GI emergencies/acute abdomen COPY

Question 1

GI emergencies can either be _____ or ______

Answer 1

bleeding or pain

Question 2

important causes of acute abdomen are ____ or _____, both of which are potentially life threatening!

Answer 2

perforation, obstruction

Question 3

what is the most frequently mentioned reason for patients visiting the ED?

Answer 3

abdominal pain

Question 4

ER patient with abdominal pain: ___% will need a surgical procedure

Answer 4

15-30%

higher if elderly

Question 5

when thinking through a patient with belly pain, one major consideration is what?

Answer 5

the anatomy!

Question 6

always consider ____ for any pain waist to chin

Answer 6

MI

Question 7

what things may cause abd. pain radiating to the back?

Answer 7

this pain is near the peritoneum..

diaphragmatic irritiation, cholecystitis, pancreatitis, gastritis/PUD, painful reflux

Question 8

itussusception happens to pt at what age?

Answer 8

children under 2 years old

Question 9

boy, <2yo with BAD intermittent abdominal pain, likely has?

Answer 9

intussusception

Question 10

intussusception causes what characteristic symptoms?

Answer 10

bad intermittent abd pain, screaming, abd distension, vomitting, current jelly stools

Question 11

intussesception pain may be what type of pain?

Answer 11

ischemic or from obstruction

Question 12

what causes intusesception?

Answer 12

worms (parasites), idiopathic

Question 13

what is intussesception?

Answer 13

telescoping of part of the gut into another part- often ileum into the cecum

Question 14

what four things must you consider in post-pubertal girls with abd pain?

Answer 14

ruptured ectopic, twisted ovary, PID (pelvic inflammatory disease), endometriosis

Question 15

nonspecific abdominal pain with benign exam, what could be a common cause? what if its cyclic in a female? recurrent but doesn’t come with eating?

Answer 15

common: IBS
cyclic: endometriosis
recurrent but not with eating: occult cholecystitis

Question 16

most common surgical Dx for adults with abd pain

Answer 16

appendicitis, cholecystitis, bowel obst., perforated ulcer, pancreatitis

Question 17

at what age ranges do people generally get appendicitis?

Answer 17

adolescent and adult (younger than 50)

Question 18

how does appendicitis present?

Answer 18

epigastric pain migrating to RLQ, anorexia, SIGNS OF PERITONEAL IRRITATION (rebound tenderness, referred tenderness)

Question 19

rebound tenderness and referred tenderness are signs of what?

Answer 19

peritoneal irritation

Question 20

cough pain is a sensitive way to note _____ without putting the patient through testing.

Answer 20

rebound tenderness

Question 21

appendicitis is a ____ Dx but …

Answer 21

clinical Dx but most surgeons will want imaging before surgery.

Question 22

nonoperative txt option increasingly for ______ appendices

Answer 22

non-perforated

*perforated will ALWAYS need surgery

Question 23

positive CT finding of appendicitis shows…

Answer 23

thickened appendix and cecum wall

Question 24

peptic ulcer- how does it present?

Answer 24

eipgastric pain that comes and goes, night pain awakening, melena

Question 25

peptic ulcer: if its perforated what will that cause? What txt will this need?

Answer 25

unrelenting pain that radiates to back, free air under diaphragm. txt: surgery and Abx for anaerobes

Question 26

what are the 5 Fs for? what are they?

Answer 26

Cholelithiasis (biliary tract disease) | fat, forty, female, fertile, flatulent

Question 27

Dx for cholelithiasis

Answer 27

US

Question 28

cholelithiasis: emergent when...

Answer 28

fully obstructing or severe cholecystitis | * will require surgery

Question 29

what is pain with biliary tract disease like?

Answer 29

crampy/colicky, RUQ, triggered with eating

Question 30

acute pancreatitis is usually caused by ____ for males and ____ for females?

Answer 30

alcohol- males | gallstones- females

Question 31

labs for acute pancreatitis show what?

Answer 31

elevated lipase and amylase (lipase more indicative)

Question 32

txt for acute pancreatitis

Answer 32

these patients are VERY SICK. NPO, pain control - surgery generally avoided

Question 33

ureteral colic presents in who? what symptoms?

Answer 33

middle-aged men, acute onset FLANK PAIN, radiates to groin, cant lie still- writhing in pain.

Question 34

acute pancreatitis pt vs ureteral colic pt

Answer 34

ureteral colic: writhing in pain | acute pancreatitis: in pain, can't move

Question 35

perforated viscus is usually from what? what are the risk factors? what is perforated viscus?

Answer 35

peritonitis (inflammation of peritoneum) risk factors: PUD, diverticulitis, mesenteric ischemia it is direct spillage of luminal contents into peritoneum

Question 36

symptoms of perforated viscus

Answer 36

tachycardia, diffuse guarding, rebound--> board like rigid abdomen.

Question 37

perforated viscus is most dangerous if...

Answer 37

air under the diaphragm! send to OR!

Question 38

what is an intestinal obstruction? what is it usually a consequence of?

Answer 38

failure of passage of intestinal contents, usually from mechanical obstruction or adynamic ileus (when gut stops contracting)

Question 39

#1 cause of obstruction

Answer 39

adhesions from surgery

Question 40

tumors, intussusception and volvulus can all cause?

Answer 40

obstruction

Question 41

what is a volvulus? who does this usually happen to?

Answer 41

generally referring to a sigmoid volvulus (most common)- sigmoid gets tangled up. usually happens in older people b/c the sigmoid elongates with age.

Question 42

proximal volvulus vs distal volvulus: what are the symptoms?

Answer 42

proximal- vomiting | distal- distention and pain

Question 43

intestinal obstructions happen to what age groups?

Answer 43

infants (intussusception) and elderly (volvulus)

Question 44

obstructions with adhesions, hernias, masses, abscesses in the elderly... what should you think about?

Answer 44

cancer!

Question 45

obstruction xray imaging will show what?

Answer 45

xray: air/fluid levels and bowel loops

Question 46

what can you txt a volvulus with?

Answer 46

barium enema- it helps unwrap it. ( a shorterm fix) | surgery (a longterm fix)

Question 47

"beaked" appearance of rectosigmoid junction on a barium enema indicates what?

Answer 47

sigmoid volvulus

Question 48

symptoms of volvulus

Answer 48

crampy abd pain that comes and goes, constipation high-pitched bowel sounds vomiting or distention (depending on proximal vs distal location)

Question 49

intestinal ischemia from volvulus can lead to ... (Weeds)

Answer 49

intestinal ischemia leading to edema, petechial hemorrhages, necrosis, gangrene, perforation.

Question 50

best imaging for volvulus? what do you see?

Answer 50

CT- shows mural edema, necrosis as obstruction persists (bowel wall thickening- means ischemia) if theres a perf you see free air

Question 51

xray of obstruction/volvulus may show what kind of pattern?

Answer 51

"stair-step" of gas-filled loops

Question 52

what do you need for Dx of obstruction?

Answer 52

symptoms plus suggestive imaging

Question 53

small bowel is responsible for ___% of ___ Abs. why is this significant for obstructions?

Answer 53

90% of H2O abs. | why small bowel obstruction can be HIGHLY lethal

Question 54

stretching of the small intestine wall reduces _____ and ______ into the bloodstream

Answer 54

reduces flux of water and ions into the bloodstream. | less absorbption

Question 55

txt for small bowel obstruction

Answer 55

- volume and electrolyte replacement (monitored closely) - decompression with N/G tube - close observation - probably surgery

Question 56

who presents with leaking AAA (abd. aortic aneurysm)

Answer 56

med with CVD risk

Question 57

how does leaking AAA present?

Answer 57

asymptomatic till rupture then TEARING bad pain, can radiate all over trunk. on exam you can usually feel the pulsatile mass

Question 58

Dx for leaking AAA

Answer 58

US imaging

Question 59

significant belly pain in the ____ is rarely benign

Answer 59

ELDERLY!

Question 60

how does mesenteric ischemia present?

Answer 60

SEVERE pain, otherwise unimpressive PE | normally elderly maybe with atherosclerotic disease

Question 61

pain out of proportion to the exam in an older person is ____ until proven otherwise

Answer 61

VASCULAR- (MI or mesenteric ischemia)

Question 62

what is diverticulitis?

Answer 62

pouches off the colon that can become infected, inflamed and bleed

Question 63

painless rectal bleeding? think...

Answer 63

diverticulitis!

Question 64

fever, even if low, could mean bad things like...

Answer 64

appendicitis or cholecystitis | - fever can be deceiving especially in older pts

Question 65

lipase labs for what?

Answer 65

pancreas issues

Question 66

best imaging for abd pain

Answer 66

US (Xray, CT, other radiology are only good if other things are positive) CT good for appendicitis Dx and pre-surgery

Question 67

_____ has reduced surgeries on normal appendices

Answer 67

CT scan