Abdominal Pain

Front 1

What are some intra abdomen causes of abdominal pain

Back 1

1. GI

2. GU

3. Gynecologic

4. Vascular

Front 2

What are some extra-abdominal causes of abdominal pain

Back 2

Cardiopulmonary

Abdominal Wall

Toxic/metabolic

Neurogenic

Front 3

What is visceral pain

Back 3

Steady ache, vague, colicky

Stretching of fibres innervating organ or ischemia/inflammation

Front 4

If you have pain in the epigastrium which structures are you considering

Back 4

Foregut (stomach, duodenum, biliary tract)

Front 5

If you have pain in the periumbilical region which structures are you considering

Back 5

Midgut (small bowel, appendix, cecum)

Front 6

If you have pain in the hypogastric region which structures are you considering

Back 6

Hindgut (Colon, sigmoid)

Front 7

What is somatic pain

Back 7

Tenderness, guarding, rigidity

Irritation of fibers that innervation parietal peritoneum

Front 8

How do you locate somatic pain

Back 8

Dermatomes (very localized can point to pain with 1 finger)

Front 9

What is referred pain

Back 9

Pain felt at a distant site from the actual area of disease

Front 10

Is referred pain ipsilateral or contralateral to the diseased organ

Back 10

Ipsilateral

Front 11

What are the referred structures to pain in:

1. ureter

2. Diaphragm

3. Gyne

4. MI

Back 11

1. Testicle

2. Shoulder

3. Back/proximal leg

4. Epigastrium, neck, jaw, arm

Front 12

What are some initial testing you would do to evaluate abdominal pain

Back 12

1. CBC

2. Lytes, urea, Creatine, Glucose (DKA)

3. LFT, Lipase

4. Lactate (Ishemic gut)

5. Urinalysis

6. Pregnancy test

7. If fever: blood, urine culture

8. X-ray

Front 13

What is some subsequent testing for abdominal pain

Back 13

1. Watchful waiting

2. CT (AAA)

3. US (AAA, gallbladder, pregnancy)

4. Angiography/CT-A (Mesenteric Ischemia)

Front 14

What are the indications for a X-Ray

Back 14

1. Free air (perforation then do upright CXR)

2. Obstruction (small or large bowel)

Front 15

How many views do you do on an abdominal X-ray

Back 15

3 views

1. Chest

2. Supine (AP)

3. Upright/lateral decubitus

Front 16

What do the following densities describe:

1. White

2. Bright white

3. Grey

4. Dark grey

5. Black

Back 16

1. Calcification

2. Metal

3. Soft tissue

4. Fat

5. Gas

Front 17

How much does an abdominal X-ray equal in comparison to a CXR

Back 17

50 CXR

Front 18

What is the approach to abdominal X-rays

Back 18

1. Adequacy

2. Air (free, gas)

3. Soft tissue

4. Bones/calcification

5. Foreign bodies

Front 19

How do you determine adequacy

Back 19

1. Confirm pt, date, view

2. 3 views

3. Pelvis to diaphragm

Front 20

1. What is free air

2. Describe what free air would look like in all 3 views

Back 20

Air that should not be there

Upright: Air under the diaphragm

Lateral Decubitus: Between lateral hepatic margin and Right Abdominal wall

Supine: Rigler's sign (outline both sides of bowel wall)

Front 21

What is Rigler's sign

Back 21

Outline of both sides of bowel wall

Front 22

What is bowel Gas

Back 22

Gas that should be there (swallowed air, fermentation)

Front 23

Where is bowel gas usually located

Back 23

stomach and colon

Front 24

1. How can you tell if gas is located in the small bowel

Back 24

1. Centrally located

2. You can see mucosal folds (valvulae conniventes)(

Front 25

How can you tell if gas is located in the large Bowel

Back 25

1. Peripherally located

2. You can see haustra

Front 26

What does fecal matter look like on an X-ray

Back 26

Stippled

Front 27

What is a volvulus

Back 27

Loop of bowel twisted on itself ("coffee bean sign")

Surgical emergency

Front 28

1. What is intramural gas

2. What is it often associated with

3. What is an example

Back 28

1. Air inside wall of bowel

2. Ischemia

3. Pneumatosis intestinalis (necrotizing entercolitis)

Front 29

1. What is an example of biliary gas

Back 29

Pneumobilia (cholangitis, cholecystitis)

Front 30

What are some examples of soft tissues on an x-ray

Back 30

1. Solid organs (liver, spleen etc.)

2. Psoas margin

3. Masses

4. Diaphragm, lungs

Front 31

What are some examples of calcifications

Back 31

1. Gallstones, urinary stones

2. Phleboliths = calcification in pelvic veins

3. Tumour calcification

Front 32

What are 2 examples of RUQ pain

Back 32

1. Hepatitis

2. Biliary Disease

Front 33

What is hepatitis caused by

Back 33

1. vira

2. EtOH

3. Immunologic

Front 34

When will liver enzymes be elevated

Back 34

AST and ALT will be elevated in liver disease

GGT and ALP are elevated in obstruction

Front 35

What are 4 examples of Biliary Disease

Back 35

1. Biliary Colic = gallstones (pain after eating)

2. Acute Cholecystitis = inflammation of gallbladder

3. Choledocholithiasis = stones in bile duct

4. Cholangitis: infection in biliary tract

Charcots triad: fever, jaundic, RUQ pain

Front 36

What is Charcot's Triad

Back 36

1. Fever

2. Jaundice

3. RUQ pain

Cholangitis

Front 37

What are the 2 causes of Epigastric Pain

Back 37

1. Pancreatitis

2. Dyspepsia

Front 38

1. What are the symptoms of Pancreatitis

2. What are the most common causes of pancreatitis

Back 38

1. Sudden onset, radiates to the back, N/V, anorexia

2. Gallstones, EthOH, Trauma

Front 39

1. What are the symptoms of Dyspepsia

2. What are some causes

3. What should you test for

Back 39

1. Epigastric pain, bloating, abdominal fullness, heartburn, nausea

2. Peptic Ulcer Disease, GERD, Gastritits, Functional (no cause just pain)

3. H.Pylori

Front 40

What are the red flags with Dyspepsia (10)

Back 40

1. Age > 50

2. Persistent Vomiting

3. Dysphagia

4. Weight loss

5. Hematemesis

6. Anemia

7. Palpable abdominal mass

8. FHx GI carcinoma

9. Previous Gastric Surgery

10. Jaundice

Front 41

What are 3 reasons for LUQ pain

Back 41

1. Splenic Abscess

2. Splenic Infarct

3. Splenic Rupture

Front 42

What are the cardiac and pulmonary conditions that can cause upper abdominal pain

Back 42

1. MI, Pericarditis

2. Pneumonia

Front 43

What is the common cause for RLQ pain

Back 43

Appnedicitis

Front 44

What are the symptoms of Appendicitis

Back 44

1. Vague, periumbilical pain migrating to RLQ (Visceral => somatic)

2. Peritoneal signs, rebound

3. Anorexia, N/V

4. Ferver, elevated WBC

Front 45

How do you treat appendicitis

Back 45

Surgery +/- antibiotics

Front 46

What is a common cause for LLQ pain

Back 46

Diverticulitis

Front 47

What are some signs and symptoms associated with Diverticulitis

Back 47

Fever, increased WBC

Front 48

How do you manage uncomplicated and complicated diverticulitis

Back 48

Uncomplicated = antibiotics

Complicated = antibiotics +/- surgery

Front 49

What are some conditions that may have upper, lower abdominal and pelvic pain

Back 49

1. Inguinal Hernia

2. IBD

3. Infectious (food poisoning, bacterial enteritis)

Front 50

What are the 3 non abdominal aetiologies of lower abdominal pain

Back 50

1. Retroperitoneal

2. Pelvic

3. Herpes Zoster

Front 51

What are some conditions that are retroperitoneal

Back 51

1. Renal colic

2. Hydronephrosis

3. Pyelonephritis

4. Cystitis

Front 52

What are the top 3 pelvic conditions that you don't want to miss

Back 52

1. PID (pelvic inflammatory disease)

2. Ectopic pregnancy

3. Torsion

Front 53

What are 5 conditions that are associated with Diffuse Abdominal Pain

Back 53

1. Peritonitis

2. Obstruction

3. Mesenteric Ischemia (POOP = pain out of proportion)(Think low flow states i.e. hypotension, MI)

4. AAA rupture/leak

5. Spontaneous Bacterial Peritonitis (anyone with fluid in abdomen i.e. cirrhosis, peritoneal dialysis)

Front 54

What are some non abdominal Etiologies of diffuse abdominal pain

Back 54

1. DKA

2. Addisons

3. Hypercalcemia (malignancy)

4. Hyper/Hypothyroidism

Typically triggered by acute precipitant (infection, dehydration, EtOH)

Front 55

What is a surgical abdomen

Back 55

Condition that is quickly going to get worse if you don't do surgery

Front 56

What are the 2 conditions you need to rule out in an emergency department if a patient comes in with abdominal pain

Back 56

1. Peritonitis

2. Obstruction

Front 57

What are the signs and symptoms of Peritonitis

Back 57

1. Look sick

2. Rebound pain

3. Rigid abdomen/guarding/decrease bowel sound

4. Shake/percussion/heel-drop tenderness

5. Little relief from analgesia

Front 58

What are the signs and symptoms of obstruction

Back 58

1. Anorexia

2. Bloating, N/V

3. Obstipation

4. Distention

5. High pitched or absent bowel sounds

Front 59

1. What is considered chronic abdominal pain

2. What age does new onset rarely occur in

Back 59

1. > 12 weeks

2. > 50 years old

Front 60

What is the common Etiology of Chronic abdominal pain

Back 60

Functional (i.e. no pathology)

Front 61

What are some conditions more prevalent with age

Back 61

1. Atherosclerosis (AAA, mesenteric ischemia)

2. Cholelithisais

3. Carcinoma

4. Immobility (volvulus)

5. Medication (PUD, pancreatitis)

6. Previous Surgery (SBO)

Front 62

What conditions must you consider for females who are not pregnant

Back 62

1. Pelvic Inflammatory Disease

2. Torsion

3. Tubo-ovarian Abscess

Front 63

Which conditions must you consider for females who are pregnant

Back 63

1. Ectopic

2. Abruption

3. Labour

Front 64

What can abdominal pain be related to in patients who have HIV

Back 64

Opportunistic Infection

Front 65

1. In a HIV patient with abdominal pain and a normal CD4 what might be the cause

2. Decreased CD4

Back 65

1. Common bacteria, neoplasia

2. CMV, histoplasmosis

Front 66

What are some of the drug side effects of HIV patients

Back 66

1. Lactic acidosis

2. Pancreatitis

Front 67

What must you consider when a patient comes into the emergency with a trauma to the abdomen

Back 67

It may not manifest for days to weeks

Front 68

What are the 9 life-threatening causes you can not miss?

Back 68

MVPP BEAMS

1. Mesenteric Ischemia

2. Volvulus

3. Perforation

4. Placental Abruption

5. Bowel Obstruction

6. Ectopic Pregnancy

7. AAA

8. MI

9. Splenic Rupture