ABDOMEN 4 Flashcards by Chubachuchu MD

Q

Refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration.

A

Acute abdominal pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

It is in many cases a medical/surgical (non trauma) emergency requiring urgent and specific diagnosis.

A

Abdominal pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

The challenge in Patients with Abdominal pain: (enumerate)

A

Misdiagnosis
Atypical presentation
Mortality of given wrong treatment

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What are the 3 Types of Abdominal pain? (Enumerate)

A

Visceral pain
Somatic (Parietal) pain
Referred pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

A physiology of Abdominal pain wherein there is “pain out of proportion”

A

Vascular compromise

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred pain)

Deep, dull, aching or cramping and poorly localized.

A

Visceral pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Stimulated by stretching, distension or contractions of the gut or other hollow abdominal organ.

A

Visceral pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Traction on the bowel mesentery, Inflammation or Ischemia

A

Visceral pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Usually felt in the midline, unaccompanied by tenderness.

A

Visceral pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Sharper and BETTER LOCALIZED and easily described.

A

Somatic pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

POORLY LOCALIZED.

A

Visceral pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Aggravated by stimulation or irritation of parietal peritoneum with movement, coughing or walking.

A

Somatic pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Cardinal signs include: pain, guarding, rebound tenderness.

A

Somatic pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

A true pain which is the SURGICAL CAUSE of abdominal pain.

A

Somatic pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Pain felt over the site other than that of the primary noxious stimulus.

A

Referred pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Occurs in an area supplied by the same neurosegment as the involved organ.

A

Referred pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Most visceral pain is of this type.

A

Referred pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Type of Abdominal pain (Visceral, Somatic or Referred)

Usually intense and most often secondary to an inflammatory lesion.

A

Referred pain

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Referred pain: (matchy matchy)

COLUMN A
Subdiaphragm
Biliary tract
Small bowel
Appendicitis

COLUMN B
Shoulder pain
Right shoulder pain
Back pain
Umbilical region

A

Subdiaphragm - shoulder pain
Biliary tract - right shoulder pain
Small bowel - back pain
Appendicitis - umbilical region

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Physical Examination:

This includes facial expression, diaphoresis, pallor, mental status and degree of agitation.

A

Overall appearance

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Physical Examination:

This includes sitting, recumbent or constantly moving around.

A

Position

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Physical Examination:

This includes temperature (<97F or >101F - consider abdominal sepsis), tachycardia, hypotension.

A

Vitals

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Physical Examination:

This includes scars, hernias, distention, discolouration or visible masses.

A

Inspection

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Physical Examination:

This includes hyper active or hypo active bowel sounds, silent BS or pulsatile bruit, borborygmi (stomach rumble).

A

Auscultation

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Physical Examination: This includes dull (fluid filled), shifting dullness, liver or spleen dullness.

Percussion

Physical Examination: This includes Tenderness (rigidity and guarding, board like abdomen, rebounding pain), Rectal digital examination, Per vaginal examination, careful examination of heart, lung and skin.

Palpation

3 Types of Peritonitis (Enumerate)

Primary Secondary Tertiary

Type of peritonitis that is caused by spontaneous bacterial seeding from states such as cirrhosis. No GI leak.

Primary peritonitis

Type of peritonitis that is caused by GI/ GU leak (PID, ulcer rupture, etc.)

Secondary peritonitis

Type of peritonitis where secondary turning into chronic infection after closure of the leak.

Tertiary peritonitis

A kind of tenderness wherein pressing on the abdomen and in upon release causes more pain.

Rebound tenderness

Voluntary tensing of abdominal muscles. Usually happens when physician performs palpation to the patient with cold hands.

Guarding

Guarding is: Voluntary or Involuntary tensing

Voluntary tensing

Rigidity is: Voluntary or Involuntary tensing

Involuntary tensing

Signs highly suggestive of peritonitis (Enumerate)

Tenderness to percussion Tenderness when the bed is gently shaken or the patient coughs Rebound tenderness

A sign where there is palpable gallbladder in the presence of painless jaundice. (Ex. Periampullary tumor)

Courvoisier’s sign

A sign that shows presence of Varicose veins at umbilicus; Cirrhosis with portal HTN.

Caput medusa

Another term for Caput medusa.

Cruveilhier sign

A sign where pain is caused during inspiration while palpating the RUQ. An example is in acute cholecystitis.

Murphy’s sign

A sign where there is paraumbilical yellow discoloration as in ruptured CBD.

Ransohoff sign

A sign when palpation on the LLQ produces tenderness at McBurney’s point.

Rovsing’s sign

A sign where persistent pressure applied at McBurney’s point causes pressure in the epigastrium and upper chest wall.

Aaron sign

A sign in hemorrhagic pancreatitis that shows periumbilical bruising (hemoperitoneum)

Cullen’s sign

A sign in hemorrhagic pancreatitis that presents local area of discoloration around the flanks (acute hemorrhagic pancreatitis)

Grey Turner’s sign

A sign where there is shoulder pain on inspiration. (Hemoperitoneum)

Danforth sign

A sign where there is left shoulder pain when supine or pressure applied to LUQ (splenic rupture)

Kehr’s sign

A sign where there is pain in the appendics when a patient coughs.

Dunphy’s sign

dark brown outer layer just beneath the capsule

capsule

inner core which is light brown

medulla

about a dozen of triangular areas in the medulla, with the base directed toward the cortex and apex projecting medially

pyramids

part of cortex extending between pyramids

columns

A paired organ located behind the peritoneal cavity. Primary function is for water and electrolyte balance

Kidney

what is the location of the kidney?

retroperitoneal/behind the the peritoneal cavity

Surrounds the kidney; Closely applied to its outer surface

Fibrous capsule

covers the fibrous capsule

perirenal fat

condensation of connective tissue that lies outside the perirenal fat and encloses the kidneys and suprarenal fat which continuous laterally with the fascia transversalis

Renal fascia / Gerota's fascia

external to the renal fascia and often large in quantity; part of the retroperitoneal fat

pararenal fat

Anterior relations of the right ureter

Duodenum, terminal part of the ileum, right colic and ileocolic vessels, right testicular/ovarian vessels, root of mesentery of the small intestine

posterior relations of the right ureter

right psoas muscle, bifurcation of Right common iliac artery

anterior relations of the left ureter

sigmoid colon, sigmoid mesocolon, left colic vessels, left testicular or ovarian vessels

posterior relations of the left ureter

left psoas muscle, bifurcation of left common iliac artery

anterior relations of the right kidney

suprarenal gland, liver, second part of the duodenum, right colic flexure

posterior relations of the right kidney

diaphragm, costodiaphragmatic recesses of the pleura, 12th rib, psoas, quadratus lumborum, transversus abdominis, subcostal; iliohypogastric and ilioinguinal nerves run downward and laterally

anterior relations of the left kidney

suprarenal gland, spleen, stomach, pancreas, left colic flexure, coils of jejunum

posterior relations of the left kidney

diaphragm, costodiaphragmatic recesses of the pleura ,11th and 12th rib, psoas, quadratus lumborum, transversus abdominis; subcostal, iliohypogastric and ilioinguinal nerves run downward and laterally

yellowish retroperitoneal organs located at the upper poles of the kidneys surrounded by renal fascia.

suprarenal glands

secretes hormones including mineral corticoids, glucocorticoids and sex hormones

cortex

hormone that controls fluid and electrolyte balance

mineral corticoids

hormone that controls the metabolism of carbohydrates, fats and protein

glucocorticoids

hormone that is needed for pre pubertal development of the sex organs

sex hormones

part of the arenal gland that secretes catecholamines and norepinephrine

medulla

lymph drainage of the kidney

lateral aortic lymph nodes

innervation of the kidney

originate from the renal sympathetic plexus distributed along the branches of renal artery afferent fibers>> renal plexus and entire spinal cord segments from T10-T12

muscular tubes that extend from the kidneys towards the posterior surfacr of the urinary bladder

ureter

venous drainage of the kidney

renal vein (direct tributaries to the IVC) the left renal vein receives the left gonadal, left suprarenal and left inferior phrenic veins before draining into the IVC

3 constrictions of the ureter

1. where the renal pelvis joins the ureter 2. bifurcation of the common iliac artery/ where the ureter is kinked as it crosses the pelvic brim 3. where it pierces the bladder wall

Arteries of the ureter

1. renal artery- Upper end/proximal part 2. testicular/ovarian artery- middle portion 3. superior vesical artery- pelvis/lower part

Arteries of the kidney

Renal arteries —> segmental arteries —> lobar arteries —> interlobar arteries —> arcuate arteries —> interlobular arteries

vein that crosses in front of the abdominal aorta just beneath the superior mesenteric artery dilation of the proximal part of the abdominal part will compress this vein

Left renal vein