What organs in the retroperitoneal can cause abdominal symptoms?
head, neck and body of pancreas, not tail duodenum except first part ascending and descending colon kidneys, ureter, bladder adrenal glands aorta and IVC rectum
What patterns of pain suggest an abdominal source?
irritation of diaphragm can go to shoulders biliary pain to right scapula renal pain to flank or butt uterine pain to low back
sudden, sharp, and well localized pain
dull, intermittent, colicky pain
constant, poorly localized pain
pain out of proportion to physical exam
ischemia, retroperitoneal inflamation (pancreatitis, pyelonephritis, aortic dissection), intestinal obstruction
What are the three most common mechanisms that result in abdominal pain?
distension of hollow viscus soilage of peritoneum ischemia
What characterizes visceral vs. parietal pain?
visceral - non specific and poorly localized, midline at dermatome of specific organ's innervation parietal - better localized, at location of initiating cause
What does diffuse abdominal pain suggest?
What is an acute vs a surgical abdomen?
acute - onset w/i 24 hrs, may or may not be surgery surgical - pancreatitis is not, perforated viscus is
What findings on clinical examination indicate a "surgical abdomen"?
virgin abdomen w small bowel obstruction, absent or high pitched sounds on auscultation appendicitis, peritonitis, complicated acute pancreatitis, acute diverticulitis (LLQ pain), mesenteric ischemia, AAA
How should the auscultation part of the exam be performed?
auscultate before percussing listen for at least two minutes
What is Rovsing's sign?
rebound tenderness when hand withdrawn from LLQ and increased pain at McBurney's point --> appendicitis
What does Psoas sign suggest?
retroperitoneal dz from abscess, bleed, or adenopathy
What does the obdurator sign suggest?
What symptoms warrant a CBC?
check hematocrit or hemoglobin before surgery to see if transfusion necessary leukocytosis indicates more intervention needed
When should electrolytes be checked?
if a pt is vomiting
What symptoms warrant checking lactic acid?
small bowel obstruction and prior hx of operations - elevation indicates vascular compromise of bowel
When should an abdominal sonogram be ordered?
What symptoms warrant a CT?
can drain perf appendicitis w/o peritonitis evaluate female pelvis or diverticulitis
What signs and symptoms indicate small bowel obstruction?
hyperactive bowel sounds, eating makes it worse