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23 Cards in this Set
- Front
- Back
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Positive McBurney’s sign
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between umbilicus and right ASIS
shows appendicitis |
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Rovsing’s sign
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press on lower left quadrant
pain goes to lower right quadrant shows appendicitis |
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Psoas sign
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stretch the psoas w/ pt on their side
pt will have pain shows appendicitis |
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T10-L1 rotated right can be associated with what GI problem
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appendicitis
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Abdominal pain from any cause is mediated by either the...
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visceral or somatoparietal afferent system
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visceral afferents arise from what spinal levels?
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T5-11
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Visceral vs Somatoparietal pain
diffuse not localized, midline ****in red |
Visceral
Distention or stretch of the visceral peritoneum produces visceral pain |
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Visceral vs Somatoparietal pain
nonradiating, precisely localized ****in red |
Somatoparietal pain
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Visceral vs Somatoparietal pain
more intense or “sharp” ****in red |
Somatoparietal pain
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source of visceral pain for pain that is perceived as
epigastric periumbilical suprapubic |
Foregut-perceived as epigastric
Midgut-periumbilical Hindgut-suprapubic Somatoparietal pain - nonradiating |
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an important defense mechanism that pts have to wall off problems is lost in these 2 populations...leading to a more diffuse peritonitis
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Children
Old people |
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bacteria that generally cause appendicitis?
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Bacteria are
E. Coli 80%, Bacteroides Fragilis 70%, Pseudomonas 40% Anaerobes exceed aerobes by 3:1 |
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how does referred pain occur?
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One explanation is that visceral afferent nerve fibers enter the spinal cord close to inputs from somatic receptors, and both types of inputs activate the same spinothalamic pathways
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what is the order for examination of the abdomen?
***RED BOLD |
INSPECTION
AUSCULTATION PERCUSSION PALPATION |
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is your pt RESTLESS or STILL?
what do these indicated? ***RED |
Restless: kidney stone (ureters are retroperitoneal)
Still: something in the peritoneum |
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4 Steps for progression of symptoms in acute appendicitis
****one step was in red |
1. Vague periumbilical pain, followed by....
2. “Tormeanor” (anorexia, nausea, vomiting, malaise), followed by.... 3. Migration of pain into LRQ (***IN RED) , followed by.... 4. Temperature elevation (~101f.) note: the whole sequence takes 24-48 hours |
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if a female pt has generalized GI pain, what test should you make sure to do?
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HCG (preggo)
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What is the definitive tx for appendicitis?
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Appendectomy
no significant difference in laparoscopic and open |
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in a woman who is pregnant, what is the most reliable symptom of appendicitis?
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is periumbilical or diffuse abdominal pain that later localizes to the right lower quadrant.
so pretty much the same thing |
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60% of jaundice cases are a result of?
** in red |
ACUTE CHOLANGITIS
USUALLY SECONDARY TO CBD STONE |
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pt is sitting up and leaning forward in pain when you walk into the room..the pt has lancinating (spearing) pain that radiated directly through to the back... what do they have?
***red |
Acute pancreatitis
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most common cause of mechanical small bowel obstruction is?
Followed by? ****RED |
Adhesions
Hernia |
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The most common cause of Large Bowel Obstruction is....
***RED BOLD |
NEOPLASM
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