Acute Abdomen Surgery-Safaoui/Davis Flashcards
(41 cards)
What is acute abdominal pain?
Severe abdominal pain with an acute onset (<8 hours) that lasts for several hours
- 2/3 of hospital admissions for this are associated with high morbidity and mortality
- surgical evaluation is warranted*
What is the difference in the presentation of visceral vs parietal pain? (trigger, characteristics of pain, autonomics, surgical intervention needed?)
Visceral:
- Triggered by inflammation, ischemia, distention, traction, and pressure
- pain is vague, deep, dull and poorly localized
- bilateral autonomics
- intra-abd disease but not necessarily surgical
Parietal:
- triggered by irritation of the parietal peritoneum
- sharp, severe, well-localized
- unilateral somatics
- frequently needs surgical intervention
What is the most common cause of acute abd pain in young people? Old people? In pregnancy?
young=appendicitis
old=biliary disease then SBO
pregnancy=appendicitis (might be in location other than RLQ)
What type of pain do foregut problems present with? Midgut? Hindgut?
Foregut (stomach, duodenum, liver, pancreas, spleen, biliary tract) =epigastric pain
Midgut (small bowel to proximal 2/3 of transverse colon) =periumbilical
Hindgut (Distal 1/3 of transverse colon to anal verge) =suprapubic pain
What comes first in a surgical conditions, pain or nausea and vomiting? Medical conditions?
surgical =pain first then n/v
medical=n/v then pain
What problems can present with RUQ pain? (3)
- Cholecystitis
- PNA
- Pyelonephritis
What problems can present with LUQ pain? (5)
- PUD
- Splenic infarct
- pancreatitis
- PNA
- Pyelonephritis
What problems can present with RLQ pain? (5)
- appendicitis (late)
- IBD
- OB/GYN
- Pyelonephritis
- Hernia
What problems can present with LLQ pain? (4)
- OB/GYN
- Pyelonephritis
- Diverticulitis
- Hernia
What problems can present with suprapubic pain? (4)
- IBD
- OB/GYN
- Diverticulitis
- UTI
What problems can present with periumbilical pain? (4)
- appendicitis (early)
- SBO
- Mesenteric ischemia
- AAA
What is the differential for colicky, crampy, intermittent pain?(4)
- Biliary colic
- Ureteral colic (kidney stones)
- Small bowel obstruction
- Large bowel obstruction
What is the differential for gradual progressive pain? (7)
- Hepatitis
- Cholecystitis
- Pancreatitis
- Appendicitis
- Diverticulitis
- Tubo-ovarian abscess
- Ectopic pregnancy
What is the differential for sudden, severe abd pain? (3)
- Ruptured AAA
- Perforated ulcer
- ureteral colic
What refers pain to the right shoulder? (3)
- liver
- gallbladder
- right hemidiaphragm
What refers pain to the left shoulder? (3)
-Heart
-Tail of pancreas
Spleen
-Left hemidiaphragm
What refers to scrotum and testicular pain?
Ureter
What is the most common type of hernia in males and females?
Indirect inguinal hernia
What are the borders of Hesselbach’s triangle? What does this determine?
- Inferior epigastrics
- Lateral edge of the rectus abdominis m.
- Inguinal ligament
- Inside triangle (Medial to epigastrics)=DIRECT hernia
- Lateral to epigastrics=INDIRECT hernia
What is the most frequently encountered surgical disorder of the small intestine? What is the most common cause in pts with previous surgery? Pts without previous surgery?
Small bowel obstruction
- previous surgery: adhesions
- without surgery: hernia
What does air in the biliary tree indicate?
Gallstone ileus
How does a Partial SBO present?
- Continued passage of flatus and/or stool beyond 6 to 12 hours after onset of symptoms
- Occurs slowly
- Strangulation is less likely to develop (much more/faster in a closed loop SBO)
What is the presence of fat wrapping, mesenteric fat creeping onto the serosal surface of the bowel pathognomonic for?
Crohns
can have a “beefy-red appearance of terminal ileum
What is toxic colitis? What can it lead to?
- > 6 bloody stools/d
- fever
- tachycardia
- inc WBC
- dec Hgb/Hct
can get toxic megacolon (all of the above symptoms w/ abd pain, tenderness and distention)
