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161 Cards in this Set
- Front
- Back
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mid upper epigastric pain could be due to?
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1 MI
2 PUD 3 Pancreatitis 4 Billiary dx 5 acute cholecystitis 6 perforated esophagus |
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LUQ abdominal pain could be due to?
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1 Splenic injury/ rupture
2 renal colic 3 gastric ulcer 4 AAA 5 perforated colon 6 pyleonephritis 7 L pneumonia |
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L midabdominal pain could be due to?
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1 diverticulitis
2 intestinal obstruction 3 acute pancreatitis 4 early appendicitis 5 mesenteric thrombosis 6 aortic aneurysm |
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LLQ pain could be due to?
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1 ovarian dx
2 PID 3 ruptured ectopic pregnancy 4 sigmoid diverticulitis 5 salpingitis 6 tubo ovarian abscess 7 incarcerated hernia 8 peforated colon 9 Chron's dx 10 ulcerative colitis 11 renal urteral stone |
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Mid abdominal pain could be due to?
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1 PUD
2 IBD 3 Bowel obstruction 4 bowel ischemia 5 appendicitis 6 AAA 7 IBS 8 DKA 9 Gastroenteritis |
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RUQ abdominal pain could be due to?
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1 Biliary dx
2 hepatitis 3 renal colic 4 diverticulitis 5 acute cholecystitis 6 duodenal ulcer 7 congestive hepatomegaly 8 pyelonephritis 9 r pneumonia |
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RLQ abdominal pain could be due to?
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1 appendicitis
2 ovarian dx 3 PID 4 ruptured ectopic pregnancy 5 salpingitis 6 renal/uretic stone 7 incarcerated hernia 8 mesenteric adenitis 9 meckel's diverticulitis 10 Chron's dx 11 perforated cecum 12 psoas abcess |
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IBS?
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Irritable bowel syndrome
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Steps to diagnosing ab pain?
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1 ID the area of pain
2 Radiation? 2 0-10? 3 What does it feel like? char 4 When did it start? acuity 5 Did you notice anything different around that time? 6 What makes it better? 7 What makes it worse? 8 Associated sympt? |
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abdominal associated symptoms?
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1 Nausea?
2 vomiting? 3 anorexia? 4 inability to pass stool 5 inability to pass flatus 6 melena? 7 hematochezia? 8 fever? 9 chills? 10 weight loss? 11 altered bowel habits? 12 chills 13 weight loss 14 altered bowel habits? 15 orthostatic symptoms? 16 urinary symptoms? 17 ETOH? |
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Hematochezia?
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Hematochezia is the passage of maroon colored stool [1]. It is distinguished from melena, which is stool with blood that has been altered by reaction with stomach acids and appears black/"tarry". It is also different from bright-red blood per rectum (BRBPR). Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper GI bleed.
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Icterus?
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Jaundice
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for the ab HEENT should look for?
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jaundice or icterus
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for the ab, heart and lung exams can reveal?
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pneumonia MI
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distension of the ab is assoc with?
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obstruction or ascites
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in the ab, high pitched tinkling sounds with rushes suggest?
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intestinal obstruction
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In the ab, what is the order?
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1 Inspection
2 Auscultate 3 Percuss 4 Palpate (area of pain last) |
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Midline areas of the abdomen?
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Midline:
Epigastric Periumbilical Suprapubic |
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for the ab, what areas do you asses?
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cardio
pulmonary pelvic testicular rectal occult stool |
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What diagnosis would you consider in a otherwise healthy patient with unexplained ab pain?
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appendicitis
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Pain of appendicitis usually migrates from?
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(diffuse) periumbilical region to the RLQ to Mc Burney's point
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Important tests for appendicitis?
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1 Clinical exam
2 CT if preg, ultrasonography if you can't find out surgical exploration |
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PUD clinical clues?
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1 NSAID use
2 H pulori infection 3 melena 4 pain relieved by eating |
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PUD important test?
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1 EGD
2 h pylori serology |
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pts with pancreatitis usually have a h/o?
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ETOH abuse
gallstones |
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Impt test for pancreatitis?
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serum lipase
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Early bowel obstruction clinical clue?
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inability to pass stool or flatus
nausea vomiting prior ab surgery |
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Early bowel obstruction impt tests
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adominal x ray
ct scan small bowel study barium enema |
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migration of pain to the RLQ is suggestive of?
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1 diverticulitis
2 Crohn's dx 3 colon ca 3 PID 4 ovarian pathology |
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ovarian pathology?
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1 ruptured ectopic pregnancy
2 ovaran torsion 3 ruptured ovarian cyst |
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diffuse ab pain that subsequently localizs and becomes mroe constant suggests?
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parietal peritoneal inflammation
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appendolith?
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Most cases of appendicitis are due to lumen occlusion by a fecalith
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anicteric
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no jaundice
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Murphy's sign?
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tenderness in the RUQ with palpation during inspiration
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episodic ab pain is often cuased by?
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1 IBS
2 biliary colic 3 mesenteric ischemia 4 renal colic |
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Severy intense crampy pain suggests?
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obstruction of a hollow visceral (biliary colic, bowel obstruction or ureteral obstruction for a stone)
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Cholangitis?
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Cholangitis is an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines. Bile is a chemical made by the liver that helps digest food.
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Pattern of biliary pain?
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depends on the location of the stone and its chronicity..usually begins 1 or more hrs after eating, RUQ sometimes epigastric pain
NV pain usually lastys for more than 30 min and may last for hrs |
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Nonsurgical tx for cholecystitis?
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Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and a low-fat diet (when food can be tolerated).
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Main sympt of cholecystitis?
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The main symptom is abdominal pain that is located on the upper right side or upper middle of the abdomen. The pain may:
Be sharp, cramping, or dull Come and go Spread to the back or below the right shoulder blade Be worse after eating fatty or greasy foods Occur within minutes of a meal |
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Besides pain, other sympt of cholecystitis?
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1 Abdominal fullness
2 Clay-colored stools 3 Excess gas 4 Fever 5 Heartburn 6 Indigestion 7 Nausea and vomiting 8 Yellowing of skin and whites of the eyes (jaundice) |
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How is cholecystitis treated?
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In the emergency room, patients with acute cholecystitis are given
fluids antibiotics to fight infection. cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually needed when inflammation continues/ recurs |
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gallstone dx may present as?
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1 cholelithiasis
2 biliary colic 3 cholecystitis 4 cholangitis 5 pancreatitis |
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gallstone dx may present as?
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1 cholelithiasis
2 biliary colic 3 cholecystitis 4 cholangitis 5 pancreatitis |
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gallstone dx may present as?
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1 cholelithiasis
2 biliary colic 3 cholecystitis 4 cholangitis 5 pancreatitis |
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Cholelithiasis?
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(gallstones)
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Cholelithiasis?
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(gallstones)
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gallstone dx may present as?
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1 cholelithiasis
2 biliary colic 3 cholecystitis 4 cholangitis 5 pancreatitis |
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gallstone dx may present as?
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1 cholelithiasis
2 biliary colic 3 cholecystitis 4 cholangitis 5 pancreatitis |
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Cholelithiasis?
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(gallstones)
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Cholelithiasis?
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(gallstones)
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Cholelithiasis?
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(gallstones)
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Tests for gallbladder dx?
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Tests that detect gallstones or inflammation include:
Abdominal CT scan Abdominal ultrasound Abdominal x-ray A CBC shows infection by an elevated white blood cell count |
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Tests for gallbladder dx?
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Tests that detect gallstones or inflammation include:
Abdominal CT scan Abdominal ultrasound Abdominal x-ray A CBC shows infection by an elevated white blood cell count |
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Tests for gallbladder dx?
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Tests that detect gallstones or inflammation include:
Abdominal CT scan Abdominal ultrasound Abdominal x-ray A CBC shows infection by an elevated white blood cell count |
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Tests for gallbladder dx?
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Tests that detect gallstones or inflammation include:
Abdominal CT scan Abdominal ultrasound Abdominal x-ray A CBC shows infection by an elevated white blood cell count |
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Lab tests for gallbladder dx?
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Amylase
Amylase, urine Chemistry panel (chem-20) Lipase Prognosis |
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Lab tests for gallbladder dx?
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Amylase
Amylase, urine Chemistry panel (chem-20) Lipase Prognosis |
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Tests for gallbladder dx?
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Tests that detect gallstones or inflammation include:
Abdominal CT scan Abdominal ultrasound Abdominal x-ray A CBC shows infection by an elevated white blood cell count |
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Lab tests for gallbladder dx?
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Amylase
Amylase, urine Chemistry panel (chem-20) Lipase Prognosis |
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Lab tests for gallbladder dx?
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Amylase
Amylase, urine Chemistry panel (chem-20) Lipase Prognosis |
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C/o with gallbladder dx?
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Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation to the back and shoulders and other concomitant symptoms such as vomiting and diarrhea.
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Lab tests for gallbladder dx?
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Amylase
Amylase, urine Chemistry panel (chem-20) Lipase Prognosis |
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C/o with gallbladder dx?
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Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation to the back and shoulders and other concomitant symptoms such as vomiting and diarrhea.
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C/o with gallbladder dx?
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Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation to the back and shoulders and other concomitant symptoms such as vomiting and diarrhea.
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C/o with gallbladder dx?
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Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation to the back and shoulders and other concomitant symptoms such as vomiting and diarrhea.
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Biliary colic ?
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-blockage by a gallstone of
-the common bile duct or the duct leading into it from the gallbladder Biliary colic is pain associated with irritation of the viscera secondary to cholecystitis and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis |
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Biliary colic ?
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-blockage by a gallstone of
-the common bile duct or the duct leading into it from the gallbladder Biliary colic is pain associated with irritation of the viscera secondary to cholecystitis and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis |
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Biliary colic ?
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-blockage by a gallstone of
-the common bile duct or the duct leading into it from the gallbladder Biliary colic is pain associated with irritation of the viscera secondary to cholecystitis and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis |
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C/o with gallbladder dx?
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Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation to the back and shoulders and other concomitant symptoms such as vomiting and diarrhea.
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Biliary colic ?
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-blockage by a gallstone of
-the common bile duct or the duct leading into it from the gallbladder Biliary colic is pain associated with irritation of the viscera secondary to cholecystitis and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis |
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Colic?
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Colic is a form of pain in the abdomen which starts and stops abruptly
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Colic?
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Colic is a form of pain in the abdomen which starts and stops abruptly
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Colic?
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Colic is a form of pain in the abdomen which starts and stops abruptly
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Biliary colic ?
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-blockage by a gallstone of
-the common bile duct or the duct leading into it from the gallbladder Biliary colic is pain associated with irritation of the viscera secondary to cholecystitis and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis |
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Colic?
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Colic is a form of pain in the abdomen which starts and stops abruptly
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Colic?
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Colic is a form of pain in the abdomen which starts and stops abruptly
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mesentry?
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is the double layer of peritoneum that suspends the jejunum and ileum from the posterior wall of the abdomenthe peritoneum responsible for connecting the jejunum and ileum, parts of the small intestine, to the back wall of the abdomen. Between the two sheets of peritoneum are blood vessels, lymph vessels, and nerves. This allows these parts of the small intestine to move relatively freely within the abdominopelvic cavity. The brain, however, cannot map sensation accurately, so sensation is usually referred to the midline, an example of referred pain
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Biliary colic
clinical clues? important tests? |
clinical clues?
episodic and crampy pain that may radiate to the back important tests? ultrasonography |
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DD for Biliary colic?
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IBS
PUD Pancreatitis Renal colic Early bowel obstruction mesenteric ischemia |
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IBS
clinical clues? |
yrs of h/o intermittent pain relieved by defecation or assoc with diarrhea
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PUD
clinical clues? important tests? |
1 NSAID use
2 H pylori infect 3 melena 4 pain relieved by eating or by antacids ----------------------------------- EGD H Pylori serology |
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Pancreatitis
clinical clues? important tests? |
ETOH abuse
Gallstones ------------------------------ serum lipase |
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Renal colic
clinical clues? important tests? |
1 hematuria
2 radiation to flank, groin, genitals ------------------------------------- 1 urinalysis 2 renal CT scan |
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Early bowel obstruction
clinical clues? |
1 inability to pass stool
2 inability to pass flatus 2 n/v 3 prior surgery |
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IBS
important tests? |
absence of sympts
1 anemia 2 fever 3 wt loss 4 positive fecal occult blood test exclusion of other diagnosis |
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Early bowel obstruction
important tests? |
1 ab x rays
2 CT scan 3 small bowel study 4 barium enema |
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mesenteric ischemia
clinical clues? |
postprandial pain
associated weight loss a fib, MI, CHF, CAD peripheral vascular dx |
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Causes of mesenteric ischemia?
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inflammation and injury of the small intestine result from inadequate blood supply
Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure) or local factors such as constriction of blood vessels or a blood clot. |
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Mesenteric ischemia
important tests? |
mesenteric doppler
angiography |
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Before advising cholecystectomy, what must you do?
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Make sure its gallstones that are causing the problem
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PTCA?
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Percutaneous transhepatic cholangiogram (PTCA)
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MRCP?
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Magnetic resonance cholangiopancreatography (MRCP)
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ERCP?
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Endoscope retrograde cholangiography (ERCP)
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RF for cholelithiasis?
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increased age
obesity high fat diet woman more than men pregnancy prolonged fasting Chron's dx Hemolytic anemias asympt gallstones |
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Hemolytic anemias can increase risk for cholelithiasis b/c?
ex of hem anemia? |
anemias can lead to increased bilirubin excretion and bilirubin stones
thalassemia Sickle cell dx |
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Crohn's dx can increase risk for cholelithiasis b/c?
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malabsorption of bile salts
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What is Crohn's dx?
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Crohn's disease is an autoimmune disease, in which the body's immune system attacks the gastrointestinal tract, causing inflammation; it is classified as a type of inflammatory bowel disease. There has been evidence of a genetic link to Crohn's disease
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S/s of crohn's dx?
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is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from anus to mouth, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody), vomiting, or weight loss,but may also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis and inflammation of the eye.
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Test of choice for biliary colic?
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ultrasonography (RUQ) 89%
CT 79% |
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new persistent changes in bowel habits(diarrhea or constipation)should be thoroughly evaluated to exclude?
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Colon ca, IBD, etc...
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IBS?
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Irritable bowel syndrome (IBS or spastic colon) is a functional bowel disorder 1] In some cases, the symptoms are relieved by bowel movements
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IBS is characterized by?
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IBS is characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause.
Diarrhea or constipation may predominate, or they may alternate. |
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IBS may be prompted by?
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IBS may begin after an infection (post-infectious, a stressful life event or onset of maturity without any other medical indicators.
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IBS criteria?
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2/ more of following
Ab distension pain relief with BM pain assoc with more frequent stools pain assoc with loose stools |
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Postprandial?
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after eating a meal
A 2-hour postprandial blood sugar measures blood glucose exactly 2 hours after you eat a meal. By this point blood sugar has usually gone back down in healthy people, but it may still be elevated in people with diabetes. Thus, it serves as a test of whether a person may have diabetes, or of whether a person who has diabetes is successfully controlling their blood sugar. |
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Preprandial?
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is before a meal
usually check BS before insulin |
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What kind of foods may worsen sympts in IBS pts?
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milk products
caffeine ETOH fatty foods gas producing veggies sorbitol products |
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When ab pain is the predominant syndrom in IBS, you should?
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modify diet
meds 1 anticholinergics 2 nitrates 3 tricyclics p16 |
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When diarrhea is the predominant syndrom in IBS, you should?
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change diet
meds loperamide diphenoxylate cholestryramine |
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When ab pain is the predominant syndrom in IBS, you should?
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1change diet (fiber,psyllium)
2 osmotic laxative (lactulose polyethylene glycol) 3 tegaserod p16 |
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Gold standard test for mesenteric ischemia?
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angiography
some cases are diagnosed intraoperatively due to acute presentation doppler ultrasonography is insensitive due to the distended bowel; CT is poor |
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Ischemic Colitis typically presents with?
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rectal bleeding
mild to moderate left sided ab pain |
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Preferred test to evaluate ischemic colitis?
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colonoscopy
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How do you r/o pancreatitis?
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normal lipase
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What makes PUD unlikely?
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combo of no NSAIDS and Negative H pylori serology
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Lithotripsy
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Lithotripsy is a medical procedure that uses shock waves to break up stones in the kidney, bladder, or ureter (tube that carries urine from your kidneys to your bladder). After the procedure, the tiny pieces of stones pass out of your body in your urine.
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(ESWL)?
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Extracorporeal shock wave lithotripsy (ESWL) is the most common type of lithotripsy. "Extracorporeal" means outside the body.
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What happens during the lithotripsy tx?
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High-energy shock waves, (sound waves) pass through your body& hit kidney stones. may feel a tapping sensation when this starts. The waves break the stones into tiny pieces.
generally 45 min to 1 hr |
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ESWL may require a tube?
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A tube may be placed through your back and into your kidney. This tube will drain urine from your kidney until all the small pieces of stone pass out of your body. The tube may be put in place before or after your lithotripsy treatment.
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pts with biliary colc should get what tx?
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cholecystectomy
lithotripsy is not advised |
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bilirubinuria?
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bile in the urine
only occurs in pts with conjugated hyperbilirubinemia only occurs in pts with CBD obstruction or hepatitis |
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Dark urine suggests?
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bilirubinuria and may precede icterus
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CBD?
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choledocholithiasis
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rigors?
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visibly shaking or teeth chattering chills suggests bacteremia and should increase the suspicion of a life threatening bacterial infection
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RUQ pain differential diagnosis?
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biliary dx
pancreatitis renal colic (usually flank pain) |
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LUQpain differential diagnosis?
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splenic infarct or rupture
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RLQ pain differential diagnosis?
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appendicitis
diverticulitis cecal volvulus ovairan dx |
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LLQ pain differential diagnosis?
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diverticulitis
ovarian dx sigmoid volvulus |
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Diffuse periumbilical pain differential diagnosis?
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appendicitis
bowel obstruction mesenteric ischemia AAA Iritable bowel syndrome |
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Epigastrium differentail diagnosis?
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peptic ulcer
pancreatitis biliary dx |
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Biliary dx
1 quality& freq? 2 radiation& assoc sympts? 3 clinical clues? |
a obstructive & episodic
b back, r shoulder, N&V c postprandial /nocturnal pain dark urine |
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Pancreatitis
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a boring &constant
b back; NV c worse supine, h/o etoh abuse or gallstones |
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Renal colic
a quality& freq? b radiation& assoc sympts? c clinical clues? |
Obstructive & episodic
a Groin; N&V b hematuria (usually microscopic, writhing, unable to get comfortable |
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Splenic infarct or rupture
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a constant
b l shoulder pain c endocarditis, trauma; orthostatic hypotension |
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Peptic ulcer
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a hunger like intermit gradual changes
b back; early satiety c melena, h/o melena, history of NSAIDs ; food may increase or decrease pain |
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Pancreatitis
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a boring constant
b back; N&V c worse supine; h/o ETOH abuse or gallstones |
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Appendicitis
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a steady, worsening
migrates to RLQ b groin; occas back N& V, anorexia c migration and progression, no prior similar episodes |
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Bowel obstruction
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a obstructive
b N&V, anorexia c inability to pass stool or flatus prior surgery |
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Mesenteric ischemia
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a severe
b wt loss c out of proportion to exam, brought on by food, bruit |
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AAA
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a excruciating
b back c low BP or abdominal mass |
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Iritable bowel syndrome
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a crampy, recurring
b intermit diarrhea/constipation c absence of wt loss or alarm symptoms, recurring nature of sympt |
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Diverticulitis
a quality& freq? b radiation& assoc sympts? c clinical clues? |
a persistent, increasing
b back;fever;N&V c may have prior episodes, localized tenderness diarrhea |
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Cecal volvulus
a quality& freq? b radiation& assoc sympts? c clinical clues? |
similar to bowel obstruction
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Ovarian dx
a quality& freq? b radiation& assoc sympts? c clinical clues? |
differentail includes ovarian torsion, Mittelschmerz, ectopic pregnancy and PID
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Ascending cholangitis
Clinical clues? |
1 RUQ pain
2 epigastric pain 3 dark urine 4 fever 5 rigors 6 icterus |
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Ascending cholangitis
impt tests? |
1 ultrasound
2 ERCP 3 CBC 4 Blood cultures |
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Acute cholecystitis
clinical clues? Impt tests? |
1 RUQ pain, fever
2 ultrasound |
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Pancreatitis
clinical clues? Impt tests? |
1 ETOH abuse, gallstones
2 serum lipase |
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Hepatitis
clinical clues? Impt tests? |
Clinical clues
1 RUQ pain 2 Nausea 3 dark urine Important tests 1 elevated ALT 2 elevated AST 3 viral serologies |
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Any of these suggests choledocholithiasis and shuold prompt preoperative ERCP or intraoperative cholangiogram?
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1 Cholangitis
2 jauncice 3 dialted CBD on ultrasound 4 elevated alkaline phosphatase 5 pancreatitis |
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Is ultrasound sensivated for choledocholithiasis?
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No, dialated CBD seen only in 25%
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sphincterotomy?
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Endoscopic sphincterotomy or endoscopic retrograde sphincterotomy
(ERS) is a relatively new endoscopic technique developed to examine and treat abnormalities of the bile ducts, pancreas and gallbladder. |
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ERCP?
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invasive endoscopy that allows for direct cannulation of CBD, extraction of CBD stones and sphincterotomy
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ERS was developed so that?
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The procedure was developed as an extension to the diagnostic examination, ERCP (endoscopic retrograde cholangiopancreatography); with the addition of "sphincterotomy," abnormalities found during the study could be treated at the same time without the need for invasive surgery.
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The term ERS has three parts to its definition...what are they?
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endoscopic refers to the use of an endoscope
retrograde refers to the insertion of the endoscope up into the ducts in a direction opposite to or against the normal flow of bile down the ducts sphincterotomy, which means cutting of the sphincter or muscle that lies at the juncture of the intestine with both the bile and pancreatic ducts. |
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MRCP?
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Magnetic Resonance Cholangiopancreatography
Noninvasive scan visualizes CBD and adjacent structures |
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MRCP is great for ?
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obstruction, stone detection
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MRCP is not great for ?
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malignancy 88% sensitive
less useful in pts for whom index of suspicion of CBD obstruction is low and unlikely to need sphincterotomy or stone extraction |
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Plain radiography is useful to ?
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rule out free air or SBO
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Elevation in alkaline phosphatase and bilirubin suggests?
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Pancreatits secondary to gallstone dx
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