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11 Cards in this Set

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Peritonitis (GI tract perforation)
Diffuse, severe abdominal tenderness
Guarding and rigidity present

Diagnosis: Obtain upright KUB and/or chest radiograph to look for free intraperitoneal air
Appendicitis
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
Acute pancreatitis
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
Cholecystitis
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
Diverticulitis
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
Small bowel obstruction
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
Large bowel obstruction
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
Mesenteric ischemia
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
Ruptured abdominal aortic aneurysm (AAA)
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
Gynecologic causes
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
Nonsurgical causes
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