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29 Cards in this Set

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type of pain:
vague, dull, poorly localized, usually midline due to bilateral innervation of organs based on embryologic origin
Visceral Pain

(Visceral is Vague)
ex: early appendicitis
type of Pain:
sharp, well-localized and involves the peritoneum and is associated w/ rebound and guarding
Parietal Pain

(Parietal is Pinpoint)
ex: late appendicitis
Referred pain:

Ureteral obstruction in man
Ipsilateral testicle
Dx:
45-yo obese woman complains of fever, RUQ pain and nausea that worsens when she eats fatty foods
Cholecystitis
Diff Dx:
Epigastric Pain
- GI (3)
- Pancreatic (2)
- Aortic (2)
- Cardiac (3)
- Gastritis; Peptic Ulcer; GERD

- Acute/Chronic Pancreatitis

- Ruptured Aortic Aneurysm; Dissecting Aorta

- Angina, MI, Pericarditis
Diff Dx:
RUQ Pain
- Hepatobiliary (4)
- GI (1)
- Cholelithiasis; Cholecystitis; Cholangitis; Hepatitis

- Peptic Ulcer
Diff Dx:
LUQ Pain
- Splenic (5)
- GI (1)
- Spleen trauma; infarction; abscess; rupture; Mononucleosis

- Gastric Ulcer
Diff Dx:
RLQ Pain
- GI (3)
Small bowel obstruction;

Appendicitis;

Crohn's Dz
Diff Dx:
LLQ Pain
- GI (2)
Inflammatory Bowel Dz;

Diverticulitis
Diff Dx:
Flank Pain
- GU (5)
NET PP:
Nephrolithiasis;
Epididymitis;
Testicular Torsion;
Pyelonephritis;
Prostatitis
Diff Dx Pain:
Adnexal (lower abdominal) Pain
(6)
PET SOCk:
PID;
Ectopic Pregnancy;
Tubo-ovarian abscess;
Salpingitis;
Ovarian torsion;
Cystitis
PET SOCk
Dx:
26-yo woman has severe LLQ pain, vaginal bleeding and light-headedness. Last menstrual period was 6 weeks ago
Ectopic Pregnancy
Diff Dx:
Pain Anywhere in Abdomen
(4)
Strangulated hernia;

Large Bowel Obstruction;

Sigmoid Volvulus;

Mesenteric Ischemia
Dx:
28-yo woman presents w/ diffuse abdominal pain, nausea, and confusion. She is not pregnant but takes a stained-glass class.
Lead poisoning
Diff Dx:
Abdominal wall Pain
(2)
Hernia

Rectus sheath hematoma
Diff Dx:
Metabolic/genetic-related Abdominal pain
(4)
HyperC;

Acute Intermittent Porphyria;

DKA;

Sickle cell
Diff Dx:
Viral-related Abdominal Pain
(3)
Herpes Zoster;

Mononucleosis;

HIV
Diff Dx:
Toxin-related Abdominal Pain
(2)
Heavy Metal poisoning

Black Widow Spider venom
(3) vascular causes of abdominal pain to always consider in the elderly
MAM:

Mesenteric Ischemia;

AAA;

MI
Diff Dx of an emergency patient w/ absent bowel sounds (3) or high-pitched sounds (1)
Absent:
Pancreatitis;
Ischemia;
Acute Abdomen

High-pitched:
Obstruction
63-yo obese man complains of pain in his "kidney" for 3 days. He has Hx of MI x 2 and no back tenderness.
AAA
Dx:
hypotension; abdominal or back pain; pulsatile mass in abdomen; Hx of vascular dz or atherosclerosis
AAA
(3) Dx tests for AAA
Angiogram (gold standard)

MRI or CT w/ contrast
Dx:
72-yo man w/ Hx of A-fib, on digoxin and complains of severe abdominal pain out of proportion to the exam
Acute Mesenteric Ischemia
72-yo woman w/ Hx of MI complains of gnawing abdominal pain after eating. She lost 15 pounds in the past month.
Chronic Mesenteric Ischemia
Cause of Acute (2) vs. Chronic Mesenteric Ischemia
Acute:
Emboli (A-fib);
Hypercoagulability

Chronic:
Atherosclerosis
(2) possible lab signs w/ Mesenteric Ischemia
Increased Lactate

Metabolic Acidosis
Gold standard test for Mesenteric Ischemia

(2) others
Gold standard: Angiogram

others:

Spiral CT w/ contrast

MRI
First step for Mesenteric Ischemia

Next?
First: Maintain tissue perfusion w/ IV fluids until...

Surgical bypass