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63 Cards in this Set
- Front
- Back
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Which type of abdominal pain is this? (visceral vs parietal)
- dull ache, not localized - pt is restless - not stimulated by touch or heat - transimitted by autonomics |
visceral pain
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Which type of abdominal pain is this? (visceral vs parietal)
- sharp/cutting, localized - pt tend to lie still - stimulated by touch or heat - transimitted by CNS |
parietal pain
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Can pain be transmitted via vagus nerve?
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NO
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Referred pain: possible disease?
- pain at tip of left shoulder |
splenic disease:
- irritates diaphragm which is supplied by phrenic nerve (from C4 nerve) |
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Referred pain: possible disease?
- Right subscapular |
- biliary colic
- perforated ulcer |
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Referred pain: possible disease?
- back pain |
- pancreatitis
- ruptured aortic aneurysm |
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Adequate peritoneal defences can result in what formation?
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abscess formation
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Inadequate peritoneal defences can result in what condition?
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diffuse peritonitis which requires surgery
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Most common abdominal abscess formation (peritonitis).
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- subdiaphragmatic
- subhepatic - pelvic areas |
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What does this suggest?
- abdominal pain - bilious vomiting |
obstruction distal to ampula of Vater
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What does this suggest?
- abdominal pain - feculent or foul-smelling vomiting |
long standing small bowel obstruction
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What ROS medications are important to ask a patient having abdominal pain?
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- steroids: immunosuppressive effects
- anticoagulants: bleeding |
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What social history (substance) is important to ask in a paitient with abdominal pain?
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cocaine: may cause visceral ischemia
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What does this suggest?
- abdominal pain - hypoactive bowl sounds |
ileus
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What does this suggest?
- abdominal pain - hyperactive bowl sounds |
obstruction
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What is this disease?
- Murphy's sign |
cholecystitis
- Murphy's sign: right subcostal pain upon palpation with an inspiratory arrest |
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What is this disease?
- Rovsing sign - Iliopsoas sign - Obturator sign |
acute appendicitis
- Rovsing sign: palpation of the LLQ causes pain in RLQ - Iliopsoas sign: pain on passive extension of the hip - Obturator sign: pain on external and internal rotoation of the flexed hip |
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What does this suggest?
- abdominal pain - abd xray: free air |
perforation of a viscous
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What does this suggest?
- abdominal pain - abd xray: air-fluid levels |
bowel obstruction
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Which imaging study is best to detect liver, gallbladder, and GYN pathology?
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ultrasound
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Which imaging mordality is best to use in elderly patient?
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CT
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What does this suggest?
- abdominal pain - HIDA scan: gall bladder not visualized within 4 hrs |
- cholecystitis
- cystic duct obstruction |
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What does this suggest?
- abdominal pain - abdominal paracentesis (ABD tap) showed >250/ul PMNs |
ascites
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Surgical indication for patients with abdominal pain.
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- peritoneal signs
- sepsis ot worsening abdominal pain - free air |
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When is the safest time to operate on a pregnant women for abdominal disease?
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2nd trimester
* operations in 3rd trimester carries the risk of premature labor |
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What are the possible causes of this pain?
- RUQ |
- biliary tract disease
- liver disease - pulmomary disease (likely pneumonia) - renal disease |
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What are the possible causes of this pain?
- LUQ |
- splenic disease
- perforated gastric ulcer - pulmonary disease (pneumonia) - myocardial infarction |
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What are the possible causes of this pain?
- RLQ |
- appendicitis
- renal disease - PID - ovarian torsion |
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What are the possible causes of this pain?
- LLQ |
- colonic disease
- renal disease - PID - ovarian torsion |
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What type of apendicitis? ( early vs supprative vs grangreeenous)
- pain at periumbilical region - mucosal edema with rising intraluminal pressure |
ealy appendicitis
- visceral pain |
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What type of appendicitis is this? (early vs supprative vs gangreenous)
- pain in the RLQ |
supprative appendicitis
- intraluminal pressure exceeds perfusion pression -> ischemia of appeniceal wall -> bacterial penetration of wall |
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What type of appendicitis is this? (early vs supprative vs gangreenous)
- rising pressure in the appendix impedes venous outflow and then arterial flow leading to perforation |
gangreenous appendicitis
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What labs are important to get to diagnose a suspicious appendicitis?
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- CBS: leukocytosis
- UA: rule out UTI - pregnancy test |
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Which imaging study is most sentitive to diagnose appendicitis?
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CT
- indicated in appendicitis with intermediate suspicion |
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What does this indicate?
CT of appendix - lack of contrast in appendix - appendiceal enlargement - inflammation arround appendix |
appendicitis
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How to manage a typical appendicitis?
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- broad spectrum antibiotics, then operation
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Open appendectomy:
What to do if no appendicitis is found? |
- remove appendix
- search other causes: IBD, meckle's diverticulitis, gynecological causes in women |
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What is this?
- occurs 5 days after accute appendicitis |
- appendiceal abscess: nonoperative, treat with antibiotics and drainage. should undergo appendectomy 6-8 wks after acute attack
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What is the most common site of ectopic pregnancy?
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oviduct: distal ampulla
abdomen ovary |
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What does this triad indicaste?
- amenorrhea - vaginal bleeding - pain |
ectopic pregnancy
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What to do in this patient?
- ammenorrhea, pain, vaginal bleeding - pt is stable |
transvaginal ultrasound
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Management of mild PID.
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empirical
- 250mg ceftriaxone (IM) followed by 100mg doxycycline BID for 14 days |
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Management of TOA (tubo-ovarian abscess).
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- admission
- broad spectrum antibiotics: ampicillin/sulbactam, IV doxycyclin - may require operation |
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What is this disease?
- severe lower abdominal pain - adenexial mass |
TOA
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What is this disease?
- sharp localized abdominal pain precipitated by exercise - tender adenexial mass |
ovarian torsion
- enlargement of ovary >6cm - need prompt surgical intervention to protect fertility |
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What to do with is condition?
- tender adenexial mass - sharp localized pain - pt is unstable |
possible rupture of ovarian cysts
- need operative exploration |
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What does this patient have?
- episodic epigastric pain, improves upon eating |
peptic ulcer posteriorly perforated
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Management of intussusception in adults.
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Always operate because it is usually due to tumors or Meckel's diverticulitis.
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What does this patient have?
- jaundice - RUQ pain - normal WBC |
cholelithiasis
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What does this elderly patient have?
- chronic constipation - LLQ coliky pain - coffee bean sign and bird's beak sign on radiology |
sigmoid volvulus
- torsion usually counterclockwise - bowel loop points to RUQ |
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Which IBD is this?
- periumbilical pain - skip lesion - transmural inflammation - string sign on xray |
Crohn's disease
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Which IBD is this?
- autoimmune - mucosal inflammation - associated with uveitis, primary sclerosing cholangitis |
ulcerative colitis
- there is a cure: total resection of colon |
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What infectious disease is this?
- abdominal pain - anchovy paste like pus in the liver - flask shaped ulcers in intestine |
amoebiasis
- cecum -> liver -> lungs -> brain - treat with Flagyl |
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What does this patient have?
- abdominal pain, shoulder and back pain - severe muscle cramps - insect bite on hand |
black widow spider bite
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What does this patient have?
- elderly - abdominal pain out of proportion to physical findings |
mesenteric vascular event
- pt could die in 6 hours |
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What is this disease?
- right side varicocele |
renal cell carcinoma most likely
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List the 7 F's associated with abdominal distention.
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- Fat
- Feces: child with Hirschsprungs - Fluid: ascites - Flatus: sigmoid vovulus - Fetus - Fibroid - "PH"antom |
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List the 7 F's associated with cholelithiasis.
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- Fair
- Fat - Flabby - Fertile - Female - Flatulent - Forty |
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Rule of 2s in Meckel's diverticulum.
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- 2% population
- 2:1 male to female ratio - a ft from ileocecal valve - 2 inches long - 2 DDX: peptic ulcer, appendicitis - 2 ectopic tissue: gastric, pancreatic - 2 complications: hemorrhage, perforation |
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List 4 s's assciated with ectopic pregnancy.
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- straining of stool
- syncope - shoulder pain - soreness |
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Sign associated with appendicitis.
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- Aaron's sign: chest and stomache pain upon pressure on McBurney's point
- iliopsoas sign - obturator sign - Rovsing sign: RLQ pain upon pressure in L side - Ten Horn sign: pain upon pulling on R testicle |
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Signs associated with ruptured spleen.
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- Ballance's sign: dullness to percussion in LUQ and shifting dullness in RLQ
- Kerhr's sign: pain on left should when spleen is palpated lying down. No pain sitting up. - Saegesser's sign: pain along lateral border of rectus abdominus muscle upon pressure on phrenic nerve (above colar bone) |
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Signs associated with ectopic pregnancy.
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- Cullen sign: discoloration of the umbilicus
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