Abdomen Pain Flashcards
(102 cards)
1
Q
What conditions do older patients have a higher prevalence of?
A
- Abdominal aortic aneurysm (AAA)
- Acute mesenteric ischemia (AMI)
2
Q
What are common causes of visceral abdominal pain?
A
- Gastrointestinal tract pathology
- Genitourinary tract pathology
- Reproductive organ pathology
3
Q
What is visceral pain characterized by?
A
Poorly characterized, difficult to localize, and located in the midline.
4
Q
What is somatic pain a result of?
A
Irritation of the parietal peritoneum.
5
Q
What is an example of the progression from visceral to somatic pain?
A
Appendicitis.
6
Q
What is referred pain?
A
Pain perceived in a location distinct from its origin.
7
Q
What is a classic example of referred pain?
A
Epigastric pain associated with inferior myocardial infarction.
8
Q
What are the two categories of differential diagnosis for abdominal pain?
A
- Abdominopelvic causes
- Non-abdominopelvic processes
9
Q
What indicates a serious underlying cause of abdominal pain?
A
Abrupt onset, severe pain accompanied by nausea, vomiting, or diaphoresis.
10
Q
What is a common indication of hollow viscus distention?
A
Colicky pain.
11
Q
What characterizes the pain associated with mesenteric ischemia?
A
Pain out of proportion to examination.
12
Q
What may cause the radiation of pain to the left shoulder?
A
Splenic pathology, diaphragmatic irritation, or free intraperitoneal fluid.
13
Q
What are common conditions associated with smoking?
A
- Perforated peptic ulcers
- Chronic mesenteric ischemia
14
Q
What can alcohol use lead to in relation to abdominal pain?
A
- Gastritis
- Peptic ulcer disease
- Pancreatitis
- Liver disease
15
Q
Populations at Higher Risk When
Presenting With Abdominal Pain
A
16
Q
Diffuse pain Ddx
A
17
Q
Right Upper Quadrant pain Ddx
A
18
Q
Left upper quadrant Ddx
A
19
Q
Right Lower quadrant pain Ddx
A
20
Q
Left Lower quadrant DDx
A
21
Q
What does tachypnea indicate in the context of abdominal pathology?
A
Metabolic acidosis
It can arise from intra-abdominal pathology, sepsis, diabetic ketoacidosis, or pain.
22
Q
True or False: Elders always mount a fever in response to a surgical cause of abdominal pain.
A
False
Elders may not exhibit fever even with significant abdominal conditions.
23
Q
What might a paradoxical bradycardia indicate?
A
Reflex, parasympathetically-mediated vasomotor disturbance
This can occur in response to peritoneal irritation, such as in ruptured ectopic pregnancy.
24
Q
What are the ‘tinkles and rushes’ indicative of?
A
Early small bowel obstruction
These sounds are pathognomonic findings during abdominal auscultation.
25
What does rebound tenderness indicate?
Localized peritoneal irritation
## Footnote
This is assessed by applying and then abruptly releasing pressure on the abdomen.
26
What does a tender, rigid abdomen suggest?
Diffuse peritonitis
## Footnote
This condition indicates widespread irritation of the peritoneum.
27
What is the utility of rectal examination in abdominal pain evaluation?
Limited utility unless for prostatitis, anorectal pathology, or fecal impaction
## Footnote
The examination is not routinely helpful for general abdominal pain.
28
What is a common practice in evaluating suspected appendicitis?
Documented serial examinations
## Footnote
This approach helps improve diagnostic accuracy.
29
What are the most time- and cost-effective laboratory tests for acute abdominal pain?
Urinalysis and pregnancy testing
## Footnote
These tests can rapidly influence patient evaluation and management.
30
What is the utility of ultrasonography in abdominal evaluation?
It can rapidly reveal biliary pathology, small bowel obstruction, or ovarian/testicular pathology
## Footnote
It can be performed at the bedside.
31
Name 6 critical causes of abdominal pain
* Ruptured ectopic pregnancy
* Ruptured AAA
* Acute mesentric ischemia
* Perforated viscus
* Massive GI bleeding
* Acute MI
32
What is the incidence of ruptured ectopic pregnancy?
Occurs in approximately 1 in every 100 pregnancies
## Footnote
Heterotopic pregnancy is seen increasingly with assisted reproductive technology (ART).
33
What are common risk factors for ruptured ectopic pregnancy?
* Nonwhite race
* Older gestational age
* Prior history of sexually transmitted diseases (STD)
* Pelvic inflammatory disease (PID)
* Infertility treatment (ART)
* Intrauterine contraceptive device (IUD) placed within the past year
* Tubal sterilization
* Previous ectopic pregnancy
34
What is the typical presentation of a ruptured ectopic pregnancy?
Severe, sharp, constant pain often localized to the affected side, diffuse abdominal pain with intraperitoneal hemorrhage, and signs of shock may be present.
35
What diagnostic tool is critical in the evaluation of a ruptured ectopic pregnancy?
Pelvic ultrasonography
## Footnote
β-hCG testing should be considered in all females of childbearing age (10–55 years old).
36
What is a significant risk factor for ruptured abdominal aortic aneurysm?
* Advancing age
* Male gender
* Hypertension (HTN)
* Diabetes mellitus (DM)
* Smoking
* Chronic obstructive pulmonary disease (COPD)
* Coronary artery disease (CAD)
37
What are common symptoms of a ruptured abdominal aortic aneurysm?
Acute epigastric and back pain, syncope, signs of shock, and pain may radiate to back, groin, or testes.
38
What is the test of choice for evaluating a ruptured abdominal aortic aneurysm in stable patients?
CT scan (CT-A)
39
What is the mortality rate associated with acute mesenteric ischemia?
70%
40
What are common predisposing factors for acute mesenteric ischemia?
* Cardiovascular disease
* Congestive heart failure (CHF)
* Cardiac dysrhythmias
* Diabetes mellitus (DM)
* Sepsis
* Dialysis
* Dehydration
41
What is a key symptom of acute mesenteric ischemia?
Severe, colicky pain starting in the periumbilical region, becoming diffuse and often associated with vomiting and diarrhea.
42
What does the physical examination of acute mesenteric ischemia often reveal?
Remarkably benign results in the presence of severe ischemia, often with pronounced leukocytosis.
43
What is the common cause of perforated viscus?
History of peptic ulcer disease or diverticular disease
44
What is the typical presentation of a perforated viscus?
Acute onset of epigastric pain, vomiting, fever, and shock may be present.
45
What is a common finding in the abdominal examination of perforated viscus?
Diffuse guarding and rebound tenderness, with a 'board-like' abdomen in later stages.
46
What age group is more commonly affected by massive gastrointestinal bleeding?
Adults ages 40–70
47
What are typical symptoms associated with upper GI bleeding?
* Nausea
* Vomiting (coffee-ground or hematemesis)
* Melena
48
What should be considered in patients with signs of liver disease and massive gastrointestinal bleeding?
Esophageal varices
49
What is a common presenting symptom of acute myocardial infarction in elderly women?
GI symptoms such as nausea, vomiting, or epigastric discomfort
50
What is the significance of a rapid electrocardiogram in the evaluation of abdominal pain?
It is crucial if the possibility of coronary ischemia is suspected.
51
Name emergent diagnosis of abdominal pain
* Gastric,esophageal or duodenal inflammation
* Acute appendicitis
* Biliary tract disease
* Ureteral colic
* Diverticulitis
* Acute gastroenteritis
* Constipation and obstipation
* Intestinal obstruction
* Acute pancreatitis
52
What is a common symptom of gastric, esophageal, or duodenal inflammation?
Epigastric pain that may be burning, radiating, or localized.
53
What physical examination finding is often present in gastric, esophageal, or duodenal inflammation?
Epigastric tenderness without rebound or guarding.
54
What tests are useful for diagnosing gastric, esophageal, or duodenal inflammation?
* Gastroduodenoscopy
* Testing for Helicobacter pylori with blood or biopsy specimens
* CT if perforation is suspected.
55
What is the peak age range for acute appendicitis?
Adolescence and young adulthood.
56
What leads to appendiceal obstruction in acute appendicitis?
Appendiceal lumen obstruction leading to swelling, ischemia, infection, and perforation.
57
What are common symptoms of acute appendicitis?
* Epigastric or periumbilical pain migrating to RLQ
* Low-grade fever
* Anorexia
* Vomiting
58
What is the mortality rate associated with perforated acute appendicitis?
Approximately 2%.
59
What imaging tests are useful for diagnosing acute appendicitis?
* CT is sensitive and specific
* Ultrasound may be useful in specific populations like women, pregnancy, and children.
60
What is the peak age for biliary tract disease?
35–60 years old.
61
What are risk factors for biliary tract disease?
* Multiparity
* Obesity
* Alcohol intake
* Use of birth control pills
62
What symptom is commonly associated with biliary colic?
Crampy RUQ pain radiating to the right subscapular area.
63
What tests are useful for diagnosing biliary tract disease?
* Ultrasound to demonstrate wall thickening, stones, or duct dilatation
* HIDA scan to evaluate gallbladder function.
64
What is the average age for the first episode of ureteral colic?
30–40 years.
65
What are common symptoms of ureteral colic?
* Acute onset of flank pain radiating to groin
* Nausea
* Vomiting
66
What is a typical finding in urinalysis for ureteral colic?
Hematuria.
67
What imaging is sensitive and specific for diagnosing ureteral colic?
Noncontrast CT.
68
What common symptom is reported in diverticulitis?
Change in stool frequency or consistency.
69
What is a common physical examination finding in diverticulitis?
LLQ pain without rebound.
70
What is the most common misdiagnosis of acute gastroenteritis?
Appendicitis and acute mesenteric ischemia
## Footnote
Acute gastroenteritis may be confused with other serious conditions.
71
What is the usual etiology of acute gastroenteritis?
Usually viral; consider bacterial or parasitic in prolonged cases
## Footnote
In immunocompromised patients, invasive causes should be considered.
72
What are common symptoms of acute gastroenteritis?
Intermittent, crampy diffuse abdominal pain; large volume watery diarrhea; nausea and vomiting
## Footnote
Diarrhea is key in diagnosis.
73
What findings are typically noted during the physical examination of a patient with acute gastroenteritis?
Usually nonspecific; may show watery diarrhea or no stool on rectal examination; fever may be present
## Footnote
Abdominal examination typically lacks peritoneal signs.
74
What is the primary treatment for acute gastroenteritis?
Symptomatic care with antiemetics and volume repletion
## Footnote
Heme-positive stools may indicate invasive pathogens.
75
In which groups is constipation and obstipation more common?
Females, elders, the very young, and patients on narcotics
## Footnote
These groups are particularly susceptible to bowel movement issues.
76
What are potential causes of constipation and obstipation?
Idiopathic, bowel hypokinesis due to disease states or exogenous sources
## Footnote
This includes factors like diet and medications.
77
What symptoms are associated with constipation and obstipation?
Abdominal pain; change in bowel habits
## Footnote
Symptoms can be variable and nonspecific.
78
What might a rectal examination reveal in a patient with constipation?
Hard stool or impaction
## Footnote
This finding can help confirm the diagnosis.
79
What is a key diagnostic tool for constipation or obstipation?
Radiographs may show large amounts of stool
## Footnote
These diagnoses are often of exclusion.
80
What demographic peaks for intestinal obstruction?
Infancy and elderly
## Footnote
History of previous abdominal surgery increases risk.
81
What are common causes of intestinal obstruction?
Adhesions, carcinoma, hernias, abscesses, volvulus, infarction
## Footnote
These causes can lead to severe complications.
82
What are typical symptoms of intestinal obstruction?
Crampy diffuse abdominal pain, vomiting
## Footnote
Obstruction can lead to fluid accumulation and necrosis.
83
What findings may be noted during the physical examination of intestinal obstruction?
Abdominal distention, hyperactive bowel sounds, diffuse tenderness; local peritoneal signs may indicate strangulation
## Footnote
Vital signs are usually normal unless dehydration or strangulation occurs.
84
What laboratory findings may suggest advanced intestinal obstruction?
Elevated WBC count
## Footnote
Volume depletion and abnormal electrolytes may occur with prolonged symptoms.
85
What is the peak age for acute pancreatitis?
Adulthood; rare in children
## Footnote
There is a male preponderance.
86
What are the risk factors for acute pancreatitis?
Alcohol abuse, biliary tract disease
## Footnote
Other factors include gallstones, hyperlipidemia, and hypercalcemia.
87
What are common symptoms of acute pancreatitis?
Acute onset of epigastric pain radiating to the mid-back, nausea, vomiting
## Footnote
Pain may be disproportionate to physical findings.
88
What findings may be present on examination in acute pancreatitis?
Low-grade fever, hypotension, tachypnea, epigastric tenderness
## Footnote
Guarding or rebound tenderness may not be present unless severe.
89
What is the test of choice for diagnosing acute pancreatitis?
Serum lipase
## Footnote
Imaging like ultrasound and CT scans are also useful.
90
What might an ultrasound examination reveal in acute pancreatitis?
Edema, pseudocyst, biliary tract disease
## Footnote
CT scans are recommended for severe cases.
91
Diagnostic algorithm for Abdominal Pain
92
Management algorithm of abdominal pain
93
What is the recommended IV morphine dose for controlling pain in adults?
0.05 to 0.10 mg/kg, usually 2 to 5 mg every 15 to 20 minutes
## Footnote
Pain should be controlled to a score of <4.
94
Which opioid analgesics are preferred for patients with renal dysfunction?
Fentanyl or hydromorphone
## Footnote
Morphine is not preferred in these cases.
95
What is the effectiveness of a 'GI cocktail' compared to liquid antacid alone?
There are no scientific studies showing increased efficacy of a GI cocktail
## Footnote
A GI cocktail typically includes an antacid, viscous lidocaine, and an anticholinergic agent.
96
What type of bacteria should be covered in antibiotic therapy for abdominal infections?
Enteric gram-negative, gram-positive, and anaerobic bacteria
97
What is the recommended single agent therapy for low-risk patients without recent hospitalization?
Piperacillin-tazobactam 3.375 g IV or ertapenem 1 g IV
98
What combination therapy is suggested for low-risk patients?
Metronidazole 500 mg IV plus a cephalosporin
## Footnote
Options for cephalosporins include cefazolin, ceftriaxone, or cefotaxime.
99
What treatment is recommended for higher-risk patients?
Meropenem 1 g IV, or higher-dose piperacillin-tazobactam 4.5 g IV, or cefepime 2 g IV plus metronidazole 500 mg IV
100
In what situation may empiric antifungal therapy be considered?
In critically ill patients with immunosuppression
101
What high-risk features may necessitate observation or admission for continued evaluation?
Immunosuppression, advanced age, worsening abdominal examination, inability to tolerate oral hydration, unstable living situation
102
What should be included in discharge instructions for clinically stable patients?
Specific symptoms for ED return, timing of follow-up, and acknowledgment of unclear etiology
## Footnote
Clear documentation of stability or improvement and ability to tolerate oral hydration is helpful.
