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Acute Abdominal Pain Flashcards

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1
Q

Is involuntary guarding concerning and what does it suggest?

A
  • Yes it is concerning

- Suggest peritonitis

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2
Q

How do you perform a psoas sign?

A

Roll onto left side, extend leg back

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3
Q

How do you perform a obturator sign?

A

Flex and externally rotate right leg

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4
Q

How do you perform a Rovsing’s sign?

A

Push in LLQ, pain in RLQ

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5
Q

How do you perform a Reverse Rovsing’s? and what diagnosis do we think when this test is positive?

A
  • Push in RLQ, pain in LLQ

- Diverticulitis

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6
Q

How do you perform a Murphy’s sign? What diagnosis do we think if this test is positive?

A
  • Pt takes a deep breath, push in RUQ, positive if pt stops inhaling due to pain
  • Cholecystitis
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7
Q

What exam should be done in all males?

A

Testicular test - do not want to miss a testicular torsion

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8
Q

What lab test should you get on every female?

A

UA/HCG for females

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9
Q

Why do you get a CBC?

A
  • Consultants want them, up to 30% of appys have normal WBC
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10
Q

What do you look at when getting a CMP?

A
  • Liver Enzymes
  • Renal fxn: Creatine for CT
  • Electrolytes: hypokalemia can cause an ileus
  • Low bicarb = acidosis
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11
Q

What COAGs do you want to order? and why do you order COAGS?

A
  • INR/PTT
  • Standard pre-op lab
  • Liver disease elevates coags before LFTs
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12
Q

What lab do you order to see pancreatic function?

A
  • Lipase to look for pancreatitis

- Amylase is unnecessary- not sensitive or specific

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13
Q

What type of pts do you order VBG + Lactate? what does the high lactate indaicte?

A
  • Older patients

- High lactate = mesenteric ischemia

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14
Q

Why is a CRP useful?

A
  • Will be increased with appy, helps to differentiate esp. if CBC is normal
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15
Q

What medication is a good option for pain control?

A

Morphine

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16
Q

What is the average loading dose of Morphine?

A

0.1 mg/kg

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17
Q

What dose of morphine do you generally want to start with?

A

4 mg IV

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18
Q

What medication and dose is typically given with Morphine to help with nausea?

A

4 mg IV of Zofran

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19
Q

What is the max dose of morphine in older pts?

A

4mg

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20
Q

What medication and dose can be given if pt is experiencing itching from the Morphine medication?

A

12.5 - 25 mg IV Benadryl

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21
Q

What are considered true allergic rxns to Morphine?

A
  • Swelling of lips, tongue and SOB
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22
Q

What imaging is effective for LUQ pain? and what are you looking for?

A

Rarely requires imaging unless you have a:
- Rigid abdomen
OR
- Suspect a bowel obstruction

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23
Q

What imaging is effective for epiastric pain? and what are you looking for?

A

Rarely requires imaging.

  • May get it for pancreatitis to check for pseudocyst
  • If you find pancreatitis, check a RUQ US for gallstone pancreatitis
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24
Q

What imaging is effective for RUQ pain? and what are you looking for?

A
  • RUQ US

- Cholecystitis

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25
What imaging is effective for RLQ pain? and what are you looking for?
CT w/ contrast or US | - Appendicitis.
26
What imaging is effective for LLQ pain? and what are you looking for?
CT w/ contrast | - Diverticulitis
27
What imaging is effective for flank pain? and what are you looking for?
CT without contrast | - kidney stones
28
What diagnosis should be written on the chart instead of gastritis or gastroenteritis?
- Abdominal pain OR - Vomiting/diarrhea
29
What do you need to have in order to diagnose a pt with gastroenteritis?
Need vomiting AND diarrhea.
30
What causes mesenteric ischemia?
- Clot thrown into mesentery or low flow state | - Classically an older patient with a-fib and pain out of proportion
31
What imaging is needed for mesenteric ischemia?
- CT w/ contrast - Angiogram - MRI
32
You should be suspicious of a bowel obstruction in a pt with what?
- Multiple abdominal surgeries - Diffuse abdominal pain - Vomiting
33
What imaging is needed for a bowel obstruction?
CT w/contrast and PO contrast
34
What imaging is needed for a AAA?
- US (>5cm = surgery) | - CT w/ angio (Test of choice)
35
What is the mortality of a STEMI vs mortality of an elderly pt with abdominal pain?
- STEMI: 8% | - Elderly pt w/ abdominal pain: 10%
36
What should you document in d/c instructions in a pt w/ abdominal pain?
- Return precautions - Document a repeat abdominal exam before discharge - Pt response to meds and f/u with specialist or PCP
37
What should you be sure to ask a female pt in regards to her OB history?
- How many Gs: pregnancies | - How many Ps: live births
38
Pain above the iliac crest indicates what?
Abdominal cause of pain
39
Pain lower towards inguinal ligament indicates what?
Pelvic pathology
40
What labs do you run after performing a pelvic exam?
- Wet-prep - KOH - G/C
41
What are the main steps for a pelvic exam?
- Insert the speculum - Observe for d/c - Examine cervix for lesions - Chaperone should always be present
42
When palpating the cervix and the pt seems uncomfortable/in distress what does this indicate and what should you check?
- Cervical motion tenderness (CMT) | - Adnexa
43
What diagnoses would you suspect that would cause you to order a Transvaginal Pelvic ultrasound?
- Ectopic pregnancy | - Threatened abortion/miscarriage
44
What are S/Sxs of an ovarian torsion?
- Sudden onset of sharp stabbing pain in lower abdomen | - N/V
45
What would a negative pelvic US tell you if you were suspicious of ovarian torsion?
- A negative pelvic US DOES NOT rule out torsion. - Intermittent torsion is possible - Time sensitive diagnosis- ovary salvage rate greatly declines after 4 hours
46
If the US is negative but you have a high suspicion that the pt has ovarian torsion what do you do?
- OB/GYN consult and admission serial abdominal exams | - Most torsions have large cysts but not all
47
What two STDs should you always treat together?
ALWAYS treat for gonorrhea and chlamydia
48
What are the medications and dose for cervicitis? and what are the medications/dose for pts w/ a PCN or cephalosporin allergy?
- Ceftriaxone 125mg IM and 1 gram of azithromycin PO x1 dose | - Allergy: 2 grams azithromycin PO x1 + Zofran
49
Do pts with cervicitis have CMT?
Negative CMT but + swab or suspicion
50
What are the medications and dose for PID?
- Ceftriaxone 250mg IM | - Doxycycline 100mg PO BID for 14 days
51
Do pts with PID have CMT?
Positive CMT
52
What is Fitz-Hugh Curtis?
a PID infxn that has spread to the liver capsule and has caused peri-hepatitis
53
What are the S/Sxs of Fitz-Hugh Curtis? and what are the lab findings
- RUQ pain - R shoulder pain - Labs: elevated LFTs
54
What is the tx plan for a pt with Fitz-Hugh Curtis?
Treat PID and consult OBGYN
55
What are common historical findings in a pt presenting with Tubo-ovarian abscess (TOA)?
- Hx of STDs - Severe or recurrent PID - Usually untreated PID that has formed an abscess.
56
What imaging and tx plan would you get for a pt with TOA?
- Diagnosed with transvaginal US - Tx w/ IV abx - OBGYN consult - Poss surgical drainage
57
What are S/Sxs of Trichomonas?
- Itching - D/c - Dysuria - Dyspaurenia
58
What is seen on the wet prep in a pt w/ Trichomonas?
Motile organism
59
What is a very common PE finding in a pt with Trichomonas?
Strawberry cervix
60
What is the tx for a pt with Trichomonas?
Flagyl (metronidazole): 2 grams PO x1 | - Treat partner as well: men are often asymptomatic
61
What is a potential SE of Flagyl?
Disulfaram reaction = vomiting | - avoid alcohol
62
What is a common sx of bacterial vaginosis?
Malodorous d/c
63
What is seen on the wet prep in a pt with bacterial vaginosis?
Clue cells
64
What causes bacterial vaginosis?
Imbalance/overgrowth of Gardanella Vaginalis
65
Who should you treat in pts with bacterial vaginosis? and what is the medication and dose?
- Tx all symptomatic pts AND pregnant pts | - Flagyl (metronidazole) 2 grams PO x1
66
What are s/sx of candidiasis and what is it usually caused by?
- Itching, burning, d/c | - caused by antibiotics
67
What is seen on the wet prep in a pt w/candidiasis?
Fungal elements
68
What are the medications/dose for a pt w/candidiasis?
- Fluconazole- 150mg PO x1 - Topical for short term - Others: Clotrimazole and Miconazole takes x7 days

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