EM Basic - Abdominal Pain Quiz

Questions and Answers

Morphine 0.1mg/kg IV, most start with ______

4-6mg

Give Zofran 8mg IV to counteract ______

nausea/vomiting

Demerol is a poor choice of opiate to use due to its side effects and causes lots of ______

euphoria

Special attention to surgical history, previous ______

colonoscopy Signup and view all the answers

Benadryl 25mg IV PRN for ______

itching Signup and view all the answers

Morphine, fentanyl and ______ are all excellent painkillers

dilaudid Signup and view all the answers

Don’t dive for the abdomen- do an ______ exam, heart/lung exam

HEENT Signup and view all the answers

Uncover the abdomen and ask patient to point where it ______

hurts Signup and view all the answers

Check ______ sounds first

bowel Signup and view all the answers

Peritoneal signs- usually indicate ______ or other surgical pathology

appendicitis Signup and view all the answers

Psoas sign- roll onto left side, extend ______ back

leg Signup and view all the answers

Murphy’s sign- patient takes a deep breath, push in ______, positive if patient stops inhaling due to pain

RUQ Signup and view all the answers

Do a ______ exam in all males- don’t miss a torsion!

testicular Signup and view all the answers

The ______ for females involves UA/HCG (no culture unless you admit or treat for UTI)

labs Signup and view all the answers

CBC is important as up to ______% of appys have normal WBC.

30 Signup and view all the answers

Hypokalemia can cause an ______.

ileus Signup and view all the answers

Before talking to the patient, it's crucial to look at them as they sit on the ______.

stretcher Signup and view all the answers

Associated signs and symptoms include nausea, vomiting, diarrhea, back pain, and ______ symptoms.

urinary Signup and view all the answers

Pain control is critical, so clinicians should not ______ it.

withhold Signup and view all the answers

For older patients, a VBG with lactate can indicate if a high lactate equals ______ disease.

bad Signup and view all the answers

Appendicitis patients usually want to remain very ______.

still Signup and view all the answers

Imaging the abdomen effectively by quadrants is important for evaluating ______ pain.

abdominal Signup and view all the answers

LUQ abdominal pain rarely requires imaging unless there is a suspect of a bowel ______.

obstruction Signup and view all the answers

To diagnose an AAA, use ______ to check for size and presentation.

ultrasound Signup and view all the answers

RUQ pain is best assessed using a ______ ultrasound for cholecystitis.

RUQ Signup and view all the answers

CT A/P is indicated for ______ to evaluate appendicitis.

RLQ pain Signup and view all the answers

LLQ pain may require a CT A/P for ______

diverticulitis Signup and view all the answers

Flank pain may require a CT A/P without ______ for kidney stones

contrast Signup and view all the answers

A suprapubic pain in isolation is usually a ______

UTI Signup and view all the answers

Patients with stones may have ______ hematuria on UA

NO Signup and view all the answers

It is better to document as 'abdominal pain' rather than using ______ or gastroenteritis

gastritis Signup and view all the answers

For gastroenteritis, one must have both vomiting and ______

diarrhea Signup and view all the answers

If you have increased pain or new pain in the right lower ______, return to the ER

abdomen Signup and view all the answers

I think you have a GI bug. These usually get better on their ______

own Signup and view all the answers

Study Notes

Abdominal Pain Assessment and Management

Not all cases require labs; surgical abdominal pain warrants testing.
History-taking should include UA/HCG for females, but no culture unless treating a UTI.
Review triage notes and vitals—evaluate the patient’s presentation carefully.
Criteria for lab tests include:
- CBC: normal WBC counts in up to 30% of appendicitis cases.
- Chem 10: checks for conditions like hypokalemia and acidosis.
- Coags: important before surgery, liver disease can elevate coags.
- LFTs: relevant for cholecystitis; not always needed for appendicitis.
- Lipase: preferred for pancreatitis diagnosis, amylase is less useful.
- VBG with lactate for older patients; high lactate indicates severe disease.

Pain Management

Administer pain control without hesitation—Morphine recommended at 0.1 mg/kg IV.
Consider Zofran 8mg IV for nausea and vomiting; prolonging antiemetic administration can help.
Beware: Demerol is discouraged due to side effects and its potential for euphoria.
Opt for morphine, fentanyl, or dilaudid as effective painkillers.

Physical Examination

Perform HEENT and heart/lung exams before assessing the abdomen.
Determine precise pain location; initiate with light palpation, increasing pressure gradually.
Monitor for signs of peritoneal irritation, indicating potential surgical issues.
Assess for tenderness, psoas and obturator signs, and utilize Rovsing’s and Murphy’s signs for diagnosis.

Differential Diagnosis

Common conditions causing abdominal pain include:
- Appendicitis: most prevalent surgical emergency.
- Cholecystitis: gallbladder inflammation, diagnosed via RUQ ultrasound.
- Pancreatitis: characterized by epigastric pain.
- Diverticulitis: typically presents with LLQ pain.
- Kidney stones: associated with flank pain, may or may not show hematuria.
- Bowel perforation: emergency requiring swift intervention.
- Gastroenteritis: must present with both vomiting and diarrhea.

Imaging Strategies

Imaging choice depends on pain location:
- LUQ: imaging rarely needed unless signs of obstruction or rigidity present.
- Epigastric: minimal imaging unless pancreatitis is suspected.
- RUQ: ultrasound is preferred for cholecystitis detection.
- RLQ: CT A/P for suspected appendicitis, can often be performed without contrast.
- LLQ: CT A/P for diverticulitis.
- Flank pain: CT A/P without contrast useful for kidney stones.

Discharge Instructions

Conduct repeat abdominal exams before discharging patients.
Communicate clearly with patients about their conditions and possible complications.
Advise patients to return if symptoms worsen or if new pain develops, particularly in the RLQ.

Important Pearls

Avoid using "gastritis" or "gastroenteritis" as diagnoses—opt for broader terms like "abdominal pain."
For gastroenteritis diagnosis, both vomiting and diarrhea are necessary.
A surgical consult may be warranted even with negative imaging if the clinical picture remains concerning.

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Description

This quiz focuses on the evaluation of abdominal pain in emergency medicine. It includes considerations for laboratory tests and surgical indications. Gain insights into effective management strategies for abdominal pain cases.