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SF3- EXAM 3 (Camelita) > Clinical Applications: Acute Abdomen > Flashcards

Clinical Applications: Acute Abdomen Flashcards

(44 cards)

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1
Q

Characteristics of Acute abdomen

A
  • Rapid onset
  • Severe pain
  • Requires urgent decision/diagnosis
  • Treatment often surgical
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2
Q

Statistics of acute abdomen

A
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3
Q

Why are older patients difficult diagnosis?

A
  • Difficult to examine
  • Patient doesn’t respond
  • Low rate of fever

NOTE: This can also apply to the very young

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4
Q

What is the pathophysiology of abdominal pain?

A
  • Referred pain
    • ​Pain occuring a considerable distance from the source
  • Somatic pain
    • ​Segmental spinal nerves
  • Visceral pain
    • ​Sympathetic, parasympathetic, or somatic pathways
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5
Q

What should be covered in a history when examining a patient with acute abdomen?

A
  • Description of pain
  • Associated symptoms
  • Gynecologic/ genitourinary (GU) history
  • Past medical history
  • Family, social history
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6
Q

What are some symptoms associated with acute abdomen?

A
  • Nausea, vomiting
  • Fever, chills
  • Anorexia, weight loss
  • Food intolerance
  • Pulmonary symptoms
  • Cange in bowel habits
  • Genitourinary complaints
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7
Q

What should be considered regarding gynecologic or genitourinary history when screening for acute abdomen?

A
  • Last menses
  • Contraception
  • Sexual history
  • Obstetric history
  • Vaginal discharge, bleeding
  • Previous STDs
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8
Q

What components of past medical history are important when screening for acute abdomen?

A
  • Cardiac or pulmoanry disorders
  • GI, vascular diseases
  • Diabetes, HIV
  • Medications
    • Specifically, all over the counter meds
  • Recent invasive procedures
  • Trauma
  • Recent URI or strep throat
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9
Q

Which components of family and social history should be gather when questioning for acute abdomen?

A
  • Inflammatory bowel disease
  • Connective tissue disorders
  • Bleeding conditions/problems
  • Cancer
  • Recent travel
  • Environmental hazards
  • Drugs, alcohol
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10
Q

What are the components of a physical examination for acute abdomen?

A
  • General appearance
  • Chest
  • Abdomen
  • Rectal
  • pelvic
  • GU
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11
Q

What are the components of a general examination for acute abdomen?

A
  • Distress
  • Acutely or chronically ill
  • Body position
  • Color
  • Vital signs
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12
Q

What the components of a chest exam for acute abdomen?

A
  • Cardiac arrhythmias
  • Murmurs
  • Mechanical heart valves
  • Signs of pneumonia

NOTE: Mechanical valves can get clots and throw emboli into systemic circulation, which can cause problems in the GI tract

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13
Q

What are the three components to an abdominal exam?

A
  • Look
    • Distention
    • Breathing pattern
    • Discolaroration
    • Scars and hernia
  • Listen
    • Auscultation
    • Percussion
      • Fluid
      • Air
  • Feel
    • Areas of maximal tenderness
    • Costoverterbal angle or flank tenderness
    • Masses
    • Hernia
    • Peritoneal signs

NOTE: The components should take place in this order

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14
Q

What abdomen conditions can result in shortness of breath?

A

Inflammation of gall bladder. Patients will have shortness of breath to prevent the gall bladder from hitting up against the periteneum.

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15
Q

What are the physical characteristics of a person with hemorrhagic pancreatitis?

A

Light skin

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16
Q

When listening to a patient during an abdominal exam, where should you begin?

A

With quadrant opposite to location of pain

NOTE: You should listen to all 4 quadrants

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17
Q

If a person has inflammation of kidney you can thumb or percuss in the ___________.

A

Costovertebral angle

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18
Q

Rovsing’s sign

Study These Flashcards
A
  • If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant

Appendix is main culprit

19
Q

Psoas sign

Study These Flashcards
A

Indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal).

RARE

20
Q

Obturator sign

Study These Flashcards
A
  • performed when acute appendicitis is suspected.
  • indicates the presence of an inflamed pelvic appendix.

RARE

21
Q

Murphy’s sign

Study These Flashcards
A
  • positive in cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.
    *
22
Q

Mechanism for testing for Murphy’s sign

Study These Flashcards
A
  1. Ask patient to take a deep breath
  2. Palpate right upper quadrant
  3. Ask patient to release breath
  4. You will see a cessation of breathing in a positive Murphy sign, becuase diaphragm pushes down and gallbladder hits peritoneum
23
Q

What should be accessed in a pelvic/rectal/ genitofemoral exam?

Study These Flashcards
A
  • Tenderness
  • Masses
  • Hernias
  • Discharge, bleeding
  • Blood-occult or gross

NOTE: A complete acute abdomen assessement includes a pelvic/rectal exam

24
Q

What is a basic work-up of acute abdomen?

Study These Flashcards
A
  • Urinalysis
  • CBC
    • Includes a WBC and a hemoglobin/hemocrit
  • Amylase, lipase
  • Pregnancy test
  • Liver test
  • EKG
  • Chest x-ray
  • Abdominal x-ray
25
What's included in a complex work-up of acute abdomen?
* Computed tomography * ultrasound * Angiography * Barium Enema * Contrast in rectum to see colon * Endoscopy * Laparoscopy, especially in women * Done when we are not sure what is going on but we know it's something serious
26
Appendicitis
* History: Periumbilical pain migrating to RLQ; **anorexia** * Exam: tenderness in RLQ and on rectal or pelvic * + Rovsing's sign, Psoas sign, obturator sign * Ultrasound useful in women * CT in equivocal cases * Laparoscopy * Appendix comes off where the 3 tenia colace
27
Small Bowel Obstruction
* History of previous abdominal operation * Triad of diagnostic symptoms * **Cramping abdominal pain** * **Vomiting** * **Obstipation** * **​Usually abdomen is symmetrically distended** * If colon, is obstructed, it will be lopsided because it is located on the side * Quartet of physical findings * **Distention** * Early: no tenderness * Late: Tenderness and guarding * **Borborygm**i (growling bowel sounds)
28
What are the radiographic findings of a small bowel obstruction?
* Air-fluid levels in dilated loops of small bowel * Paucity/absence of air in colon/ rectum
29
What are the most common causes of a small bowel obstruction?
Post-surgical adhesions * Most common in a person who has had a hysterectomy
30
Large Bowel Obstruction
* Better tolerated than small bowel obstuction * Less fluid and electrolyte disturbance * Abdomen **asymmetrically distended** * **Sudden** onset of abdominal distention
31
Causes of large bowel obstruction
* Extrinsic: **Volvulus (#2)**, hernia * Intrinsic: **Cancer (#1)** * Inflammatory: Ulcreative colitis, diverticulitis, radiation, ischemic structure * Congenital: Imperforate anus * Intraluminal: Meconium ileus, intussusception, impaction * Adynamic: Ogilvie's-electrolyte abnormal, post-op, opoids, intra-abdominal infection, anticholinergics Hirchsprung's **NOTE: Adhesions almost never cause obstruction of the colon**, because the colon is too powerful to give time for adhesions to obstruct
32
Volvulus
* Twisting of a loop of bowel **NOTE:** A sigmoid volvulus is the most common because the sigmoid is redundant and floppy and has a long mesentery
33
Perforated Peptic Ulcer
* History: **Peptic ulcer disease**, NSAIDS, steroids, critically ill * @ stomach and 1st part of duodenum * Exam: Generalized peritonitis * Free air seen on plain radiographs or CT
34
How is a perforated duodenal ulcer treated?
* Antibiotics * Tie greater omentum over perforation, suture like a patch * Do not close hole **NOTE:** Patient will be extremely sick ICU afterwards
35
Acute diverticulitis
* History: LLQ pain, fever, constipation, diarrhea * Exam: LLQ tenderness, mass * Labortatory tests * Pyuria, WBC elevated * CT- up to 93% sensitivity
36
What is the gold standard used to diagnose acute diverticulitis?
CT scan of the abdomen and pelvis * If a diverticulitis is associated with an abscess you will see puss in the pelvis
37
Tx for acute diverticulitis
* Antibiotics * Surgery is not a great situation. Nothing looks normal due to inflammation
38
Pancreatitis
* History: **alcohol, gallstones,** epigastric pain radiating to the back * Exam: Generalized upper abdominal tenderness, most marked in epigastrium * **Increased amylase and lipase levels**
39
How is acute pancreatitis diagnosed?
* With murphy's sign at RUQ * Use ultrasound for confirming acute pancreatitis * In CT, pancreas will appear light
40
Cholecystitis
* History: Crampt epigastric and RUQ pain, fatty food intolerance * Exam: RUQ tenderness, +Murphy's sign, jaundice * US- thickened GB wall, pericholecystic fluid **NOTE:** If jaundice is present, there is a stone in the common bile duct
41
What is the diagnostic procedure of choice for acute cholecystitis?
Ultrasound * Fluid around gallbladder * Acoustic shadow from gall stones
42
Cholecystectomy
* Laparoscopic * Does NOT require _emergency_ operation * Urgent operation is what is done- 24-48 hrs * Make sure they are hydrated
43
Common Causes of Acute Abdomen
—Appendicitis —Diverticulitis —Cholecystitis —Pancreatitis —Bowel obstruction * Small Bowel Obstruction * Large Bowel Obstruction * Colorectal cancer * Colonic Volvulus —Perforated viscus —IBD —Ectopic pregnancy —PID/TOA —Gastroenteritis —Mesenteric ischemia —Nephrolithiasis
44
Additional Causes of Acute Abdomen
—Cholangitis —Pneumonia —Acute MI —Ovarian torsion/cyst —Hepatitis —Sickle cell disease —Ureterolithiasis —IBD: Crohn Disease —Gastroenteritis —Diabetic ketoacidosis —Uremia —Porphyria —Intussusception —Lupus —HIV intestinal disease —Mesenteric ischemia/ Infarction

SF3- EXAM 3 (Camelita) (23 decks)

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