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51 Cards in this Set
- Front
- Back
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acute abdomen definition
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any sudden, n on traumatic disorder whose chief manifestation is in the abdomen for which an urgent operation may be needed
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what is visceral pain?
what causes it? |
pain in
*walls of hollow viscera *solid organs which have capsules that distend caused by distention, inflammation or ischemia |
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what are the 4d's of visceral pain
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1. Delayed
2. Dull 3. Deep 4. Diffuse |
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what is parietal pain
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*pain caused by DIRECT irritation of the parietal peritoneum by pus, bile, blood or urine
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how does parietal pain compare to visceral
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sharper, better defines and localized to one quadrant
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what are signs of parietal pain?
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*involuntary guarding
*localized tenderness *rebound tenderness |
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what are the 9 specific areas of diagnosis?
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1. epigastric
2. umbilical 3. suprapubic 4&5 hypochondrium 6&7 lumbar 8&9 inguinal |
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what is located in RUQ?
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*liver and gallbladder
*pylorus *duodenum *head of pancreas *right adrenal gland *portion of right kidney *Hepatic flexure of colon *portions of ascendign and transverse colon |
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what is in RLQ?
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*lower pole of right kidney
*cecum and appendix *portion of ascending colon *bladder *ovary and salpinx *uterus if enlarged *Right spermatic cord *right ureter |
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what is in LUQ?
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*left lobe of liver
*spleen *stomach *body of pancreas *left andrenal gland *portion of left kidney *Splenic flexure of colon *portions of transverse and descending colon |
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what is in LLQ?
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*lower pole of left kidney
*sigmoid colon *portion of descending colon *bladder if distended *ovary and salpinx *uterus if enlarged *left spermatic cord *left ureter |
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what does pain BEFORE vomiting usually indicate?
and reverse? |
Pain before is often surgical
vomiting before pain is often medical (ie gastroenteritis) |
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what is the medical term for constipation?
what are common causes? |
*paralytic ilius
*nearly any abdominal surgical pathology, bowel obstruction and perforation |
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what is increased peristalsis?
what is hematochezia? what is melena? |
increased peristalsis
red blood in stool black, tarry stools |
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what is hematemesis?
what is hematuria? |
vomiting blood (ie, upper GI lesion-mallory weiss tear)
hematuria=gross or microscopic blood in urine |
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Based on age what can be ddx?
*infant *child *adult *geriatric |
infant=intussusception
child=mesenteric adenitis, appendicitis adult=cholecystitis, perforated ulcer geriatric=diverticulitis, colon cancer, ruptured aneurysm, ischemic colitis |
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what should you think when you medical hx shows:
*anticoag *steroids *oral contraceptives |
anticoag=retroperitoneal bleed
steroids=may mask peritonitis oral contraceptives=prediscpose to embolism |
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what should you think when any female is of child bearing age?
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childbearing age thing pregnancy
*ectopic pregnancy, mittleschmerz, PID, endometriosis |
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what should you think with male that is 60 yo w/ pain radiating to back?
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AAA
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why is fam hx impt?
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can reveal bleeding dyscrasia or hereditary colon cancer
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why is travel hx impt?
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*malaria
*salmonella *dysentery |
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what are the 6F's of cholecystitis?
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1. Fat
2. Forty 3. Female 4. Fatty food intolerance 5. Flatulence 6. Fertile |
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what should you think if a patient has trouble sitting still?
what is colic pain characterized by? |
colic
by pain free interval |
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what is colicky pain?
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unbearable intense pain caused by lesions that occlude the smaller conduits
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what are systemic signs of sepsis?
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*pallor
*hypothermia *tachycardia *diaphoresis |
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if a patient has fever what should you think?
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perforationw/ infection
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when inspecting what are you looking for?
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*old surgical scars (WHSS=well healed surgical scar)
*visible peristalsis |
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what are you feeling for on palpation?
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*masses
*gallbladder *appendiceal abscess *large colon cancer *hernias |
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where is Mcburney point
what does tenderness in at this point indicate? |
2/3 b/w naval and ASIS of iliac crest
tenderness indicates |
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what is ilipsoas sign?
what does it indicate? |
Hyperextension of right hip
causing abdominal pain |
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what is Cullen's sign
what does it indicate? |
Bluish periumbilical
discoloration Retroperitoneal hemorrhage (hemorrhagic pancreatitis, abdominal aortic aneurysm rupture) |
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what is Kehr's sign?
what does it indicate? |
Severe left shoulder pain
Splenic rupture Ectopic pregnancy rupture |
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what is Murphy's sign?
what does it indicate? |
Abrupt interruption of
inspiration on palpation of right upper quadrant Acute cholecystitis |
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what is obturator signs?
what does it indicate? |
Internal rotation of
flexed right hip causing abdominal pain appendicitis |
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what is grey-turner's sign?
what does it indicate? |
Discoloration of the flank
Retroperitoneal hemorrhage (hemorrhagic pancreatitis, abdominal aortic aneurysm rupture) |
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what is chandelier sign?
what does it indicate? |
Manipulation of cervix
causes patient to lift buttocks off table Pelvic inflammatory disease |
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what is rovsing's sign?
what does it indicate? |
Right lower quadrant
pain with palpation of the left lower quadrant appendicitis |
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what must be performed with EVERY abdominal exam?
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rectal and GU
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what is the pneumonic for DDx of acute abdomen problems?
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VINDICATE
Vascular Inflammatory Neoplasm Degerative Intoxication Congenital Autoimmune Trauma Endocrine |
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what does a WBC >13000 suggest?
when does a high serum amylase suggest? |
peritonitis
pancreatitis |
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when is ABG indicated?
what other lab tests should be considered? |
ABG w/ hypotension, peritonitis, SB infarction
other tests: -LFT's -stoll cultures and sensitiviy -U/A |
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what are possible xrays to order?
what will be present in about 80% if perforated ulcers |
*Pa CXR
*ABD XRAY(flat, upright, lateral decubitus) |
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what are things to look for in radiology?
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*free air under diaphragm
*free fluid *ileus stepladder bowel gas pattern *dilated colon *sentinel loop *fecalith *psoas shadow obliteration *elevated hemi-diaphragm |
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what are diagnostic procedures?
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*angiography
*endoscopy *culdocentisis *paracentesis *diagnostic peritoneal lavage *laparoscopy *exploratory laparotomy |
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what are most common causes of acute abdmen in older patients?
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*cholecystitis, ileus, appendicitis, bowel obstruction, cancer, acute vascular emergencies
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what is the most comon cause of acute abdomen in younger patients?
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apppendicities
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what are special considerations for females?
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*salpingitis (inflamed fallopian tubes)
*ectopic pregnancy *ovarian cyst |
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what are special considerations for elderly?
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*colon cancer
*ischemic colitis *femoral hernias *gallstone ileus |
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what are medical causes of the acute abdomen
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*pneumothorax
*pneumonia *hepatitis *MI *herpes zoster |
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what are the principles of initial management?
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*oxygen
*IV hydration *NPO (nothing by mouth) *Nasogastric Tube (NG) *analgesics *antibiotics |
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what are indicates for surgery?
(3 b's) |
1. Bleed
2. Block 3. Burst intractability to medical managment |
