Flashcards in Acute Abdomen Emergencies Deck (167)
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1
Extra-abdominal systems that can cause abdominal pain
Cardiac, thoracic, metabolic, hematologic, infections or others
2
What are life threatening causes of abdominal paint that can't be missed?
Abdominal aortic aneurysm and dissection
GI perforation
Incarcerated hernia
Acute bowel obstruction
Mesenteric ischemia
Ectopic pregnancy
Placental abruption
Splenic rupture
3
#1 cause of abdominal pain in ER
Appendicitis
4
Red flags in the history of acute abdominal pain
Age >65
Alcoholism
Immunocompromised
CV disease
Comorbidities
Prior surgery
Recent GI instrumentation
Early pregnancy
5
Red flags in the pain characteristics of acute abdominal pain
Acute onset
Significant pain at onset
Pain followed by emesis
Constant pain for <2 days
6
Red flags on PE for acute abdominal pain
Rigid abdomen
Signs of shock (hypotension and tachycardia)
Involuntary guarding
7
What cause of abdominal pain radiates to right subscapular area?
Gallbladder disease
8
What cause of abdominal pain radiates to shoulders
Perforated duodenal ulcer
9
What cause of abdominal pain radiates to testicles?
Ureteral obstruction
10
What cause of abdominal pain radiates to epigastric area, jaw, neck or UE?
MI
11
What cause of abdominal pain radiates to low back?
GYN
12
How does visceral abdominal pain present?
Dull, aching and colicky
Poorly localized
Distention, ischemia, inflammation or spasm of a hollow organ
13
How does parietal abdominal pain present?
Sharp
Well localized
Peritoneal irritation, ischemia, inflammation, stretching of parietal peritoneum
14
What are aggravating and alleviating factors to always ask about with abdominal pain?
BM
Eating
Antacids
Exertion
15
What patient is restless and can't sit still?
Renal colic
16
What patient is lying perfectly still and supine?
Peritonitis
17
Common causes of hypoactive or absent bowel sounds
Peritonitis or small bowel obstruction
18
Common causes of hyperactive bowel sounds
Blood or inflammation in the GI tract
19
What must be done with men and women that present with lower quadrant/hypogastric pain?
Testicular/pelvic exam
20
Initial diagnostics for abdominal pain
CBC with diff
BMP/CMP
AST, ALT, alk phos, total bilirubin
Lipase/amylase
Lactic acid
UA
Urine pregnancy test
Stool guaiac
21
What is lactic acid a marker of?
Tissue hypoxia
22
What do you use plain films for?
Dilated bowel loops, air fluid levels, free air, constipation or foreign body
23
What is a CT without contrast used for?
Renal stone or obstruction
24
What is a CT with IV contrast used for?
Ischemic bowel, diverticulitis, peritonitis or AAA
25
What is a CT with oral contrast used for?
Really skinny adults or kids
26
When is an u/s used?
Gall bladder, free fluid, renal, ovarian or testicular
27
General management for abdominal pain
IV fluids
Anti-emetics
Analgesia
Anti-pyretic
NPO
Abx if indicated
Consults, monitor for sepsis and shock, repeat exa, and vitals
28
Reasons for urgent surgical referral
Obstruction
Perforation
Peritonitis
Ischemic bowel
Dissection
Rapid sx evolution (increasing TTP/rigidity, pain is severe)
29
Who may have atypical presentations related to abdominal pain?
Elderly
Diabetic
Immunocompromised
30