clinical presentatino

Study These Flashcards

Fever, anorexia, n, abd pain (severe and upper abdomen with radiation to back), no v/d
Elevated WBC, slight elevation of LFTs
Gross elevation of lipase and amylase

Acute pancreatitis

- common causes

Study These Flashcards

etoh
gallstones
elevated TG

What is the purpose of the Ranson Criteria?

Study These Flashcards

Help predict mortality related to acute pancreatitis. Used to help determine whether pt should be discharged home

Mesenteric ischemia

- clinical presentation

Study These Flashcards

*Medical emergency, don’t let the gut die!!
Ill appearing: diaphoretic, pain, severe distress (pain out of proportion to exam)
Elevated vitals
Abd: distended, TTP, rigidity, guarding, rebound tenderness
Possible reduced unilateral pulses to LE

Mesenteric ischemia | - dx testing

- WBC elevation | - CTA: reveals stenosis

Peptic ulcer disease | - Clinical presentation

- Burning epigastric pain - N/V - Vomiting red blood - Melanotic stool - Anemia - Perforation - Gastric outlet obstruction

Peptic ulcer disease | - signs of perforation or hemorrhage

- PE and lab signs of blood loss (volume depletion, decreased H&H, etc.) - Perf: Signs of free air in abdomen, usually hypotensive, worry for sepsis

Acute appendicitis - presentation - dx - tx

- periumbilical pain that localizes to McBurney's point - leukocytosis - Dx: CT is best, US if pregnant - tx: surgery

Mallory-Weiss tear - presentation - Dx - Tx

- Usu after bout of vomiting or retching - Increased risk if portal HTN - Usu middle-aged men who present with hematemesis, usually after vom or etoh - Dx: endoscopy - Tx: most stop bleeding spontaneously

Intussusception - clinical presentation - dx - tx

- MC: 3 months ot 6 years - M>F - Sudden, intermittent, colicky abd pain. Episodes of pain usu spontaneously resolve - Current jelly stool (late finding) - Lethargy, v, diaphoresis. No melena, HA, fever, hematemesis - Dx and Tx: air contrast enema o Will have coiled spring appearance o CI to air enema: perforation which needs surgical treatment

Incarcerated hernia | - clinical presentation

- Severe pain, usu acute onset - n/v - Inability to have a BM or bloody stool - signs of infection

Incarcerated hernia | - tx

- surgery | - not sure if she wants more details than this

Dont' forget

to read the required readings too!

workup for GI pain

- CBC - CMP - Lipase - UA - Preg test - cardiac enzymes - ECG - Flat/upright abd x-rays - KUB - CT - US

workup for Gi bleeding

- VITALS!!!! - CBC - PT/INR - PTT - BMP - Stool guiac - CTA/endoscopy

Workup for n/v/d without pain/bleeding

assess fluid volume

GI workup | - radiology

X-rays - Upright and supine: air-fluid levels, free air - KUB (upright chest, upright abdomen, and supine abdomen): gallstones, kidney stones, masses, perforations, obstruction - Lateral decubitus: eval for free air (pneumoperitoneum) * usually left side down

Lab and/or radiologic w/u | - cholelithiasis

- US - HIDA scan - ERCP (also removes the stones) - CBC: slight WBC elevation

Lab and/or radiologic w/u | - acute cholecystitis

- US: pericholecystic fluid (indicates acute not chronic) - HIDA scan: failure of isotope to appear in GB in 4 hours is high suspicious - Lipase

Lab and/or radiologic w/u | - Cholangitis

- ERCP (with intent to remove stone), secondary US and MRCP - Elevated WBC - Elevated CRP - Elevated LFTs - Elevated bilirubin * *may look like hepatitis early on

Lab and/or radiologic w/u | - acute pancreatitis

- Elevated lipase (3X) and amylase - Hyperglycemia or hypocalcemia - Leukocytosis - Elevated bilirubin, alk phos, LFTs - US: gallstones and pancreatic edema - CT: eval extent and complications

Lab and/or radiologic w/u | - chronic pancreatitis

ERCP is GS test

Lab and/or radiologic w/u | - appendicitis

- CT abdomen and pelvis W/contrast | - US: pregnant and children

Lab and/or radiologic w/u | - PUD

- Endoscopy | - Look for signs of blood loss

Lab and/or radiologic w/u | - bowel obstruction

- CT abd and pelvis w/contrast | - XR: AP supine (bowel loops), upright abd (air fluid levels), upright chest (free air)

Lab and/or radiologic w/u | - Intussusception

Air contrast enema: dx and tx

Lab and/or radiologic w/u | - Mesenteric ischemia

CTA of abdomen

Lab and/or radiologic w/u | - AAA

- US | - CT abd/pelvis

Acute Abdomen Flashcards

(48 cards)