Abdominal Pain Flashcards
(36 cards)
In acute presentations of abdominal pain, what diagnosis do you need to rule out? List NINE
Ascending cholangitis Pancreatitis Perforated viscus Appendicitis Ectopic pregnancy (rupture) Abdominal aortic aneurysm rupture Incarcerated hernia Bowel obstruction Cancer
What are the red flag symptoms of ascending cholangitis? (Hint Charcot’s triad and Reynaud’s pentad)
Charcot: Fever, Jaundice, RUQ abdominal pain
Reynaud: Fever, Jaundice, RUQ abdominal pain, hypotension, altered mental status
In a woman with abdominal pain:
1) Always R/O pregnancy
2) Suspected gyne etiology
3) Do pelvic examination if appropriate
In a patient with acute abdominal pain, what symptoms would lead you to consider surgery?
- Diffuse peritonitis
- Severe or increasing localized tenderness
- Progressive Distention
- Rigidity
- Guarding
- Rebound tenderness
- Tender mass with fever/hypotension
- Ecchymosis
In a patient with acute abdominal pain, what test findings would lead to surgery?
Paracentesis: blood, pus, poop, pee
X-ray: Free air, massive bowel distention (Colon > 12cm), space occupying lesion with fever
History for abdominal pain approach?
OPQRST
Farting (constipation vs obstipation)
Cancer: early satiety, weight loss, night sweats, change in stool character + habit, bleeding
Lifestyle: EtOH (GERD/Gastritis/PUD), Smoking (Ischemic gut)
MEDs: NSAIDs (GERD/gastritis/PUD)
Surgery Hx (obstruction)
List laboratory tests for chronic abdominal pain
- Urea breath test
- Urinalysis, urine C + S
- Serum: Hgb, Na, K, Cr, Glucose, Ferritin,
- Liver: T. bili, ALT, AST, Alk phos
- Preg: Serum HCG
- Celiac: Anti-tissue transglutaminase
- Immunoglobuin A
You want to rule out appendicitis in young female, what test do you order?
Abdominal U/S
*CT in male
If you want to rule out gynecological conditions, what imaging do you order?
Pelvic U/S or Transvaginal U/S
Patient has suspected abdominal aortic aneurysm, what one test do you order?
Computed tomography of abdomen
What investigations do you order for suspected upper GI problems?
Urea breath test
Endoscopy
ERCP-Endoscopic retrograde cholangiopancreatography
Contract radiography of Upper GI tract
What investigations do you order for suspected lower GI problems?
Colonoscopy
Anoscopy
FOBT
Abdominal X-ray (3 view= supine, upright, chest)
What investigations do you order for suspected gyne cause?
PAP
Cervical swabs
Pelvic/Transvaginal U/S
Endometrial Biopsy
DDx for children with non-surgical acute abdominal pain:
- Cystitis
- Nephrolithiasis
- Diabetic Ketoacidosis
- Pneumonia
- Gastroenteritis
- Sickle cell crisis
- Henoch Schonlein Purpura
DDx for children with surgical acute abdominal pain:
- Incarcerated hernia
- Volvulus
- Intestinal malrotation
- Intussusception
- Cholecystitis
- Appendicitis
- Meckel’s Diverticulitis
DDx for children with chronic abdominal pain:
- Constipation
- Inflammatory Bowel Disease (Crohn’s, UC)
- Pancreatic
- Recurrent UTI/stones
- Functional/Recurrent Abdo Pain (RAP)
In pregnant patients with abdominal pain, what do you need to rule out?
- Ectopic pregnancy rupture
- Incomplete or septic abortion
- Endometritis
Abdo pain in women DDx:
- Mittleschmertz
- Dysmenorrhea
- Endometriosis
- Pelvic inflammatory Disease (Salpingitis)
- Pregnancy (loss, ectopic)
- Ovaries (cysts, torsion, tubo-ovarian abscess)
In elderly, DDx of their abdo pain:
- Cancer
- Bowel obstruction
- Perforated viscus
- AAA dissection
- Mesenteric Ischemia
- Biliary causes
- Pancreatic
- Diverticolosis/Diverticulitis
- UTI (Cystitis, pyelonphritis)
Life threatening causes of abdo pain that you should not miss:
AAA rupture
Ectopic pregnancy rupture
Signs and symptoms of AAA rupture?
Sudden onset chest/back/abdo pain Shock hypotension Syncope Cool mottled extremities Pulsatile Mass
Signs and symptoms of rupture ectopic pregnancy?
Increasing abdominal pain Abdominal distention Rebound tenderness Fever Shock
You encounter life-threatening acute abdominal pain, what are your actions?
ABC
IV access: fluids, type + screen, cross-match
Refer for emergency laparotomy/laporscopy
What is the most important part of management of chronic/recurrent abdo pain?
Ensure adequate follow-up to monitor new/changing symptoms/signs
