Acute Abdomen Flashcards by Jessica H

How long does and pain have to last to be considered acute?

less than 1 week

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What is visceral pain caused by?

from stretching of anatomic nerve fibers surrounding viscus

-can also result from ischemia and inflammation

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What organs are associated w/ visceral pain? Describe visceral pain

intra-peritoneal

cramping, colicky
ill-defined, diffuse, vague
intermittent
unable to find a comfortable position

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How is parietal pain described? What is another name for it? Ex?

sharp
precisely located
constant
lie still and motionless

Somatic pain

late appendicitis

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what is referred pain?

Pain felt at a location distant from the diseased organ

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what is guarding vs rigidity??

guarding= voluntary contraction of musculature

rigidity= involuntary contraction

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Bruising around the umbilicus is called what?

Cullen’s sign

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bruising of the flank area is called what?

Grey Turner’s sign

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DDX for and pain in the RUQ

Cholecystitis
biliary colic
hepatic abscess
perforated duodendal ulcer
pancreatitis
retrocecal appendicitis
herpes zoster
MI
RLL pna

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DDX for and pain in the LUQ

gastritis
pancreatitis
splenic rupture
splenic infarction
MI
LLL pna

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DDX for and pain in the RLQ

appendicitis (late)
Meckler's diverticulum
leaking AAA
ruptured ectopic
ovary torsion
PID
endometriosis
urinary calculi
psoas abscess
hernia

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DDX for and pain in the LLQ

sigmoid diverticulitis
leaking AAA
ruptured ectopic
ovarian torsion
PID
endometriosis
urinary calculi
psoas abscess
hernia

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DDX for diffuse abdominal pain

peritonitis
pancreatitis
sickle cell crisis
early appendicitis
DKA
mesenteric thrombosis
gastroenteritis
aortic dissection
ruptured AAA
intestinal obstruction

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Describe sx of Appendicitis? Only what pt would complain of

periumbilical pain
Anorexia and N/V

Pain localizes to RLQ over 24 hrs

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Explain Rovsing’s sign, Iliopsoas sign, and Obturator sign

Rovsing’s= pain in RLQ when palpating LLQ

Illiopsoas= elicited by having supine pt keep R knee extended and flex R hip while examiner resists

Obturator sign= elicited by having supine pt flex R knee to 90 degrees, examiner int/externally rotates hip

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What is Alvarado score?

for appendicitis

7-8= probable
>9 = very probable

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How do you treat appendicitis?

fluid resuscitation
Abx- Ceph

TOC= Appendectomy

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How does cholecystitis present?

Intermittent RUQ pain radiating to R shoulder w/ N/V associated w/ ingestion of fatty meal or large meal after fats

fever/chills

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What diagnostic tools can be used to see if a pt have cholecystitis?

US- stones, thickened CB wall, distended GB, sonographic Murphy’s sign

HIDA scan- TOC FOR DX CHOLECYSTITIS

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What is Charcot’s triad

Reynold’s Pentad? Significance?

fever
jaundice
RUQ pain
(seen in 25% cholangitis)

Reynolds= +confusion and shock
-100% mortality if not tx properly

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How does Mesenteric ischemia present?

poorly localized, intermittent pain out of proportion to exam findings

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MCC of Mesenteric ischemia? Risk factors?

MCC= arterial embolism to SMA

Risk factors= over 60, AFib, ASVD, decreased ejection fraction, hyper coagulable states, hypotension

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What lab values will you see in mesenteric ischemia?

How do you treat?

Study These Flashcards

Increased WBC, amylase, phosphate, and metabolic acidosis

TOC= arteriography, heparin, abx

Triad for ectopic pregnancy?

Study These Flashcards

pain, vaginal bleeding, and amenorrhea

Risk factors for ectopic pregnancy

- PID - prior ectopic - women w/ IUD - in vitro fertilization - prior tubal surgery - smoking - age

Tx for ectopic

fluid resuscitation (+/- blood products) preoperative labs OB/GYN for OR

What are perforated gastric ulcers and how do they MCly occur?

Mucosal breaks of 3 mm or larger helicobacter pylori infection

Risk factors for perforated gastric ulcer?

``` steroids or aspirin smoking alcohol or coffee stress delayed gastric emptying duedenogastric bile reflux ```

Sx of perforated gastric ulcer

Pain occurs <2 hrs after meals - localized to epigastrium - gnawing, burning, or aching in nature anorexia, weight loss, belching, bloating, nausea, heartburn

Tx for perforated gastric ulcer

fluid resuscitation H2 blocker or PPI Surgery consult

MCC of SBO?

adhesions from previous surgery, incarcerated hernia

Sx of SBO

- abdominal distention - constipation - bowel sounds high pitched at first then go silent - vomiting

Signs and sx of AAA

- abdominal, back, flank, or groin pain - usually not affected by movement - +/- pulsatile abd mass - hypotension (may be asymptomatic)

if AAA is > 5 cm then? Smaller ones?

> 5 cm= significant risk of spontaneous rupture smaller ones are followed by US every 6 months

What deformity is common in testicular torsion? | What side is more commonly affected?

inappropriately high attachment to tunica vaginalis L side

What sign when absent, has 99% association w/ testicular torsion?

absent cremasteric reflex

What is tx for testicular torsion?

manually detours 180 degrees at time from medial to lateral

What is Phren's sign and what dx is it a/w?

Phren's= relief of pain w/ scrotal elevation a/w Epididymitis

``` Testicular torsion: avg age? pain quality? onset? time to presentation? assoc. sx? ```

neonate, 12-15 yo sudden onset, unilateral, no positional change onset after sleep or exercise present < 6 hrs vomiting (rare= fever, discharge)

``` Epididymitis: avg age? pain quality? onset? time to presentation? assoc. sx? ```

25 yo gradual onset, b/l, worse w/ standing rarely after sleep present > 24 hrs A/s= fever, testicular swelling (rare= vomiting, discharge)

How will UA for testicular torsion differentiate from epididymitis?

Torsion= 30% have WBC and bacteria rare voiding complaints Epididymitis= 50% normal, frequent voiding

MCC of acute scrotal pain in 3-13 yo?

Torsion of testicular appendix

sx of Torsion of testicular appendix? what sign is pathognomonic?

pain to superior testicular pole N/v rare Blue dot sign= pathognomonic

What is the basic pathophys of urolithiasis?

involves supersaturation of urine w/ salt, lack of urinary inhibitors of crystalization

MC type of Urolithiasis?

Calcium 70-80% | 2nd = Struvite 10%

how are the majority of urinary stones < 5 mm treated?

90-95% pass spontaneously

Management of urolithiasis?

toradol morphine antiemetics IV fluids

MMC of pancreatitis?

alcoholism, cholelithiasis, and hypertriglyceridemia

Sx of pancreatitis?

pain is usually severe, constant - located in epigastrium and radiates to back - worse w. lying down, better sitting up and leaning forward fever, tachy, N/V

What do labs and abd X-ray show in pancreatitis?

elevated amylase, lipase xray= localized ileum, gallstones, widening of duodenal sweep

Pain and sx a/w diverticulitis

abrupt onset (usually LLQ) fever Leukocytosis w/ L shift

Dx and tx of diverticulitis?

CT A/P w/ IV/PO contrast tx= Levaquin and Flagyl, zosyn

In DKA, blood glucose is? what about in hyperosmolar hyperglycemic state? which one has presence of ketones?

DKA= > 250 mg/dl hyper= > 600 mg/dl DKA has ketones

Signs and sx of DKA?

- polyuria, polydipsia - weight loss, N/V, dry mucus membranes - dizziness, weakness - Kussmaul breathing - fruity odor on breath

Tx of DKA?

IV fluids Insulin Potassium replacement bicarbonate check glucose and electrolytes every 1-2 hrs

Acute Abdomen Flashcards

(55 cards)