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35 Cards in this Set
- Front
- Back
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what does "acute abdomen" mean?
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pain that occurs suddenly & suggests serious physiologic alterations. This is a potential emergency requiring immediate surgical evaluation.
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where does somatic pain originate from? visceral pain? describe the two pains.
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somatic--> originates from the abdominal wall & parietal peritoneum & is sharp, localized
visceral: originates in internal organs & from the visceral peritoneum--> achy, dull pain, not localized. |
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what is visceral abdominal pain sensitive to? what is it not sensitive to?
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sensitive to stretching of the walls of hollow organs or of the capsule of solid organs (like bowel obstruction).
NOT sensitive to cutting, tearing, burning or crushing. |
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what are the major causes of "acute" abdominal pain? what falls under those categories?
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1) inflammation--> appendicitis, cholecystitis, pancreatitis, diverticulitis
2) perforation 3) obstruction 4) vascular causes---> AAA, ischemic bowel. |
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pt presents to your ER complaining of abdominal pain & blood stools. They have a hx of A fib & CVD. What should be high on your ddx?
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ischemic bowel.
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What are the major causes of "chronic" abdominal pain? What falls under those categories?
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1) inflammation--> peptic ulcer, esophagitis, IBD, chronic pancreatitis
2) Vascular causes--> chronic ischemia 3) Metabolic causes--> DM, porphyria 4) fxnal causes--> dyspepsia, IBS 5) abdominal wall pain--> neurogenic, MSK 6) chronic benign abdominal pain syndrome |
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where does appendix pain usually start before working its way down to the R lower quadrant?
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starts epigastric or periumbilical --> LLQ--> RLQ
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name the associated illness associated with these diagnostic clues: (all having to do w/ abdominal)
Intense--> a tearing, ripping or cruhing + midthoracic back pain---> b More severe abdominal pain-->c Less severe abdominal pain --> d constant, dull abdominal pain --> e "gnawing" or hunger pain, often relieved with food--> f |
a) perforated viscous
b) Dissecting aneurysm c) acute pain d) chronic pain e) IB or dyspepsia f) chronic peptic ulcer. |
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what is the pattern of pain in these acute abdominal conditions?
1) acute cholecystitis 2) perforated peptic ulcer 3) acute obstruction to bowels blood supply 4) acute pancreatitis 5) acute sigmoidal diverticulitis |
1) pain shifts to the right shoulder blade
2) diffuse pain & tenderness over all of the abdomen 3) pain & tenderness located periumbilically w/ pain shifting diffusely over the rest of the abdomen 4) pain & tenderness located in the epigastric area only 5) shifting pain from the periumbilicus to the LLQ |
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what disorders/ GI issues associate with these findings on physical exam?
1) writhing, unable to find a position of comfort--> a 2) avoiding any motion w/ knees flexed (trying to reduce stretching)--> b 3) abdominal distention--> c 4) visual peristalsis--> d 5) focal areas of distention--> e |
a) bowel obstruction
b) peritonitis c) obstruction or ascites d) small bowel obstruction in early stages e) hernia |
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what is common after surgery that displays an absence of bowel sounds? what might hyperactive, high pitched sounds indicate?
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ileus: temporary slowing or no moving at all of the bowels.
indicate obstruction. |
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what are you checking for when you palpate the abdomen? what other exams are important to determine the cause of abdominal pain?
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- the degree of severity
- guarding? rebound? rigidity? - pulsatile mass. other exams: rectal (tumor, GI bleeding or tenderness high in the rectum seen in acute appendicitis) & pelvic |
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what are you ascertaining when percussing the abdomen?
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- the presence or absence of ascites
- peritoneal rxn/ inflammation (when pain upon percussion of the abdomen) |
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what causes an acute abdomen?
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sudden inflammation, perforation, obstruction, or infarction of various intra-abdominal organs.
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pt presents with sudden crampy pain & abdominal distention, what may be the cause?
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intestinal obstruction caused by adhesions or an incarcerated hernia.
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what extra-abdominal conditions can cause acute abdominal pain?
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pneumonia, MI, nephrolithiasis & metabolic disorders (like porphyria)
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T/F
A normal WBC rules out an emergency for an acute abdomen |
FALSE!!!!!
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pt presents w/ epigastric pain & lab work up shows a low hb. what test should be done next? what is highest on DDX?
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hemoccult test next
ddx: perforated ulcer |
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what are you looking for in an upright abdominal xray? what can you identify with US? CT?
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XRAY: intra-abdominal air (free air under the diaphragm)
US: gallbladder dz or appendicitis CT: intra-abdominal abscess, diverticulitis (w/ oral & IV contrast), appendicitis, traumatic rupture of organs or acute pancreatitis. |
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when is abdominal pain considered chronic?
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when it has been present for several months or more.
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what does postprandial N/V suggest in chronic abdominal pain? what should be your main concern when an elderly pt presents w/ weight loss + anorexia?
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--- chronic peptic ulcer, disorders of gastric emptying or outlet obstruction.
-- CANCER |
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sxs: distention + flatulence + disordered bowel function
ddx: |
IBS---
mostly LLQ crampy pain too |
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when is appendicitis most common? d/t?
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2nd and 3rd decades d/t obstruction of the lumen by a fecalith
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what are the clinical manifestations of appendicitis?
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-poorly localized abdominal pain to periumbilical area or epigastrium "achy" visceral pain
- Mc Burney's tenderness is classic - pain increases in severity & becomes more localized when you involve the peritoneum. -anorexia - N/V AFTER pain. |
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what are the findings on PE that are found in appendicitis?
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- Mcburney's point tenderness (which may be decreased ina retrocecal appendix)
- guarding, rebound, rigidity - obturator sign (pain upon rotating a flexed hip when supine) - Psoas sign: pain upon raising a straightened leg against resistance - Rovsings sign: pressure to LLQ results in pain to RLQ |
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which diagnostic exam has the best accuracy for appendicitis? tx?
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abdominal CT w/ contrast
tx: surgical removal; for acutely ill pts--> surgical exploration is mandatory |
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WHat is on the DDX for appendicitis?
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- mesenteric adenitis
- ectopic pregnancy - ovarian torsion - ovarian cyst - intussusception - Meckels diverticulitis |
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How do you distinguish btwn mesenteric adenitis and appendicitis?
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Mesenteric adenitis--> N/V PRIOR to pain
appendicitis--> N/V AFTER pain |
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7 month of pt who has inconsolable crying w/ drawing up of the legs toward the abdomen. positive for N/V. Mom found current-jelly stools on the diaper. DX
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Intussusception: telescoping of proximal bowel (usu terminal ileum) into the distal bowel. Crampy paroxymal pains followed by periods of calm.
Majority of cases in children are idiopathic, sometimes viral. In adults its associated w/ an intraluminal mass. dx: constrast barium enema which is also therapeutic |
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Discuss Meckels diverticulitis. What are the sxs associated w/ Meckels? Dx?
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Meckels' is congenital pouch approximately 2" long, located 2 feet from the ileoceccal valve, presenting around 2 years old.
sxs: asymptomatic, but can present w/ pain & rectal bleeding. dx: technetium 99 m scan. |
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what causes diverticulitis? where is it most commonly found? who is usually affecteD? sxs? DX? RX?
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causes: fecalith becomes impacted in a diverticulum w/ erosion through the serosa resulting in perforation.
MC found: left colon & sigmoid affects: >50 yo sxs: LLQ pain w/ gradual onset, low grade fever dx; CT RX: iv antibiotics. |
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A 10yr. Old female presents with periumbilical abdominal pain. She has a decreased apetite, a low grade fever. The pain is crampy and severe. Positive Psoas sign. What is at the top of differential diagnosis?
1. Appendicitis 2. Mesenteric Adenitis 3. Intussusception 4. Meckel’s Diverticulitis |
1. appendicitis
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What is the study of choice for appendicitis?
1. CBC 2. US 3. CT 4. Tech 99m |
3. CT
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A 8 month old male is brought to the ER by his mother after 3 hours of intermittent crampy pain. The child has had low grade fevers and some abdominal distention. Between episodes of pain he seems very comfortable. He has passed some odd colored “currant-jelly” stools. A mass is felt in the RLQ. Diagnosis?
1.Appendicitis 2.Mesenteric Adenitis 3.Intussusception 4.Meckels’ Diverticulitis |
3. intussusception
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A 2yr. Old male presents with mild RLQ pain. Pain began 2 hours ago. Mother has noticed some blood in the diaper. CBC is normal. Mild tenderness at RLQ. X-ray is normal. What is at the top of your differential diagnosis?
1.Appendicitis 2.Mesenteric Adenitis 3.Meckels Diverticulitis 4.Intussusception |
3. Meckels diverticulitis
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