Approach to the acute abdomen Flashcards
my role in determining the level of care needed in acute abdomen
observation, admission, imaging, lab test
location of radiation tells you what about an acute abdomen
certain quadrants are attributed to different problems and helps narrow the differential
Description of acute abdomen pain
location, temporal elements (gradual vs sudden, quality, severity, aggravating factors, and associated sypmtoms
what are the types of abdominal pain
visceral, parietal (somatic), and Referred
visceral pain
walls of organs and capsules of solid organs, dull, poorly localized (midline), manifest in location correspoding to diseased organs embryonic origin
Parietal (somatic) pain
distinct (sharper) and localized, ie. ischemia, inflammation, stretching of parietal peritoneum
referred pain
felt at site far from diseased organ dt shared cerntral pathways in the nervous system. i.e. gallbladder dz felt in r suprascapular area,
acute abd hx
pmh, etoh/drug, fmh, travel, sick contacts, meds
acute abd physical exam
bs, abd exam (inspection, auscultation, percussion, palpation), rectal, pelvic,
acute abd what test should I order
abd xray, us, ct: abd/pelvis, with/without contrast, oral contrast/iv contrast, MRI
acute abd what labs should i order
cbc, chem, lft, lipase/amylase, coag studies, ua w/ culture, GC/Chlamydia swab, lactate
what constitutes emergent evaluation of surgical abd?
unstable vs
signs of peritonitis on exam,
concern that and pain is life-threatening condition
S&S of peritonitis
abd rigidity, rebound tenderness, pain that is worse if stretcher lightly bumped
er abd pain, must rule out
ruptured AAA, aortic dissection, perforated bowel, Volvulus (twisted loop), mesenteric ischemia, torsion of structures (ovarian/testicular)
common causes of acute abd in er
non specific 34%, appendicitis, biliary tract dz, SBO, GYN dz, pancreatitis, perforated ulcer, cancer, diverticular dz
