Acute Abdomen

Front 1

most common emergency surgical admit

Back 1

acute abdomen

Front 2

definition of acute abdomen

Back 2

abdominal pain + peritoneal signs
rigidity, tenderness, guarding
(requires surgery)

Front 3

abdominal pain
visceral vs somatic

Back 3

visceral-organs-distention/traction/inflammation/ischemia

somatic-parietal layer-sharp/localized (irritation of peritoneum)

Front 4

right shoulder pain =

Back 4

diaphragm

Front 5

right subscapular pain =

Back 5

biliary pain

Front 6

if abdominal rigidity, then.....

Back 6

go straight to the OR

Front 7

acute abdomen: motionless

Back 7

peritonitis

Front 8

acute abdomen: restless

Back 8

urinary colic or
intestinal colic

Front 9

acute abdomen: writhing

Back 9

mesenteric ischemia

Front 10

acute abdomen: flexed

Back 10

pancreatitis

Front 11

acute abdomen: jaundauce

Back 11

biliary obstruction

Front 12

acute abdomen: dehydration

Back 12

SBO or
peritonitis

Front 13

ominous sign on PE of abdomen

Back 13

absent BS

Front 14

Diff Dx: RUQ pain

Back 14

biliary colic, acute cholecystitis, acute hepatitis, right pylonephritis, CHF, retrocecal appendicitis, RLL PNA

Front 15

Diff Dx: LUQ pain

Back 15

splenic rupture, fractured ribs, pancreatitis, gastritis, PUD, PNA

Front 16

DIff Dx: RLQ pain

Back 16

acute appendicitis, mesenteric adentitis, right renal colic, torsed right testes/ovary, Crohns dz, ruptured follicle, ruptured ectopic, PID

Front 17

DIff Dx: LLQ pain

Back 17

diverticular dx, acute urinary retention, IBD, large bowel obstruction, left renal colic, torsion of testes/ovary, ruptured follicle, ruptured ectopic, PID

Front 18

Diff Dx: periumbilical pain

Back 18

gastroenteritis, constipation, IBD, early appendicitis, SBO, ischemic bowel

Front 19

abdominal series indications- highest yield with presentation suggestive of__________ or _____________.

yield is higher/lower in the elderly

Back 19

air or
obstruction

(if free air contact surgeon)

higher

Front 20

3 views for Plain series xray in acute abdomen

Back 20

upright chest
upright abdomen
supine abdomen

Front 21

_____ PNA may present as abdominal pain

Back 21

RLL

Front 22

chest xray in acute abdomen is best for ______

Back 22

free air (to also eval for intrathoracic abnormalities presenting with abdominal complaints, like RLL PNA)

Front 23

supine abdomen xray in acute abdomen is best for_____

Back 23

abdominal detail (organs, bones, joints, calcifications, fat and gas pattern)

Front 24

erect abdomen xray in acute abdomen is best for ________

Back 24

air-fluid levels

Front 25

left lateral decubitus abdominal xray (rarely used) for_______

Back 25

sub for erect chest and erect abdomen in a patient unable to sit or stand

Front 26

xray has the best sensitivity in ________

Back 26

intestinal obstruction

Front 27

free air in abdomen = probable perforated viscous (unless recent abd surgery)

2 most common perforations

Back 27

perf gastric ulcer
perf diverticulitis

(tx=laparotomy or laparoscopy)

Front 28

indications for surgery (6)

Back 28

acute pain
septic/toxic
board-like abdomen
absent BS
WBC 25,000
free air under diaphragm

Front 29

most common etiology of acute abdominal pain

Back 29

nonspecific (no cause), followed by appendicitis then intestinal obstruction

Front 30

normal appendix formed from the convergence of the ______ and is located ______ of the cecum

Back 30

taenia coli (smooth mm)

posteromedially

Front 31

most common surgical emergency

Back 31

acute appendicitis

Front 32

peak incidence of acute appendicitis

Back 32

2nd and 3rd decades

Front 33

3 complication of acute appendicitis

Back 33

perforation (20%)
abscess/phlegmon (5%)
septic thrombophlebitis (rare)

Front 34

pathogenesis of acute appendicitis

Back 34

luminal obstruction (from an appendicolith)

Front 35

pain in acute appendicitis

Back 35

periumbilical then to McBurneys point (RLQ)

Front 36

sx favoring the dx of acute appendicitis (5)

Back 36

elevated WBCs
RLQ pain
pain <12hr
vomitting
rebound, guarding
female= against dx

Front 37

ratio of occurence
SBO vs colon

Back 37

70:30

Front 38

most common cause of SBO

Back 38

adhesions/scar tissue (80%

hernia (15%)

Front 39

risk factors for SBO (6)

Back 39

previous surgery
hernia
IBD
diverticulosis
cholelithiasis
foreign body

Front 40

S/Sx of SBO (5)

Back 40

crampy pain
distention
tinkling BS
N/V
no flatus (partial vs. complete)

Front 41

SBO xray findings (4)

Back 41

step ladder dilated bowel loops- supine view
step ladder air fluid levels- erect/lat. decub view
stretch sign- supine view
string of pearls- erect/lat. decub view

Front 42

Jejunum >______cm and Ileum >____cm is abnormal but not diagnostic for SBO

Back 42

Jejunum >3cm
Ileum >2cm

Front 43

________ may have minimal visible small bowel which is normal, but in adults is always abnomal

Back 43

Kids

(so look for air fluid levels)

Front 44

air fluid levels in small bowel: normal or not

Back 44

always abnormal but not specific for SBO

Front 45

fluid filled bowel may be more/less significant than air filled bowel, but the significance is the same

Back 45

fluid filler= more significant

Front 46

If small bowel and colon dilated equally?

Back 46

nonspecific ileus (not SBO)

Front 47

If small bowel significantly more dilated than colon?

Back 47

suggests SBO (over ileus)

Front 48

some gas in colon does/does not exclude SBO

Back 48

does NOT exclude SBO

Front 49

Treatment of SBO (6)

Back 49

IVF (and foley)
NPO
NGT-Sx
correct metabolic abnormailites
observation
OR (if worsening pain or fever)

Front 50

Colon obstruction- most common cause

Back 50

carcinoma of the colon (80%)

Front 51

Carcinoma of the colon is usually located where?

Back 51

Sigmoid colon

Front 52

What is the most distensible part of the colon?

Back 52

Cecum

Front 53

A cecum of ____cm diameter is cause for concern

Back 53

9cm

Front 54

A cecum of ____cm diameter is impending perforation

Back 54

11cm

Front 55

risk factors for kidney stones (Ca oxylate or struvite) 4

Back 55

dietary hx
immobilization
hot climate
UTI

Front 56

4 s/sx of kidney stones

Back 56

severe crampy pain that radiates to flank or genitalia
N/V
distention
hematuria

Front 57

Gallbladder stores_______, empties in response to __________ and drains through the ________________.

Back 57

bile
food (fatty)
ampulla of Vater

Front 58

Acalculous cause of cholecystitis

Back 58

biliary stasis

Front 59

risk factors for gallstones

Back 59

female
fat
fertile
forty

Front 60

s/sx of cholecystitis (4)

Back 60

RUQ pain >3hrs
fever
N/V
Murphys sign

Front 61

DIagnosis of Cholecystitis (3)

Back 61

amylase, lipase (pancreatitis), LFTs (common bile duct stones)
US
HIDA scan

Front 62

Treatment of Cholecystitis (5)

Back 62

NPO
IVF
IV abx
IV analgesia
OR (may wait 24-48 hr)

Front 63

Diverticulitis is herniation of the ____ and _____ layers with small outpouchings, usually in the ______ colon, and occurs on the ______side of the colon and is associated with _____ and ______.

Back 63

mucosa, submucosa
sigmoid colon
mesenteric side
old age
low fiber

Front 64

Imaging in Diverticulitis: 4 findings

Back 64

ileus
distention
free air
pericolonic inflammation (CT)

Front 65

What diagnostic procedure is contraindicated in diverticulitis?

Back 65

BE and colonoscopy (can lead to perf)

Front 66

Treatment of diverticulitis (4)

Back 66

IVF
NGT for N/V
IV abx
OR (if complicated) with colostomy and reanastamosis in 4-6 wks when inflammation subsides

Front 67

Risk factors for PUD (5)

Back 67

men
etoh
smoking
nsaids
H.pylori

Front 68

2 complications of PUD

Back 68

bleeding (20%)

perforation (7%)
posterior-severe radiation pain
anterior- free air

Front 69

Exocrine fx of the pancreas

Back 69

digestive enzymes

Front 70

Endocrine fx of the pancreas (4)

Back 70

insuiln
glucagon
pancreatic polypeptide
somatostatin

Front 71

2 most common causes of acute pancreatitis

Back 71

gallstones (40%
etoh (40%)

others: lipids, drugs, trauma, tumor, infection, idiopathic

Front 72

s/sx acute pancreatitis (6)

Back 72

severe abd/back pain
N/V
distention
shock
Turners sign (flank ecchymosis)
Cullens sign (periumbilical hematoma)

Front 73

Pancreatic calcui are found in acute/chronic pancreatitis

Back 73

chronic

Front 74

Ranson Prognostic Criteria in acute Pancreatitis
on admit
within 48 hr

(does NOT include amylase/lipase!!!!!)

Back 74

on admit
>55, WBC>16,000, BS>200, LDH>350, AST>250
within 48hr
Hct decreased 10%, BUN increased 5, ****Ca<8, PaO2<60, Base deficit >4, fluid sequestration >6l

Front 75

What is the most common cause of ischemic bowel?

Back 75

afib

Front 76

high WBCs and severe abdominal pain with negative imaging is ______

____= dead bowel

Back 76

ischemic bowel

gas (in bowel wall/portal vein) = dead bowel

Front 77

Thumbprinting is a finding on imaging r/t _________.

Back 77

ischemic bowel

Front 78

AAA is if over ____cm AP diameter of abdominal aorta and ____ and ____ imaging are sensitive.

Back 78

>3cm
US and CT