Acute Abdomen & Referred Pain Flashcards Preview

Surgical Recall > Acute Abdomen & Referred Pain > Flashcards

Flashcards in Acute Abdomen & Referred Pain Deck (55):
1

What is an acute abdomen?

Acute abdominal pain so severe that the patient seeks medical attention

2

What are peritoneal signs?

Signs of peritoneal irritation (extreme tenderness, percussion tenderness, rebound tenderness, voluntary guarding, motion pain, involuntary guarding (late))

3

What is rebound tenderness?

Pain upon releasing the palpating hand pushing on the abdomen

4

What is motion pain?

Abdominal pain upon moving, pelvic rocking, moving of stretcher, or heel strike

5

What is voluntary guarding?

Abdominal muscle contraction with palpation of the abdomen

6

What is involuntary guarding?

Rigid abdomen as the muscles guard involuntarily

7

What is colic?

Intermittent severe pain (usually because of intermittent contraction of a hollow viscus against an obstruction)

8

What conditions can mask abdominal pain?

Steroids, diabetes, paraplegia

9

What is the most common cause of acute abdominal surgery in the US?

Acute appendicitis

10

What should the acute abdomen physical exam include?

Inspection (surgical scars, distention).
Auscultation (bowel sounds, bruits).
Palpation (tenderness, R/O hernia, CVAT, rectal, pelvic exam, rebound, voluntary guard, motion tenderness).
Percussion (liver size, spleen size).

11

What is the best way to have a patient localize abdominal pain?

Point with one finger to where the pain is worse

12

What is the classic position of a patient with peritonitis?

Motionless (often with knees flexed)

13

What is the classic position of a patient with a kidney stone?

Cannot stay still, restless, writhing in pain

14

What is the best way to examine a scared child or histrionic adult's abdomen?

Use stethoscope to palpate abdomen

15

What lab tests are used to evaluate the patient with an acute abdomen?

CBC with differential, Chem-10, amylase, T&S, U/A, LFTs

16

What is a left shift on CBC differential?

Immature neutrophils; sign of inflammatory response

17

What lab test should every woman of childbearing age with an acute abdomen receive?

B-HCG

18

Which XRs are used to evaluate the patient with an acute abdomen?

Upright CXR, upright AXR, supine AXR.
If patient cannot stand, left lateral decubitus AXR.

19

How is free air ruled out if the patient cannot stand?

Left lateral decubitus (free air collects over the liver and does not get confused with the gastric bubble)

20

What is the differential diagnosis for RUQ pain?

Cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumors, gastritis, hepatic abscess, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis, pleurisy, pneumonia, PE, pericarditis, MI

21

What is the differential diagnosis for LUQ pain?

PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurysm, pyelonephritis, nephrolithiasis, hiatal hernia, Boerhaave's syndrome, Mallory-Weiss tear, splenic artery aneurysm, colon disease, pleurisy, pneumonia, PE, pericarditis, MI

22

What is the differential diagnosis for LLQ pain?

Diverticulitis, sigmoid volvulus, perforated colon, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic cause

23

What is the differential diagnosis for RLQ pain?

Appendicitis, mesenteric LAD, cecal diverticulitis, Meckel's diverticulum, intussusception, sigmoid volvulus, perforated colon, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic cause

24

What is the differential diagnosis for epigastric pain?

PUD, gastritis, MI, pancreatitis, biliary colic, gastric volvulus, Mallory-Weiss tear

25

What is the differential diagnosis for gynecologic pain?

Ovarian cyst, ovarian torsion, PID, mittelschmerz, TOA, uterine fibroid, necrotic fibroid, pregnancy, ectopic pregnancy, endometriosis, cancer (cervix, uterus, ovary), endometrioma

26

What is the differential diagnosis for thoracic causes of abdominal pain?

MI, pneumonia, dissecting aorta, aortic aneurysm, empyema, esophageal rupture or tear, PTX, esophageal foreign body

27

What is the differential diagnosis for scrotal causes of lower abdominal pain?

Testicular torsion, epididymitis, orchitis, inguinal hernia, referred pain from nephrolithiasis or appendicitis

28

What are nonsurgical causes of abdominal pain?

Gastroenteritis, DKA, sickle-cell crisis, rectus sheath hematoma, acute porphyria, PID, kidney stone, pyelonephritis, hepatitis, pancreatitis, pneumonia, MI, C. difficile colitis

29

What is the unique differential diagnosis for the patient with AIDS and abdominal pain?

CMV, Kaposi's sarcoma, lymphoma, TB, MAC

30

What are the possible causes of suprapubic pain?

Cystitis, colonic pain, gynecologic causes, appendicitis

31

What causes pain limited to specific dermatomes?

Zoster

32

What is referred pain?

Pain felt at a site distant from a disease process.
Caused by the convergence of multiple pain afferents in the posterior horn of the spinal cord.

33

What is gastroenteritis?

Viral or bacterial infection of the GI tract, usually with vomiting and diarrhea, pain (usually after vomiting)

34

What is classically stated to be the great imitator?

Constipation

35

What are the classic locations of referred pain with cholecystitis?

Right subscapular pain

36

What are the classic locations of referred pain with appendicitis?

Early: periumbilical pain
Late: testicular pain

37

What are the classic locations of referred pain with diaphragmatic irritation (from spleen, perforated ulcer or abscess)?

Shoulder pain

38

What are the classic locations of referred pain with pancreatitis or pancreatic cancer?

Back pain

39

What are the classic locations of referred pain with rectal disease?

Pain in the small of the back

40

What are the classic locations of referred pain with nephrolithiasis?

Testicular or flank pain

41

What are the classic locations of referred pain with small bowel disease?

Periumbilical pain

42

What are the classic locations of referred pain with uterine disease?

Midline small of back pain

43

What disease classically presents as hypotension and pulsatile abdominal mass?

Ruptured AAA

44

What disease classically presents as fever, LLQ pain, and change in bowel habits?

Diverticulitis

45

What is the test of choice for cholelithiasis?

U/S

46

What is the test of choice for bile duct obstruction?

U/S

47

What is the test of choice for mesenteric ischemia?

Mesenteric A-gram

48

What is the test of choice for ruptured abdominal aortic aneurysm?

None - operate

49

What is the test of choice for AAA?

Abdominal CT or U/S

50

What is the test of choice for abdominal abscess?

Abdominal CT

51

What is the test of choice for severe diverticulitis?

Abdominal CT

52

What is the most common cause of RUQ pain?

Cholelithiasis

53

What is the most common cause of surgical RLQ pain?

Acute appendicitis

54

What is the most common cause of LLQ pain?

Diverticulitis

55

What endocrine problems can cause abdominal pain?

Addisonian crisis, DKA