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11 Cards in this Set
- Front
- Back
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Peritonitis (GI tract perforation)
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Diffuse, severe abdominal tenderness
Guarding and rigidity present Diagnosis: Obtain upright KUB and/or chest radiograph to look for free intraperitoneal air |
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Appendicitis
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Mild fever and focal RLQ pain (McBurney point) with rebound tenderness
Anorexia, nausea, vomiting common in early disease Pain may begin periumbilically, later localize to RLQ Diagnosis: Low-grade fever, moderate leukocytosis Pelvic exam in females, rectal exam in all patients |
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Acute pancreatitis
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Relatively rapid onset of severe epigastric pain radiating to the back
May have anorexia, nausea, vomiting Diagnosis: Tenderness best elicited in mid-epigastric region, rebound tenderness may be present Bowel sounds hypoactive or absent CBC (elevated WBCs; depressed hematocrit of hemorrhage), amylase, lipase CT with oral, IV contrast (presence of pseudocysts, necrosis, masses) Surgery only for infection or severe pancreatic necrosis |
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Cholecystitis
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Five F’s (female, forty, fat, fertile, fair)
Difficult to differentiate from biliary colic Diagnosis: RUQ tenderness and positive Murphy’s sign + nausea and vomiting Febrile, with distension and guarding CBC and LFTs, amylase, lipase US is imaging test of choice: gallstones, thickened-wall gallbladder, peri-fluid Hepatobiliary iminodiacetic acid (HIDA) scan: acute if no uptake of radiolabeled bile |
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Diverticulitis
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Diverticulosis throughout colon; diverticulitis in L and sigmoid colon; ↑incidence with ↑age
Sigmoid diverticulitis: LLQ pain , often with fever and chills, palpable mass (if phlegmon) Diagnosis: CT with oral contrast Interval barium enema, colonoscopy after acute inflammation has resolved |
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Small bowel obstruction
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Nausea, bilious vomiting, distension; sharp, colicky abdominal pain
Advanced disease: tachycardia, hypotension, fever Diagnosis: Abdominal distension, high-pitched bowel sounds, tympanitic abdomen Labs: hypochloremia, hypokalemia, metabolic alkalosis Supine, upright abdominal films (look for dilated loops of sm. bowel, air-fluid levels) CT, upper GI series to identify point of obstruction |
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Large bowel obstruction
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Constipation and abdominal distension; gradual onset of pain
Most common causes: colon carcinoma, acute diverticulitis, volvulus Diagnosis: Abdominal tenderness and distension Plain abdominal films, retrograde contrast studies to localize obstruction Volvulus: colonoscopy is both diagnostic and therapeutic |
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Mesenteric ischemia
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Sudden, severe abdominal pain; nausea, vomiting, diarrhea, GI bleeding
Classic finding: disproportional pain with abdominal palpation Risk of sudden overwhelming sepsis with hypotension, tachycardia, hypovolemia Diagnosis: Plain films often nondiagnostic CT may reveal thickened loops of bowel with air in bowel wall (pneumatosis) Tx: exploratory laparotomy, removal of disease bowel |
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Ruptured abdominal aortic aneurysm (AAA)
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Abdominal pain accompanied by back or flank pain
First seen in hypovolemia or frank shock Diagnosis: Supraumbilical mass on physical exam (if known aneurysm, presume rupture) hree criteria: abdominal pain, shock, pulsatile mass US, CT are diagnostic; often there is no time for imaging Emergency surgery is necessary for survival |
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Gynecologic causes
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Most life-threatening: ruptured ectopic pregnancy
Detailed gynecologic history should be obtained, crampy abdominal pain elicited PID common in females 15-35 years old; presenting sx: crampy LQ pain and high fever Other causes: ovarian cysts, endometriosis, ovarian torsion, ruptured uterus Diagnosis: Pregnancy test on all women with abdominal pain and possibility of pregnancy PID: hyperemic, extremely tender cervix with vaginal discharge (Get cervical smear and culture) Ultrasound can help Dx tubo-ovarian abscess |
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Nonsurgical causes
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Acute MI, pericarditis
R or L lower lobe pneumonia, pleuritis, effusion Gastroenteritis, biliary colic, IBD Pyelonephritis, urolithiasis, renal cysts Sickle cell anemia Salmonella, Shigella infection AIDS pts: CMV enterocolitis, lymphoma, Kaposi's sarcoma, TB or GI tract |
