Acute Abdomen Flashcards Preview

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Flashcards in Acute Abdomen Deck (35)
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1

Visceral pain

Poorly localized, dull, achy

From distention or spasm in hollow organs (crampy pain during intestinal obstruction)

Mid-epi = stomach, duodenum, hepatobiliary, pancreas

Mid-abd = jejunum, ileum

Lower abd = colon, internal repro organs

2

Parietal pain

Sharp, well-localized, somatic pain from irritation (usually by pus, bile, urine, GI secretions) of parietal peritoneum.

3

Examples of gradual, steady pain

Acute cholecystitis
Acute cholangitis
Hepatic abscess
Diverticulitis

4

Examples of abrupt, excruciating pain

Perforated ulcer
Ruptured aneurysm
Ureteral colic

5

Examples of intermittent, colicky pain

SBO
IBD
Biliary colic

6

Examples of rapid-onset severe constant pain

Acute pancreatitis
Ectopic pregnancy
Mesenteric ischemia
Stangulated bowel
Acute appendicitis

7

Kehr's Sign

Pain referred to L shoulder due to irritation of left hemidiaphragm - seen with splenic rupture

8

Radiation to right shoulder/right scapula

Biliary tract pain

9

Radiation pattern of kidney pain

loin to groin

10

Pancreatic pain radiation

back

11

Most common cause of free air under diaphragm?

Perforated peptic ulcer (90%)

Could also be hollow viscus injury secondary to trauma, mesenteric ischemia (L hemidiaphragm) and large bowel perforation

12

Signs of perforated viscus

Scaphoid, tense abdomen
reduced BS (late)
Loss of liver dullness
Guarding or rigidity

13

Signs of peritonitis

Motionless
No BS (late)
Cough and rebound tenderness
Guarding or rigidity

14

Signs of inflamed mass or abscess

Tender mass (ab, rectal, pelvic)
Punch tenderness
Murphy's, Psoas, Obturator signs

15

Signs of intestinal obstruction

Distention
Visible peristalsis (late)
Hyperperistalsis (early) or quiet abdomen (late)
Diffuse pain without rebound tenderness
Hernia or rectal mass (some)

16

Signs of paralytic ileus

Distention
Minimal BS
No localized tenderness

17

Signs of ischemic or strangulated bowel

Not distended (until late)
BS variable
Severe pain but little tenderness
Rectal bleeding (some)

18

Signs of bleeding

Pallor
Shock
Distention
Pulsatile (aneurysm) or tender (ectopic) mass
Rectal bleeding (some)

19

Diagnosis for acute abdomen

CBC
lytes
Amylase, Lipase
ECG (rule out MI and as preop baseline cardio assessment)
LFTs for RUQ pain
b-hCG for all women of age
CXR and KUB (look for free air - easier to see in right side since stomach blocks the left)
CT-abd after the above is complete and dx still unclear (young male with clinical signs and symptoms of appendicitis won't need CT)

Get contrast oral and IV when possible unless allergy or poor renal function. Non contrast will still give info

20

Splenic rupture patient giveaway

Elevated WBC in setting of trauma

21

Most common surgical emergency in pregnant woman?

Still appendicitis

22

Review: Signs that point to obstruction as source of abdominal pain

Vague/general

Colicky pain
Writhing around patient that finds no comfort

No fever

No leukocytosis

Can be gallstones, kidney stones, early SBO

23

Review: Signs that point to inflammation as source of abdominal pain

Still visceral pain

Constant pain

Writhing patient with no comfort

(+) fever
(+) WBC

Cholecystitis, cholangitis, diverticulitis, appendicitis

24

Review: Signs that point to perforation as source of abdominal pain

Still visceral

Sudden onset, constant pain

Frozen patient - hurts to move

Floridly peritoneal - fever, leukocytosis, guarding, rebound

XR shows free air under diaphragm

PUD
Cancer
Penetrating trauma

25

Review: Signs that point to ischemia as source of abdominal pain

Still visceral

Constant pain

Pain out of proportion to physical exam (no peritoneal signs)

PVD
CAD
CVA
AFib
Bloody BM

Can be Mesenteric ischemia or ischemic colitis

26

Review: Signs that point to distention as source of abdominal pain

Visceral

Referred pain. Diffuse, extremely vague

Can be constipation, bloating, Gyn

27

RUQ causes of abdominal pain

Lungs
Diaphragm
Liver
Duodenum
Gallbladder

U/S best in upper quadrants

Surgical:
Perforated duodenal ulcer
Acute cholecystitis
Hepatic abscess
Retrocecal appendix
Appendicitis in pregnant woman

28

RLQ causes of abdominal pain

Kidneys/ureters
Colon-appendix
Gyn/testes

CT best in lower quadrants

Surgical:
Appendicitis
Cecal diverticulitis
Meckel's diverticulitis intussusception

29

LLQ causes of abdominal pain

kidneys/ureters
Colon - diverticula
Gyn/testes

Surgical:
Sigmoid diverticulitis
Volvulus

30

LUQ causes of abdominal pain

Lungs
Diaphragm
Spleen

Surgical:
Splenic rupture
splenic abscess