Abdominal Pain Flashcards
(34 cards)
What are the primary causes of immediate life-threatening causes of abdominal pain?(A.S.EP.BI.PV.AMI) (S.AMI.PV.BI.EP.)
1-ruptured abdominal aortic aneurism(AAA)
2-rupture of the spleen
3-ruptured ectopic pregnancy
4-bowel infarction
5-perforated viscus(perforated hollow organ)
6-acute myocardial infarction
What is not a sign/symptom of ruptured ectopic pregnancy?
Missed period
What are the lab findings of bowel infarction?
High WBC
Severe lactic acidosis(anion gap>18)
What are the X-ray finding of bowel infarction?
Free air under the diaphragm,
air in portal vein,
air in bowel wall(pneumatosis intestinalis)
What are the causes of perforated viscus?
Blunt, penetrating trauma
tumors, inflammaory bowel disease, typhoid fever, amebiasis, other parasites
what do you typically see in a perforated viscus?
free air under diaphragm (on X-ray)
bowel infarctions occurs due to clot embolus or thrombosis in which artery?
mesenteric artery; superior is most life-threatening
what are the signs that show in physical exam of bowel infarction?
[H.I! M.P.G.]
-peritonitis,
-hypoactive bowel sounds (no bowel sounds))
-blood in rectum (MELENA)
-ischemia
-guaiac positive stool (looks for hidden (occult) blood in a stool sample. It can find blood even if you cannot see it yourself.)
which type of abdominal pains causes “pain out of proportion”?
abdominal pain caused by BOWEL INFARCTION
what is the best diagnosis for unstable and stable patient in ruptured abdominal aortic aneurism?
bedside ultrasound for unstable patient
&
CT scan for stable patient
how does ruptured abdominal aortic aneurism pain present as?
** present in shock from intraperitoneal rupture
back or groin pain
+typically epigastric or periumbilical pain radiating to back
+pulsating supraumbilical mass
Neurological inn of the abdominal pain
Sphlanchnic nerve
What is the general approach to a pt with abdominal pain?
1-check: ABC; airway, breathing and circulation
2-determine if situation is life threatening
3-start resuscitation and consult surgeon
4-treat pain
**What is the affected nerve during ruptured spleen or liver?
***Phrenic nerve(supplies diaphragm and some vague parts of liver and spleen +shoulder and back i.e like in Kehr’s sign)
What is the sign present in a pt with ruptured spleen or liver?
Reffered pain to shoulders; KEHR’s SIGN(especially for liver trauma)
What is the dx and tx for ruptured spleen or liver?
(Same for ruptured AAA);
+IV fluid,
+Blood type &cross matching for blood Transfusion
+U/S or CT scan,
+call surgeon
***What is the diagnostic test for ruptured ectopic pregnancy?
Pelvic U/S (on fallopian tube)
+HCG test
Which type of abdominal pain etiologies present with coronary artery disease?
Bowel infarction
Why must bowel infarction be operated within minutes?
Bcz unlike muscles, which can endure hypoxia for hours, the bowel organs can sustain only minutes of hypoxia before ischemia occurs
In which etiology of abdominal pain is the pain considered mild regardless of the severe findings(s.a lactic acidosis and high WBC)?
Bowel infarction
what is an ex of pregnancy related cause of abdominal pain?
Abruptio placentae(premature separation of placental from uterus)
what are the genitourinary tract causes of abdominal pain?
cystitis
pyelonephritis
UTI
renal infarction
testicular torsion
ureterolithiasis
what is the key Rx of Peritonitis causing abdominal pain?
early pain relief with narcotics
