Quiz 16: Abdominal Pain And Vomiting

Front 1

Luanne is a 15-year-old female with 3 hours of abdominal pain and 2 episodes of non-bilious, non-bloody vomiting. She rates her pain at 8/10 and constant, located mainly in the middle of her belly, but is somewhat present throughout her abdomen. It is worse with coughing and moving. She has never had this pain before, and has had no appetite since the pain started. She is sexually active with her boyfriend of 3 months, always uses condoms, and has not been tested for STIs. Her last menstrual period was 2 weeks ago. Vitals: 37.9, HR 100, BP 120/85, RR 14. On exam, she exhibits involuntary guarding, mild rebound tenderness and tenderness to palpation between her right anterior superior iliac spin and umbilicus. On pelvic exam, she reports tenderness when attempting to palpate her right adnexa, but no masses are appreciated and there is no cervical motion tenderness. Her WBC and CRP are within normal limits. Based on the information above, what is the most likely diagnosis?

Back 1

Appendicitis

Front 2

A 4-year-old girl with a history of type 1 diabetes mellitus was admitted to a local hospital for treatment of DKA. A few hours after the treatment, she develops grunting, tachypnea, and has vomited twice. On exam, her left eye is pointing downward and out on straight gaze. Her diastolic blood pressure is 90 mmHg. What is a likely diagnosis?

Back 2

Cerebral edema

(administration of bicarb increases risk of cerebral edema)

Front 3

Signs of cerebral edema

Back 3

tachypnea

headache

vomiting

third nerve palsy

high blood pressure

Front 4

A 9-year-old female is brought to clinic by her mother because of two days of abdominal pain and vomiting. She has vomited six times today and has had decreased appetite, but no diarrhea, fevers, sick contacts, or changes in diet. Her mom states that she has been otherwise healthy apart from increased thirst and occasional bedwetting over the last few weeks. Of note, patient’s maternal grandmother suffers from celiac disease. On exam, patient is afebrile and has a HR of 180 bpm, BP 90/60 mmHg, RR 50 bpm, and O2 saturation of 98%. She is lying in bed, appearing slightly drowsy, taking rapid, deep breaths and is slow to respond to questions. Her heart and lung exams are normal apart from being tachycardic, and abdominal exam reveals mild diffuse tenderness to palpation with no rebound or guarding. Which of the following would be the most appropriate next step in management?

Back 4

DKA

Front 5

DKA

Back 5

• abdominal pain
• vomiting
• tachycardia
• tachypnea
• autoimmune disease in family history

Front 6

A 9-year-old male presents to the ED in an ambulance after he was found unconscious at a local playground. In the ED he is arousable but extremely obtunded. He is able to minimally verbalize that his head hurts and his stomach feels uncomfortable. He states the pain is constant and non-radiating. He vomits clear liquid twice over the course of 30 minutes. Vital signs are as follows: T 37.6 C, P 66 bpm, BP 155/80 mm Hg, RR 18 bpm. You further notice that his breathing is irregular with brief episodes of apnea. On physical exam you are unable to reproduce the abdominal pain and there is no rebound tenderness or guarding. The rest of the physical exam is unremarkable. What is the most likely diagnosis?

Back 6

Intracranial hemorrhage

Front 7

Cushing's triad

Back 7

• hypertension
• inappropriate slowing of heartrate
• irregular respirations
  
  
• can also have epigastric discomfort
• vomiting

Front 8

A 7-year-old boy is brought by ambulance to the ED with altered consciousness. The EMT said he found the boy in a pool of vomit. He is unable to answer questions coherently and he is alone. Physical exam findings indicate dry mucous membranes, tachypnea, tachycardia, and moaning on palpation of the abdomen. His physical exam is otherwise normal, including a normal blood pressure. What is the most likely cause of his condition?

Back 8

DKA

Front 9

DKA presentation

Back 9

• altered LOC
• vomiting
• dehydration
• abdominal pain
• preceding DKA, patient will have had polydipsia polyuria
• metabolic acidosis causes tachypnea as the body tries to blow off carbon dioxide

Front 10

A 9-year-old male is brought to the ED in a coma secondary to diabetic ketoacidosis. Which of the following laboratory results would NOT likely be found in this patient?

Back 10

Potassium of 3.3 mEq/L

Front 11

What do you expect in a patient with diabetic ketoacidosis?

Back 11

anion gap of 20

venous pH of 7.1

sodium of 132

creatinine of 1.0