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34 Cards in this Set
- Front
- Back
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Food makes ____________ ulcer pain better and __________ ulcer pain worse.
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Duodenal
Gastric |
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If a bowel movement provides relief of abdominal pain, what is the implied source?
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Colonic or small bowel source
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If vomiting provides relief, what is the implied process?
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Proximal bowel lesion or gastric process
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Motion, walking, heel tap, or couching cause aggravation of abdominal pain, what is the suggested problem?
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Peritonitis
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If sitting up or bending forward cause relief of abdominal pain, what is the diagnosis?
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Retroperitoneal process such as pancreatitis
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What is one of the most important things to take into consideration when dealing with abdominal pain?
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Location and description of pain
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If the pain is localized in the right upper quadrant, what are some possible diagnoses?
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Acute cholecystitis
Biliary colic Acute hepatic inflammation |
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If the pain is in the left upper quadrant, what are some possible diagnoses?
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Splenic infarct
Splenic flexure ischemia Constipation |
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If the pain is in the epigastric region, what are some possible diagnoses?
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Gastroenteritis, PUD
Pancreatitis Small intestinal colic |
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If the pain is in the right lower quadrant, what are some possible diagnoses?
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Appendicitis
Infective ileitis Crohn's disease |
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If the pain is in the left lower quadrant, what are some possible diagnoses?
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Acute diverticulitis
Renal disorders Infectious colitis |
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In females, what should always be considered if they present with abdominal pain?
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Pregnancy or complications thereof
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What is the problem with a diffuse abdominal pain?
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It could be anything so it requires a more intensive workup
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How does a patient with appendicitis present?
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Abdominal pain beginning T8-T10 that migrates to RLQ
Retrocecal appendix pain is more dull Anorexia Low grade fever Nausea and vomiting |
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What are McBurney's point, Rovsing's point, Psoas sign, and Obturator sign?
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McBurney's: Tenderness 1.5 to 2 inches from ASIS to umbilicus
Rovsing's: Pain in RLQ with palpation in LLQ Psoas: RLQ pain with passive right hip extension Obturator: RLQ pain with flexion, internal rotation of right hip and knee |
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How does a patient with a duodenal ulcer present?
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Sudden, localize epigastric pain that quickly becomes generalized
May radiate to top of right shoulder Worsens with respiration |
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How is a duodenal ulcer diagnosed and treated?
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Diagnosed: Plain film xray, spiral CT, or ultrasound
Treatment: Surgery (Graham patch, omentum), antibiotics, IV PPI |
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What is the most common cause of small bowel obstruction?
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Post op adhesions, 70-80%
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How does a patient with a small bowel obstruction present?
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Abdominal pain, crampy periumbilical
Nausea and vomiting Abdominal distention Obstipation |
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How is a small bowel obstruction diagnosed?
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X-ray - dilated loops of bowel with no air in colon for complete obstruction
Small bowel follow thru CT scan with oral contrast - etiology of obstruction |
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How is a small bowel obstruction treated?
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Partial: NG tube an IV hydration, if it doesn't improve in 48 hours surgical exploration
Complete: emergent laparoscopy |
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What is diverticulitis?
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Increased intraluminal pressure within a diverticulum causing inflammation
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How does a patient with diverticulitis present?
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LLQ pain (sigmoid)
Abdominal distention Low grade fever Leukocytosis |
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What two diagnostic tests are contraindicated in patients with diverticulitis?
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Barium enema and endoscopy due to risk of peroration
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What is the treatment for diverticulitis?
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Complicated: requires surgery
Uncomplicated: can be initially managed with medical therapy |
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What is ascites and how does the patient present?
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Accumulation of peritoneal fluid
Abdominal distention Anorexia, nausea, heartburn Umbilicus may evert Positive fluid wave test |
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How is ascites diagnosed?
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Ultrasound
CT scan Abdominal paracentesis - appearance, cell count, albumin, total protein, culture |
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What does a translucent yellow, cloudy, milky, and pink/bloody paracentesis indicate?
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Translucent yellow: cirrhosis
Cloudy: infection Milky: malignancy Pink/bloody: traumatic tap, malignancy |
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How is a serum-ascites albumin gradient calculated and what does it mean?
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Subtracting ascitic fluid albumin value from serum albumin value
Identifies presence of portal hypertension if greater than 1.1g/dL |
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What is primary peritonitis?
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Inflammation of the parietal and visceral peritoneum
Less common Caused by gram negative bacteria Mostly occurs in patients who have underlying hepatic cirrhosis and ascites No intra-abdominal source |
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What is secondary peritonitis?
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Inflammation of parietal and visceral peritoneum
More common Caused by disease or injury to intra-abdominal organs Spillage of intestinal contents into peritoneal cavity |
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How does a patient with peritonitis present?
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Anorexia
Nausea/vomiting Diffuse abdominal pain Fever Shallow respirations |
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How is peritonitis diagnosed?
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Positive culture and absolute polymorphonuclear leukocyte (PMN) count in ascites >250 cells/mm^3
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How is peritonitis treated?
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Resuscitation with fluids
IV antibiotics for 5-10 days Laparascopy with exploration to remove source of infection, repair rupture, and irrigate peritoneal cavity |
