Icm Winter 2 Acute Abdomen

Front 1

what is "nonspecific" abd pain

Back 1

cant find cause after WU

Front 2

describe visceral pain

Back 2

midline, dull, achy, crampy, poor localization

associated with other viscera prblms: NV, diaphoresis

Front 3

what might be involed in a midline dull, achy, crampy epigastric pain

Back 3

Liver
GB
stomach
duodenum

Front 4

what might be involved in a dull achy crampy periumbulical pain

Back 4

sm intestine, appendix cecum

Front 5

what might be involved in a dull achy crampy pain in the hypogastric area

Back 5

colon
kidney
bladder
pelvic orgen

Front 6

where are the pain R for visceral pain
where are they for somatic pain

Back 6

Visceral: visceral peritoneum of hollow organs and the capsule of solid organs

Somatic: parietal peritoneum and roots of mesentary

Front 7

how is pain from ischemia, inflammation and stretch sent?

Back 7

somatic pain- myelinated UL fibers. gives a more sharp, discrete, localized pain

Front 8

what is somatic pain

Back 8

sharp, discrete, localized

Responsible for guarding and rebound pain

Front 9

is gruading/reboud pain visceral or somatic

Back 9

somatic
sharp, demarcated, localized

Front 10

what is referred pain

Back 10

diseased organ sends pain to distant cutaneous area

both areas are supplied by the same or adjacent dermatomes

Front 11

where is the referred pain

1. MI
2. Pneumonia/PE
3. Appendiciits, SBO
4. uretal colic

Back 11

1. MI- diaphragm line
2. pneumonia/PE: at the corners of the transverse colon
3. appendicitis/SBO: periumbilical
4. ureter colic: groin

Front 12

where does this refer pain to
1. diaphragm/spleen
2. cholecystitis
3. pancreatitis
4. salpingitis/cystitis

Back 12

1. diaphragm/spleen: R neck/shoulder
2. cholecystitis: tip of R scapula
3. pancreatitis: T7-8 midline
4. salpingitis/cystitis_ just above butt crack

Front 13

what 2 goups of pts with abd pain might have more severe sx. what are the causes

Back 13

1. OLD: surgical: vascular, heart disease, sepsis

2. Young: dehydration, septic, no hx


**vitals wont accurately reflect degree of illness

Front 14

do vitals reflect accuratly the disease state in old and young ppl

Back 14

nope, old nad infants might be sicker than they let on

old: ischemia, heart, sepsis
babes: dehydration, sepsis, no accurate hx

Front 15

in old and young (infants) what do you REALLY need to be on the look out for with cc abd pain

Back 15

they may not present as sick as they actually are

VS may not be totally reflective so take ANY abnormal serious
severe abd pain, rapid onset
dehydration
pallor/diaphoresis

Front 16

what are associated signs with Abd pain

Back 16

NV
diarrhea
bleeding

Front 17

tell me about abd pain with FAST onset v INSIDIOUS

Back 17

FAST: vascular, stone, rupture of viscus, cyst, ectopic pregnancy. more liekly to be surgical- esp pain less than 24 hours that increasing in severity

INSIDIOUDS: inflammatory- appey, cholesystitis

Front 18

how will vascular problems present onset wise

what about cholecystitis

Back 18

vascular, stone, rupture, cyst, ectopic: RAPID

cholecystisi, appey: INSIDIOUS

Front 19

would a surgen prefer an old pt with a rapid onset of abd pain or a younger kid with insidioud onset

Back 19

OLD- vascular, heart, sepsis (likely surgical)

FAST- vascular, stone, rupture, cyst, ectopic (likely surgical)


infant- dehydrated
insidious- inflammatory: appendicitis, cholecystitis

**pain that is less than 24 hrs and increased intensity is likely surgical

Front 20

what does this mean. keep in mind the character of pain as described by t depends on their culture, education, anxiety and motive

dull achy burning
sharp stabbing
crampy
tearing

Back 20

dull achy burning: visceral
sharp stabbing: somatic, peritoneal
crampy: obstruction of viscus
tearing: dissecting aneyrysm- old HTN

Front 21

if the pain is out of proportion to PE whats likely

Back 21

pancreatitis
mesenteric ischemia

Front 22

whats the pain prigression for appenciditis

what the pain progression for cholecystitis

Back 22

appey: periumbilical (RUQ if prego) migrates to RLQ

chole: epigastric migrates to RUQ

Front 23

what kind of pain is...

1. aggrevated by moveming
2. relief with eating
3. increased Pain after eating
4. change in position

Back 23

. aggrevated by moveming- parietal peritoneal pain

2. relief with eating: ulcer

3. increased Pain after eating: biliary colic

4. change in position: pancreatitis, peritonitis,

Front 24

what diseases might present when the pt says they have had a simliar pain

Back 24

cholecystitis (tip of scapula)
ulcers
diverticulitis
pancreatitis (lots of vomit)

**these all tend to be recurrent

Front 25

what does vomiting tell us about abd pain

excess vomit

NO vomit

Back 25

1. prbly visceral (dull achy)
2. dehydration
3. cant take PO meds- hospitalize

**excess vomit--> obstruction, pancreatiti

NO vomit: ovarian, uterine

Vomit AFTER pain- surgica;
Vomit BEFORE pain- nonspecific gastroenteritis

Front 26

would the surgeon like a pt who is vomiting BEFORE the pain or AFTER

Back 26

AFTER

Before- likely nonspecific gastroenteritis

**vomit- visceral
**lots of vomit- pancreatitis
***no vomit- uterine, ovary
**vomit + diarrhea- gastroenteritis, pancreatitis, diverticulitis,

Front 27

how can you detemine if a kid is anorexic

Back 27

did you eat breakfast

if you could eat your fav food now would you

**anorexia indicated intraabd inflammation

Front 28

what does pooing have to do with it

Back 28

diarrhea- dehydration

vomit + diarrhea- gastroenteritis, diverticulitis, pancreatitis

constipation: ileus due to inflammation or mechanical block

Front 29

what does increased frequency of bathroom use in a kid mean

Back 29

DM
inflammation

Front 30

hx of what is importantan in abd pain

meds

surgery

LMP

Back 30

hx: SM, cardiovascular, HTN, respiratory, renal path

meds: steroids (immunosuppressants), AB, laxatives, narcotics, ASA, NSAIDS

Surgery- ADHESION

Front 31

laxative abise is assoicated with what
EtOH abuse...

Back 31

1. diverticular disease
2. cecal volvulus

EtOH abuse: gastritis, ulcers, pancreatitis

Front 32

you walk in and you pt is pale, sweaty and totally still. whats likely

you walk in and your pt is writing and agitated and moving around

Back 32

still: local or diffuse peritonitis

moving: VISCERAL, non sepcific, renal/biliary colic, mesenteric ischemia

Front 33

who might have a normal temp but be infectious

Back 33

old, immunosuppressed

low grade fever- appenditcitis, cholesystitis

high- salpingitis, pyelonephritis, bacterial enteritis, ruptured viscus

Front 34

when is RR increased

Back 34

sepsis
hypoperfusion

Front 35

whats the order of looking at a pt

Back 35

1. insepect: look for caput medussa (portal HTN)
2. auscultate: increased BS- non sepcific, gastroenteritis. decreased BS- peritonitis, inflammation. HIGH pitch BS- obstruction

3. percuss: distension

4. palpate: localize tenderness- LOOK for facial grimace

Front 36

guarding, how do you tell voluntary from involuntary

Back 36

involuntary is more significant

while palpating the tender ares, ask them to take a breath in. if you can get in deeper its voluntary

Front 37

rebound tenderness

deep palpate then quickly release

Back 37

if tender, peritonitis

if cough elicits pain--> rebound
a kid jumping around --> pain --> rebound

Front 38

what does a + psoas or obturator sign mean

Back 38

inflammation in rectocecal area- appey, salpingitis

Front 39

Murphy

Back 39

Palpate RUQ, have pt take a breath in, if they stop breathing its painful and cholecystisis, hepatitis,

Front 40

what is fist percussion good for

Back 40

percuss CVA--> pyelonephritis if tender, or obstructive uropathy

Front 41

with CC abd pain, what will kill your patient. you cant afford to miss these ones

Back 41

1. aortic aneurysm (ruptured)
2. perforated viscus
3. acute pancreatitis
4. intestinal obstruction
5. mesenteric ischemia

Front 42

tell me about acute pancreatitis

Back 42

adults (not kids or elderly)
male
EtOH
biliary tract disease

galltoinse, hypercalcemia, hyperlipidemia --> necrosis

Front 43

you have a 45 yo male with a hx of EtOH and biliary disease. he presents with acute onset of epigastric pain that radiates to his back. He has NV and a low grade fever. He develops ARDS, sepsis, hemorrhage, and renal failure. what is it.

Back 43

pancreatitis that you missed

Front 44

how does pancreatitis present

Back 44

45 yo male
spigastric pain, radiated to back
low fever, NV


can go into ARDS, sepsis, renal failure

Front 45

tell me about mesenteric ischemia

Back 45

common eldery and super deadly

ischemia: transient hypotension, artherosclerosis, thrombi, emboli

SEVERE pain, colicky. starts periumbilical, and becomes DIFFUSE,

vomit + diarrhea

PE unremarkable

do a rectal

Front 46

a 85 yo male presents with epigastric pain that becomes diffuse. He has come vomit and diarrhea. He states the pain is SO SEVERE but your PE is unremarkable. Is he

1. drug seeker
2. crazy, the PE didnt show anything, old ppl have diarrhea. its NBD
3. bored
4. mesenteric ischemia

Back 46

mesenteric ischemia

**take it serious, SUPER deadly.

**ischemia bc of transient hypotension + artherosclerosis/thrombi/emboli

Front 47

who gets appendicitis
who perforates

Back 47

adolencence and young adults

women, kids, and eldery perforate

obstruction of lumen--> swelling, ischemia, infection, perforation (in kids its lymphoid hyperplasia, in adults its old stuck poo)

pain, anorexia. periumbilical to RLQ

temp and leukocytosis, but maybe not in older folks

Front 48

tell me about peptic ulcers

age
sex
perforation
pain
PE

Back 48

50 yo most common, but ALL ages
M>W
not common, not lots of bleed
epigastric pain, non radiating. gets better with food/antacid. pain wakes pt from sleep
PE unremarkable

Front 49

tell me more about non specific abd pain

Back 49

young, middle age women. child bearing years. associated psych disorder

**often see cancer much later
**chronic recurrent
PERITONEAL SIGNS NOT PRESENT

Front 50

are peritoneal signs present in nonspecific abdomen

Back 50

nope

women w/psych disorders. turns our later they have cancer

Front 51

whats teh deal with kids and abd pain

presentation
common
not common

Back 51

1. they cant tell you about it
2. everything makes their belly hurt- pharyngitis, pneumonia etc
3. common: gastroenteritis, mesenteric adenitis, appendicitis
4. NOT common: biliary tract disease, pancreatitis, gyne problems, vascular

Front 52

whats the deal with old ppl and abd pain

Back 52

1. they are TOUGH, high pain tolerance (altered neurotransmission)
2. present weird, no high fevers, vitals wont represent
3. dont like hospitals
4. more likely to have vascular (mesenteric ischemia), cancer, complicating diseases, perforation, cholecystiis, diverticulitis

Front 53

abd pain and...

1. WBC
2. Hgb.HCT
3. Amylase
4. UA
5. Pregnancy test

Back 53

1. WBC: infection. appendicitis, PID, cholecystitis. super high in: peforation, peritonitis, fulminant pancreatitis, sepsis

2. Hgb.HCT: hemorrhage, dehydration, anemia. acute heorrhage (ectopic preg, leaking AAA) will initially be normal values and then drop

3. Amylase: increased in pancreatitis, PUD, SBO/ischemia, common duct stones, ectopic preggo, renal failure, EtOH, facial trauma (salivary amylase)

4. UA: WBC- UTI, RBC- tumor, trauma, stones

5. Pregnancy test: ALWAYS on any woman of childbearing years

Front 54

abd pain and...

1. Electrolytes
2. Liver fx test

Back 54

Electrolytes: low bicarb--:>anion gap acidosis, sepsis, mesenteric ischemia, DKA. confirm with ABG

2. Liver: biliary disease hepatitis etc

Front 55

abd pain and imaging

1. CXR
1. ABD series
3. Contrast imaging

Back 55

1. CXR- upright to determine free air under diaphragm as is seen with ruptured viscous

2. ABD seriesL dilated loops, air fluid levels, clacification, gallstones. little value

3. contrast: barium CI in perforations. contrast enema determines ileus vs mechanical obstruction

Front 56

abd pain and

1. US
2. CT

Back 56

US- biliary tract, GB, pancreas, kidney, aorta, uterus. gasstones,

CT- expensive, NOT screening. pancreas, petroperitoneal space, spleen. pancreatic abcess, retroperitoneal hamorrhage, leakign AAA

Front 57

who with abd pain gets EEG

Back 57

old ppl, heart disease mistaken for abd pain

Front 58

pain relief

Back 58

dont give before surgical consult, masks peritoneal signs

give anxiety relif (hydroxyline) to help pt and not block peritoneal signs

Front 59

who gets immediate wurgical consult

Back 59

appendicitis
obstruction
perforated ulcer
acute cholesystitis

fast onset, increased severity, local/diffuse peritoneal signs