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Elaina: Emergency 2 > ED 2 Abdomen > Flashcards

ED 2 Abdomen Flashcards

(60 cards)

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1
Q

crescendo-descrescendo crampy pain should make you think of what abdominal emergency?

A

obstruction

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2
Q

localized, then generalized severe, explosive pain should make you think of what abdominal emergency?

A

perforation

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3
Q

progressive, worsening severe pain should make you worry about what abdominal emergency?

A

ischemic necrosis

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4
Q

where will pain of cystitis or salpingitis refer to?

A

low back

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5
Q

where will pain of pancreatitis, PUD, or cholecystitis refer to?

A

mid-back

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6
Q

pain of diaphragmatic irritation will refer where?

A

shoulder

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7
Q

ABRUPT, localized, unrelieved epigastric pain preceded by violent emesis should make you think what?

A

esophageal perforation

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8
Q

what will you note on auscultation of a patient with esophageal perforation?

A

may have pneumomediastinum

will have subcutaneous emphysema (snap, crackle, pop)

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9
Q

what is the most common cause of esophageal perforation?

A

50-60 percent iatrogenic

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10
Q

what GI condition is characterized by periodic pain that awakens the patient at night, often worsened with food?

A

gastric ulcer

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11
Q

risk factors for gastric ulcer?

A

heavy NSAID, ASA, ETOH, smoking

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12
Q

gastric ulcers are usually considered benign abdomens, unless they perforate. how will they present?

A

hematochezia

epigastric tenderness

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13
Q

how do we treat gastric ulcers?

A

GI cocktail! IV PPI/H2 blocker

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14
Q

hematemesis after repetitive vomiting is often due to what?

A

mallory weiss-tear

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15
Q

what is the difference between an esophageal perforation and a mallory weiss tear?

A

esophageal perforation=rip esophagus from stomach

mallory weiss=partial thickness tear at esophogastric junction

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16
Q

how do we DX and TX a mallory weiss tear?

A

will need EGD, but not emergently

most do well with conservative TX

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17
Q

what is the term for a gallbladder stone? how do these patients typically present?

A

cholelithiasis

often asymptomatic; found incidentally…usually a benign abdomen

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18
Q

what is the best test for DX cholelithiasis?

A

ultrasound

all labs should be normal

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19
Q

if patient with cholelithiasis were symptomatic, what would they complain of? how do we TX?

A

RUQ pain esp after fatty meal, may radiate to chest or right shoulder

will NOT be sick or have fever!

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20
Q

a positive murphy’s sign should make you think of what abdominal DX?

A

cholecystitis

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21
Q

how will a patient with cholecystitis present?

A

fever, chills, vomiting, POSTPRANDIAL severe pain

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22
Q

what are complications of untreated cholecystitis?

A

empyema, gangrenous gallbladder, perforation

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23
Q

how do we manage cholecystitis in the ED?

A

keep patient NPO as you prep them for cholecystectomy

can TX symptoms with IV mefoxin, nausea meds, pain meds

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24
Q

intermittent, colicky pain in the RUQ that may radiate to the back should make you think of what? what on PE will clue you into this DX vs. cholecystitis?

A

choledocolithiasis

may be jaundiced!

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25
what will labs look like in a patient with choledocolithiasis?
elevated hepatic function panel, bilirubin
26
why must we emergently consult surgery for choledocolithiasis? what can and does it often lead to?
MC pancreatitis also sepsis, obstructive jaundice
27
what is the DX and TX of choice for choledocolithiasis?
ERCP emergently! keep them NPO, but give IV narcotis, fluids, pain meds
28
most common cause of pancreatitis?
alcoholism
29
severe, unrelenting epigastric pain that radiates to the back and is worse when laying down should make you worry about what?
acute pancreatitis
30
what two signs on PE can predict a very severe attack of pancreatitis?
grey-turner's and cullen's sign
31
what will the abdominal exam of a patient with acute pancreatitis look/feel/sound like?
abdominal distension NO rebound tenderness guarding on exam decreased to no bowel sounds
32
which two labs are the MOST important in diagnosing acute pancreatitis?
1) lipase: 3x normal and 100 percent specific/sensitive | 2) ALT 3x normal and 95% positive predictive value for biliary pancreatitis
33
what is the name of the criteria we use for prognosis of pancreatitis?
ranson's criteria
34
TX of acute pancreatitis? (4)
1) NPO!! 2) IV hydration (LARGE amnt of fluid) 3) IV nausea meds 4) IV pain meds
35
when is the only indication for ABX in treating pancreatitis?
if pancreas is necrotic
36
old man with a history of ATHEROSCLEROSIS presents with sudden-onset severe belly pain that radiates to his back and groin...what is it until proven otherwise?
AAA
37
what will PE of patient with an intact AAA look like?
1) palpable, pulsatile, non-tender mass | 2) may hear a bruit
38
what may PE of a patient with a ruptured AAA look like?
1) vital signs initially normal, then tank fast 2) grey-turners and cullen's sign 3) femoral pulses asymmetric!
39
how fast does an AAA grow per year?
1-1.5 cm
40
if patient's AAA is asymptomatic and less than 5 cm, what do you do?
wait, serial ultrasounds
41
patient with abdominal pain with history of Afib or hypercoagulable conditions should make you worry about what!
ischemic bowel!
42
what is the classic presentation of ischemic bowel?
periumbilical pain out of proportion to exam also N/V, diarrhea may have fever if perforation
43
what is the definitive study for ischemic bowel done in the ED?
CT with oral AND IV contrast!
44
how will we manage a patient with ischemic bowel in the ED?
1) NPO, NG tube while waiting surgery 2) ABX such as zosyn 3) GET TO SURGERYYY
45
what is the term for inflamed lymph nodes in the mesentery? what else will these younger patients present with?
mesenteric adenitis fever, nausea, vomiting
46
who is appendicitis very rare in?
kids under 5
47
which 4 signs will likely be positive in patient with appendicitis?
1) rovsings: push in LLQ, pain in RLQ on rebound 2) heel strike: lift leg, bang on heel, ow 3) obturator: flex at knee while on back, pain in RLQ 4) psoas: extend leg straight backwards while on side, pain in RLQ
48
when palpating a patient with appendicitis, what will you note?
guarding | rebound tenderness
49
how do we definitively diagnose appendicitis?
CT with PO and IV contrast
50
how will we manage appendicitis in the ED?
1) NPO 2) pain and nausea meds IV 3) IV mefoxin 4) surgery
51
bacterial overgrowth by ____ occurs in 80 percent of appendicitis patients?
e. coli
52
most common sites for ischemic bowel to occur? (3)
watershed areas of intersecting circulation (splenic flexure, rectosigmoid junction, ascending colon)
53
where do 90 percent of diverticulitis cases occur?
sigmoid colon
54
definitive diagnosis of diverticulitis? how do we treat?
CT with contrast pain and nausea meds cipro and flagyl ABX!
55
MC cause of diverticulitis?
fecolith in diverticulum causes invasion of colonic bacteria
56
what is your typical presentation of diverticulitis?
older person | constant LLQ pain, fever, constipation, anorexia
57
how will the abdomen appear in someone with a bowel obstruction? what will bowel sounds sound like?
crampy, distended, diffusely tender abdomen hyperactive bowel sounds
58
how do we diagnose a bowel obstruction?
KUB upright! to see air fluid levels
59
management of bowel obstruction?
NPO NG tube to wall suction pain meds surgery consult
60
diarrhea and rectal bleeding with blood/mucus should make you think of what?
ulcerative colitis

Elaina: Emergency 2 (11 decks)

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