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Abdominal pain lecture Flashcards

(50 cards)

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1
Q

Parietal pain

A

Sharp
Very well located
D/t stretching or inflammation, tearing of the peritoneum

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2
Q

Visceral

A 
Colicky, poorly localized
distension, ischemia, 
Biliary tract
Ureters
Bowel obstruction
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3
Q

For OLD CARTS, dont forget to ask about Alleviating/Exacerbating factors

A 
Food
Antacids
Bowel movements
Exertion
Position changes
Stress
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4
Q

Position changes

A

Pancreatitis

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5
Q

Imp ROS

A

heartburn, dysphagia, odynophagia, EARLY SATIETY, n/v/d/c, melena, hematochezia, jaundice, PRURITIS, pallor

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6
Q

GU/GYN

A

dysuria, frequency, urgency, hematuria, flank pain, d/c, vaginal bleeding, USE OF BIRTH CONTROL, risk of STI

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7
Q

GI Alarm Sx

A 
Blood
Iron def anemia
Unexpl Weight loss
Nocturnal wakening
Dysphagia
Acute onset 
Fever/recurrent vomiting
Personal/Famhx CA
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8
Q

Meds to consider if pt is taking

A 
NSAIDs
Steroids
Anticoags
Hypomotility
Abx
Bisphosphonates
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9
Q

Past history

A

GI
Surgeries
Cardiac risk factors/surgeries

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10
Q

Family hx

A

IBD- Crohns or UC

Cancer

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11
Q

Social hx

A

Alc, Tobacco

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12
Q

Afebrile does NOT r/o infectious if pt is

A

OLD or Immunocompromised

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13
Q

Orthostatic vitals

A

may be sign of Dehydration

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14
Q

Tachypneic

Hypoxic

A

may be Heart or Lung cause

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15
Q

Pt writhing in agony

A

Biliary (gallbladder)

Renal (kidney)

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16
Q

Cullen sign- bellybutton

Grey turner- flank

A

Pancreatitis

necrotizing

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17
Q

Order of Abd exam

A

Inspection
Listen (auscultate)
Percuss
Palpate

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18
Q

What am I inspecting for on an abdominal exam?

A

Distention
Pulsation
Scars
Hernias

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19
Q

Tinkling high pitched

A

early obstruction

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20
Q

Percussion: Tympany

A

distended bowel

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21
Q

Percussion: Dull sound

22
Q

If blood was present or suspect obstruction

23
Q

All lower abdominal pain should have Rectal/GU exam

Study These Flashcards
A

not necessarily RUQ though

24
Q

Alk phos

Study These Flashcards
A

Renal and Hepatic function (kidney and liver)

electrolytes

25
Lactic acid
concern for: - Ischemic Bowel or - DKA (diabetic ketoacidosis)
26
Concern for Perforation perfed ulcer
need to order CXR!!
27
Concerned for obstruction
Abdominal X Ray
28
CT A/P
Appendicitis Pancreatitis Diverticulitis
29
Abd US
Hepatobiliary (liver or gallbladder) | Pancreas
30
What to do for - Obstruction - Perf - Peritonitis - Ischemic bowel - Dissection - Strangulated bowel
IMMEDIATE surgical consult
31
What do I need to add to Pt education along with plan?
RETURN precautions | ED precautions
32
worried about Biliary cause (gallbladder)
get US
33
Tx for Acute Cholecystitis Imaging: gallstones and GB wall thickening
``` Admit, NPO, IVF Pain meds Abx Surgical consult Pt education ```
34
Epigastric pain better with sitting up and leaning forward
Pancreatitis
35
Hx of gallstones and alcohol use
Pancreatitis
36
Complications of PUD (gastric or duodenal ulcer)
Hemorrhage Perforation Obstruction
37
What labs are indicative of dehydration?
Elevated Hct, BUN, and SG
38
Most common cause of SBO
Adhesions (past surgery scar tissue)
39
Most common cause of LBO
Cancer
40
After finding Bowel obstruction on CXR with free air fluid levels, what next?
Need to get a CT to further assess where the obstruction is
41
Choledocholithiasis often leads to --->
Acute CHOLANGITIS Jaundice, elevated Alk Phos, AST/ALT elevated
42
Fever Jaundice RUQ pain
Charcot triad | Cholangitis
43
Asymmetric pulses and | CXR with widened mediastinum
Aortic dissection
44
``` Elderly Hx of A-fib Hx of Valvular/ atherosclerosis Abrubt onset Pain out of proportion Increased LDH (lactate dehydrogenase) ```
Acute Mesenteric Ischemia
45
Elevated lactate means
Lactic acid is accumulating, often d/t LACK OF OXYGEN
46
Crohns
Transmural (deeper) skip lesions mouth --> anus anywhere
47
What things can cause Splenic abscess/infarct/rupture other than trauma
Endocarditis A-fib Hypercoagulable state
48
Most common Volvulus
Sigmoid | requires immediate decompression
49
Tamponade and Beck's Triad Becky was wearing a Tampon
Hypotension Muffled heart sounds JVD
50
Plan
``` Disposition Meds/therapy Future diagnostic Pt education F/u rec ED PRECAUTIONS ```

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