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Questions and Answers
What is the primary goal in the management of upper gastrointestinal bleeding (UGIB)?
In which scenario is the use of antimotility agents such as loperamide contraindicated?
Which of the following is the most common cause of viral gastroenteritis?
What is the recommended initial fluid for patients experiencing severe losses who cannot tolerate oral intake?
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Which complication is associated with peptic ulcers, a common cause of upper GI bleeding?
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What is the initial approach to a patient presenting with acute abdominal pain in the ED?
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Which imaging technique is preferred for detecting bowel obstructions or perforation?
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What medication is commonly used for managing acute abdominal pain?
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In the treatment of appendicitis, what is the primary intervention?
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Which symptom is not typically associated with acute diarrhea?
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Which of the following is a potential cause of acute diarrhea?
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For a patient with suspected peritonitis, what is the appropriate course of action?
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Which factor is least relevant when assessing a patient with abdominal pain?
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Study Notes
Acute abdominal pain
- Abdominal pain is the most common reason for ED visits
- Obtain a detailed history of previous similar episodes, including diagnostics and treatments.
- Review previous medical records.
- Inquire about occupation and living circumstances to identify potential toxic exposures.
- Physical examination should include inspection for distension, scars, and hernias.
- Palpate for tenderness, masses, guarding, and rebound tenderness.
- Perform pelvic and rectal exams if indicated.
- Auscultate for bowel sounds.
- Laboratory tests: CBC, LFT, Electrolytes, lipase, urinalysis, and B-HCG.
- Imaging: Abdominal/pelvic ultrasound for gall bladder, liver, and gynecological issues.
- CT scan for bowel obstruction, perforation, and vascular issues.
- X-ray to detect free air (pneumoperitoneum) and bowel obstruction.
Treatment for Acute Abdominal pain
- Provide analgesia, for example opioid like morphine.
- Use anti-emetics such as ondansetron.
- Administer IV fluids.
- Consider antibiotics in cases of peritonitis, diverticulitis, and cholecystitis.
Causes and Treatment of Acute Abdominal Pain
- Appendicitis: requires surgery.
- Bowel obstruction: requires nasogastric decompression.
- Perforated ulcer: requires surgical intervention.
- Pancreatitis: requires supportive care.
- Ectopic pregnancy: is a gynecological emergency.
Diarrhea
- Acute diarrhea is defined as sudden onset of increased water content in stool, resulting in increased frequency of stools (3 or more times daily up to 20 bowel movements in 24 hours).
- Acute diarrhea lasts less than 14 days, chronic diarrhea lasts longer than 2 weeks.
- Causes include infections, medications, and other medical conditions.
Diarrheal Disease
- Obtain a detailed history: duration, frequency, consistency, associated symptoms (fever, pain, weight loss), recent travel, food intake, and antibiotic use.
- Assess for pre-existing medical conditions, such as Irritable Bowel Syndrome (IBS) and Celiac Disease.
- Examine for signs of dehydration, distention, and tenderness.
- Investigate with stool analysis and culture.
- Fluid and electrolyte replacement with oral rehydration solution (ORS).
- For severe, continuous losses, and patients unable to tolerate oral intake, use IV fluids such as Ringer's lactate or normal saline.
- Antibiotics are indicated for severe bacterial infections and C. difficile.
- Antimotility agents such as loperamide can be used, but avoid them in cases of bloody diarrhea or suspected inflammatory diarrhea.
- Probiotics are safe and beneficial when used alongside rehydration therapy.
Common Causes of Diarrhea
- Viral gastroenteritis (GE) is the most common cause.
- Bacterial infection: Salmonella, Shigella, E. coli, Campylobacter, Vibrio cholera.
- Parasitic infection: Giardia lamblia, Entamoeba histolytica.
- Antibiotic-associated diarrhea caused by Clostridioides difficile (C. difficile).
Upper GI Bleeding
- Refers to any GI bleeding originating proximal to the ligament of Treitz (esophagus, stomach, duodenum).
- A potentially life-threatening condition requiring prompt evaluation and management.
- The primary goals of management are to stabilize the patient, identify the source, and treat the underlying cause.
Causes of Upper GI Bleeding
- Peptic ulcer: the most common cause (gastric and duodenal ulcers).
- Esophageal varices: common in patients with liver cirrhosis and portal hypertension.
- Mallory-Weiss syndrome: mucosal tear at the gastroesophageal junction due to severe vomiting.
- Malignancy.
Initial Stabilization of Upper GI Bleeding
- Use the ABCD approach:
- A: ensure a patent airway, especially in cases of massive bleeding and/or altered mental status. Consider intubation for airway protection.
- B: administer oxygen.
- C: insert at least two large-bore (18G) intravenous cannulae. Begin IV fluid resuscitation with normal saline or lactated Ringer's.
- D: consider blood transfusion if hemoglobin levels are low.
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Description
This quiz covers the evaluation and treatment of acute abdominal pain, a common reason for emergency department visits. It includes details about patient history, physical examination techniques, diagnostic tests, and treatment options. Test your knowledge on essential practices for managing acute abdominal conditions.
