dull, aching, colicky and poorly localized pain
visceral pain
sharp, well localized pain
parietal pain
referred pain to the right scapula
gallbladder
referred pain to the umbilicus
appendix
referred pain to the left scapula
stomach
condition with a rapidly worsening prognosis in the absence of surgical intervention
surgical abdomen/generalized peritonitis
signs of obstruction
anorexia, bloating, N/V, obstipation, high pitched or absent bowel sounds, tympany on percussion
extrinsic causes of SMO (3)
adhesions, hernia, volvulus
intrinsic causes of SMO (5)
congenital malformations, atresia/stenosis, neoplasm, inflammatory stricture, radiation enteritis
obstruction of normal bowel lumen causes (5)
intussusception, gallstones, feces, bezoar, traumatic intramural hematoma
signs of perintonitis
sick appearing, rebound tenderness, pain with light palpation, diminished BS
Testing for suspected bowel obstruction
abd. plain films or CT
testing for suspected peritonitis
US (esp in children) or CT
Signs of sepsis/shock
fever, tachycardia, hypotension, mental confusion
what is a “top priority” in treating acute adbominal pain while waiting for surgical intervention?
IV fluids
Causes of RUQ pain
hepatitis, cholecystitis, cholangitis, biliary colic, pancreatitis, budd-chiari syndrome, PNA, subdiaphargmatic abscess
sxs of acute cholecystitis
severe RUQ pain, infrascapular radiation, N/V
PE of acute cholecystitis
RUQ pain, +Murphy’s sign, low grade fever
Labs for acute cholecystitis
leukocytosis, ^ bili, ^alk phos, ^amylase
test of choice for acute cholecystitis
U/S
Tx of acute cholecystitis
IV fluids, 1st/2nd gen cephalosporins, cholecystectomy within 3 days of sx onset, percutaneous drainage for extremely high risk patients (to save surgery until pt is stable)
triangle of calot
common hepatic duct, cystic duct, and cystic artery
what type of choledocho is the most common? (primary or secondary)
secondary
cause of choledocho
gallstones
sxs of choledocho
RUQ pain
PE of choledocho
RUQ pain +jaundice**
DX of choledocho
U/S
labs of choledocho
^serum bili, ^alk phos
tx of choledocho
ERCP
cause of cholangitis
ascending bacterial infection due to obstruction of the biliary ducts
most common cause of cholangitis
choledocho
charcot’s triad
RUQ, fever, jaundice (cholangitis)
reynold’s pentad
charcot’s+ AMS and hypotension (cholangitis)
dx of cholangitis
ERCP (dx and tx), ^LFTs, leukocytosis
tx of cholangitis
fluid/electrolytes, abx, ERCP or PTC
KUB showing localized ileus and bi-basilar atelectasis
pancreatitis
causes of epigastric pain
PUD, GERD, gastritis, pancreatitis, MI, pericarditis, ruptured aortic aneurysm
causes of pancreatitis
gallstones, EtOH, obstruction, hypercalcemia
sxs of pancreatitis
epigastric pain with radiation to back, N/V
PE of pancreatitis
fever, tachycardia, hypotension, paralytic ileus, grey turner’s sign, culen’s sign
labs of pancreatitis
^amylase and lipase
amylase peaks within 12hours; lipase is better but may take a few days to peak
tx of pancreatitis
ICU, NPO, IV fluids, NGT, foley cath, serial labs, pain management, surgery (ERCP with stent placement)
sxs of pancreatic psudocyst
upper abd pain/asx, N/V, early satiety, jaundice
PE of pancreatic pseudocyst
abd tenderness, palpable firm area
test of choice for pancreatic pseudocyst
CT
tx of pancreatic pseudocyst
most resolve spontaneously, cystgastrostomy
most common type of gastric CA
adenocarcinoma
risk factors for gastric CA
diet, H. pylori, chronic gastric inflammation, gastric polyps, EtOH, tobacco
sxs of gastric CA
vague epigastric discomfort, indigestion, early satiety, abd pain with vomiting
PE of gastric CA
virchow’s nodes, sister mary joseph’s, jaundice, ascites, palpable adb mass (late in ds)
dx of gastric CA
upper endoscopy with bx
complications of gastric CA
bleeding, obstruction, perf
tx of gastric CA
surgical resection
causes of LUQ pain
splenic abscess/infarct/rupture, gastritis, gastric ulcer, pancreatitis
sxs of splenic abscess
fever, LUQ pain with or without splenomegaly
cause of splenic abscess
endocarditis
sxs of splenic infarct
LUQ pain without fever
tx of splenic abscess
IV abx, eval for splenectomy
tx of splenic infarct
uncomplicated-analgesia/monitor
complicated-eval for splenectomy
causes of RLQ pain
appendicitis, salpingitis, ectopic pregnancy, inguinal hernia, femoral hernia, nephrolithiasis, IBD, mesenteric adenitis
PE of abd wall hernia
reducible bulge/small mass (exam while supine and standing)
dx of abd wall hernia
PE, U/S, or CT
complications of abd wall hernia
incarceration, strangulation, recurrence, obesity
tx of abd wall hernia
observation, tension free repair
hesselbach’s triangle
inguinal ligament, inferior epigastric vessels, lateral margin of the rectus sheath
evisceration
rupture of all layers and extrusion of abd viscera
dehiscence
partial or total disruption of any or all layers of the operative wound
most common post op day a/w dehiscence
between 5th-8th
pain control for acute abd pain
dilaudid, morphine sulfate, demerol, toradol
what PPI can be given IV
protonix
antiemetics for acute abd pain
phenergan or zofran
