Acute Abdomen Emergencies Flashcards Preview

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Flashcards in Acute Abdomen Emergencies Deck (167)
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1

Extra-abdominal systems that can cause abdominal pain

Cardiac, thoracic, metabolic, hematologic, infections or others

2

What are life threatening causes of abdominal paint that can't be missed?

Abdominal aortic aneurysm and dissection
GI perforation
Incarcerated hernia
Acute bowel obstruction
Mesenteric ischemia
Ectopic pregnancy
Placental abruption
Splenic rupture

3

#1 cause of abdominal pain in ER

Appendicitis

4

Red flags in the history of acute abdominal pain

Age >65
Alcoholism
Immunocompromised
CV disease
Comorbidities
Prior surgery
Recent GI instrumentation
Early pregnancy

5

Red flags in the pain characteristics of acute abdominal pain

Acute onset
Significant pain at onset
Pain followed by emesis
Constant pain for <2 days

6

Red flags on PE for acute abdominal pain

Rigid abdomen
Signs of shock (hypotension and tachycardia)
Involuntary guarding

7

What cause of abdominal pain radiates to right subscapular area?

Gallbladder disease

8

What cause of abdominal pain radiates to shoulders

Perforated duodenal ulcer

9

What cause of abdominal pain radiates to testicles?

Ureteral obstruction

10

What cause of abdominal pain radiates to epigastric area, jaw, neck or UE?

MI

11

What cause of abdominal pain radiates to low back?

GYN

12

How does visceral abdominal pain present?

Dull, aching and colicky
Poorly localized
Distention, ischemia, inflammation or spasm of a hollow organ

13

How does parietal abdominal pain present?

Sharp
Well localized
Peritoneal irritation, ischemia, inflammation, stretching of parietal peritoneum

14

What are aggravating and alleviating factors to always ask about with abdominal pain?

BM
Eating
Antacids
Exertion

15

What patient is restless and can't sit still?

Renal colic

16

What patient is lying perfectly still and supine?

Peritonitis

17

Common causes of hypoactive or absent bowel sounds

Peritonitis or small bowel obstruction

18

Common causes of hyperactive bowel sounds

Blood or inflammation in the GI tract

19

What must be done with men and women that present with lower quadrant/hypogastric pain?

Testicular/pelvic exam

20

Initial diagnostics for abdominal pain

CBC with diff
BMP/CMP
AST, ALT, alk phos, total bilirubin
Lipase/amylase
Lactic acid
UA
Urine pregnancy test
Stool guaiac

21

What is lactic acid a marker of?

Tissue hypoxia

22

What do you use plain films for?

Dilated bowel loops, air fluid levels, free air, constipation or foreign body

23

What is a CT without contrast used for?

Renal stone or obstruction

24

What is a CT with IV contrast used for?

Ischemic bowel, diverticulitis, peritonitis or AAA

25

What is a CT with oral contrast used for?

Really skinny adults or kids

26

When is an u/s used?

Gall bladder, free fluid, renal, ovarian or testicular

27

General management for abdominal pain

IV fluids
Anti-emetics
Analgesia
Anti-pyretic
NPO
Abx if indicated
Consults, monitor for sepsis and shock, repeat exa, and vitals

28

Reasons for urgent surgical referral

Obstruction
Perforation
Peritonitis
Ischemic bowel
Dissection
Rapid sx evolution (increasing TTP/rigidity, pain is severe)

29

Who may have atypical presentations related to abdominal pain?

Elderly
Diabetic
Immunocompromised

30

Causes of GI perforation

Spontaneous due to inflammatory changes (gall bladder, appendix)
Bowel obstruction
Trauma
Instrumentation