Abdominal Pain Flashcards
(28 cards)
Can’t miss abdominal diagnoses
Ruptured AAA (Hypotension, abd or back pain)
Aortic Dissection (Tearing back pain, unequal pulses)
Mesenteric Ischemia (Pain out of proportion to exam)
Perforated bowel (Peritonitis)
Acute Myocardial Infarction
Ectopic pregnancy
Actions to always perform
IV access O2 Complete VS (w/temp and pulse ox) EKG Abdominal exam
High yield history
Appetite (No appetite = pancreatitis, appendicitis)
Last Bowel movement or flatus (obstruction, constipation)
Blood in stool/vomit (GI bleed)
Relation to food (Gallbladder disease, ischemic colitis, ulcer)
Pregnancy status (Ectopic pregnancy, other OB/GYN)
Previous surgeries (SBO)
ETOH (Pancreatitis, hepatitis, cirrhosis)
Recent ABX use (C Diff)
Ddx for abdominal pain with diarrhea
Non-bloody: C Diff
Bloody: Mesenteric ischemia or infection
Ddx for abd pain with no flatus or bowel movements
SBO
Ddx for abd pain with anorexia
Pancreatitis, appendicitis
Ddx for abd pain with nausea/vomiting
W/ blood: GI bleed
W/ diarrhea: gastroenteritis
W/o flatus/bowel movements: SBO
Ddx for abd pain with shortness of breath
PNA
PE
MI
Ddx for abd pain with vaginal bleeding
Ectopic pregnancy
Abortion
Description of pain for AAA or pancreatitis
Radiates to back
Description of pain for SBO
Diffuse
Severe
Colicky
Signs and symptoms of mesenteric ischemia on exam
Pain out of proportion to exam
Bloody diarrhea
Description of pain of renal colic
Radiates to groin
Items to note on abdominal exam
Location of tenderness (quadrants)
Rebound/guarding (surgical abdomen/perforation)
Distention (SBO)
Fluid wave (cirrhosis/ascites)
Bowel sounds (high pitched or absent for SBO)
Special abdominal exam signs or tests for cholecystitis
Murphy’s point: Patient ceases inspiration when tested associated with cholecystitis
Special abdominal exam signs or tests for appendicitis
McBurney’s point: TTP 2/3 of distance between umbilicus and R anterior superior iliac spine
Obturator: Pain with flexion and internal rotation of R leg
Psoas: Patient on left side, pain with hyperextension of R leg
Rovsing: Pain in RLQ when palpated in LLQ
Initial lab work up for ABD pain
UA (Infection, blood) CBC BMP LFT HCG Lipase Lactate
In what cases or patients would you get an EKG for ABD pain?
Women
Elderly of either sex
Diabetics
Suspected mesenteric ischemia (arrhythmias)
When and why to order X-ray, CT, US?
X-ray: Upright for perforated viscous, KUB to assess SBO - dilated loops of bowel
CT: IV contrast helps visualize vasculature, masses, or abscesses; Oral contrast helps visualize hollow viscous structures
RUQ US: Imaging of choice for biliary system
Pelvic US: If concerned for cysts, torsion, TOA, ectopic, heterotopic
Ddx for RUQ pain (8 total)
PE (SOB, pleuritic chest pain) RLL PNA (SOB, fever, cough) Biliary colic (associated with food) Cholecystitis (Asso w/ food, Murphy's point) GERD (Heartburn, cough, asso w/ food) hepatitis (ETOH, jaundice) Ulcer (Assoc w/ food) Cholangitis
Ddx for LUQ pain (7 total)
PE (SOB, pleuritic chest pain) Pericarditis Myocarditis LLL PNA (SOB, fever, cough) Pleural effusion (SOB, fever) Gastritis (ETOH, NSAIDs, asso w/ food) Splenic pathology (infarction/rupture)
Ddx for RLQ pain (13 total)
Appendicitis (Evolving pain, peritonitis, obturator, rovsing)
Hernia
Ectopic preg (HCG, US, hemodynamics?)
TOA (PID, sexually transmitted infections)
Ovarian torsion (Sudden onset, hx of cysts?)
Ovarian cyst (US/CT)
Meckel’s diverticulum (Peds primarily)
Diverticulitis
PID (Inflamed & painful cervix)
Endometriosis (Asso with menstrual cycles)
Psoas abscess (fever, sweats)
Kidney stone (Hx of stones, radiation to groin, severe pain)
UTI (frequency, burning)
Ddx for LLQ pain (11 total)
Ectopic Preg (HCG, US, hemodynamics?)
Diverticulitis (CT)
Hernia
Ovarian torsion (sudden onset, hx of cyst?)
Ovarian cyst (US/CT)
TOA (PID, sexually transmitted infections)
PID (Inflamed painful cervix, hx of STI)
Endometriosis (Assoc w/ menstrual cycle)
Psoas Abscess
UTI (frequency, pain/burning, odor)
Kidney stone (Hx of stones, radiation to groin, severe pain)
Ddx for epigastric pain
Gastritis (ETOH, NSAIDs, asso w/ food) Pancreatitis (ETOH, Gall stone dz, hypertriglyceridemia) ACS (EKG, esp women, elderly, diabetics) PUD (Assoc w food) Biliary colic (assoc w food)
