EM 5 Abdominal Pain (tidbits)

Question 1

Most common surgical entity in elderly patients

Answer 1

Cholecystitis

Question 2

Describe an ileus abdominal x-ray

Answer 2

dilated loops of small and large bowel WITHOUT air fluid levels

Question 3

an inflammed appendix will look >__mm in diameter?

Answer 3

> 6 mm

Question 4

Sudden severe abdominal pain that leaves a patient looking ill & laying still is seen in:

Answer 4

Perforated peptic ulcer

Question 5

What is Kehr’s sign?

Answer 5

referred acute pain in shoulder tip due to blood/irritants in peritoneal cavity (perforated peptic ulcer, cholecystitis)

Question 6

Dx:
Sudden or explosive onset of severe
Agonizing mid or lower abdominal pain
Shock
Nausea and vomiting are common
Abdomen rigidity
High fever with leukocytosi

Answer 6

Perforation of bowel

Question 7

Tx of Diverticulitis

Answer 7

Ciprofloxacin & Metronidazole.

Question 8

What would you see when doing RUQ U/S on cholecystitis?

Answer 8

GB wall thickening (distension) > 3mm, pericholesystolic fluids,

Question 9

Esophageal varices are due to ___ caused by ___

Answer 9

portal HTN caused by alcoholism

esoph veins –> l gastric vein –> hepatic portal vein

Question 10

Tx of esophageal varices

Answer 10

Sengstaken-Blakemore tube. Triple lumen & double balloon

Question 11

What describes this:

Patient has diarrhea followed by hemolytic anemia, thrombocytosis, & renal failure.

Answer 11

E coli 0157:H7 invasive diarrhea

Question 12

Prodrome of sx of E coli 0157:H7 invasive diarrhea (4)

Answer 12

diarrhea followed by hemolytic anemia, thrombocytosis, & renal failure.

Question 13

Tx of food bolus impaction

Answer 13

Glucagon (relaxes smooth muscle including LES)