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Senior - Emed 3 > 1 - Acute ABD Pain > Flashcards

1 - Acute ABD Pain Flashcards

1
Q

What is the MC reason for an ER visit in the US?

A

ABD pain / cramps / spasms / whatever — some kind of abdominal thing

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2
Q

What is often req’d for dx?

A

Imaging to make a specific dx

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3
Q

Visceral pain

A

Form the organ

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4
Q

Parietal pain

A

From the overlying serosa

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5
Q

Referred pain

A

Felt somewhere else

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6
Q

Causes of visceral pain

A

Obstruction
Ischemia
Inflammation

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7
Q

Visceral pain feels:

A

Crampy, dull, achey

Can be either steady or intermittent (colicky)

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8
Q

Is visceral pain highly specific?

A

No, generalized due to nerve segmental distribution

Body can’t really locate it bc it’s fed by the spinal cord

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9
Q

Epigastric pain

A

Stomach, 1st / 2nd parts of duodenum, liver, gallbladder, pancreas

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10
Q

Periumbilical pain

A

Third/fourth parts of duodenum, jejunum, ileum, cecum, appendix, ascending colon, first two-thirds of transverse colon

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11
Q

Suprapubic pain

A

Last third of transverse colon, descending colon, sigmoid, rectum

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12
Q

Why is parietal pain (somatic pain) more localized?

A

Irritation of the myelinated fibers that innervate the parietal peritoneum

Can be localized to the dermatome superficial to the painful stimulus

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13
Q

As the dz process evolves:

A

Sxs change from visceral pain -> parietal pain, causing tenderness and guarding

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14
Q

Pts c peritonitis prefer to remain:

A

Immobile

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15
Q

Referred pain patterns are based on

A

Developmental embryology

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16
Q

Referred pain is usually perceived:

A

Ipsilateral

Only midline if process is midline

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17
Q

Markers high acuity:

I.e. they are not doing well

A 
Age
Severe pain c rapid onset
Abnormal V/S
Dehydration
Evidence of visceral involvement
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18
Q

ABD pain then shock?

A

Suspect bleeding (AAA)

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19
Q

How much blood loss required to see SBP drop?

A

30-40 percent of normal volume (so, by the time you see a drop in BP, that means they’ve lost a lot (30-40 percent of their blood!))

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20
Q

Does the absence of tachycardia mean their fluid level is good?

A

No - they could just be compensating in other ways

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21
Q

Tachypnea may indicate

A

Cardiopulmonary process
Metabolic acidosis
Anxiety
Pain

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22
Q

If you suspect hemorrhage or urgent transfusion is anticipated, what should you order?

A

Cross-matched blood

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23
Q

How can I quickly measure and visualize the ABD aorta?

A

Bedside ultrasound

ID a AAA quickly

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24
Q

High-risk groups:

A 
Cognitive impairment
Cannot communicate effectively
Asplenic patients
Neutropenic patients
Transplant patients
Immunosuppressed
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25
Q

What’s the problem with assessing immunosuppressed?

A

They can have delayed or atypical presentation

Also, more likely to present c opportunistic infx

26
Q

What’s the most important measure of immunocompetence in an HIV (+) patient?

A

CD4 count

If over 200, less likely to have opportunistic stuff

27
Q

Don’t forget to check what?

A

SKIN! Color, temp, turgor, perfusion status

Also, targeted heart and lung exam

28
Q

Distention could mean:

A

Ascites
Ileus
Obstruction
Volvulus

29
Q

Obvious masses could mean:

A

Hernia
Tumor
Aneurysm
Distended bladder

30
Q

Surgical scars could mean:

A

Adhesions

31
Q

Ecchymoses could mean:

A

Trauma

Bleeding diathesis

32
Q

Stigmata of liver disease is:

A

Spider angiomata

Caput medusa

33
Q

Decreased BS, consider:

A

Ileus, mesenteric infarction, narcotic use, or peritonitis

34
Q

Hyperactive BS, consider:

A

Small bowel obstruction

35
Q

Abdominal rigidity and involuntary guarding reflex suggests:

A

Peritoneal irritation

36
Q

How common is rebound tenderness in appendicitis?

A

About a third

37
Q

Lower abd pain in a female?

A

Its wise to do a pelvic exam in women who have not had a complete hysterectomy

Lower quadrant vs pelvic / suprapubic can be difficult to differentiate

38
Q

With lower abd pain in males, you also wanna check for:

A

Hernia

Testicular and prostate exams

39
Q

What is the main value of the rectal examination?

A

Detection of grossly bloody, maroon, or melanotic stool

40
Q

Two main approaches to grouping ABD pain

A
  1. By location (quadrant)

2. By presenting symptomalogy

41
Q

Slide 30

A

Breakdown of ddx by quadrant

42
Q

Slides 31-32

A

Ddx by symptomalogy

43
Q

Will opioid analgesia obscure exam findings?

A

No - treat the pain

44
Q

Consider placing what while waiting for surgical consult?

A

NG tube (can confirm bleeding, decompress the stomach)

Foley Cath (can relieve bladder obstruction and help gauge renal function by measuring UOP)

45
Q

What’s the deal with lab tests?

A

Comprehensive H and P, PE, way more important

Pt’s can have real disease c (-) lab findings

ex. - up to 25% of pts with acute mesenteric ischemia have normal serum lactate initially

46
Q

Slide 36 and 37

A

If you suspect this, order that

47
Q

If suspect pancreatitis , order:

A

Lipase

48
Q

Is suspect pregnancy, get

A

HCG

49
Q

Abdominal series usually includes:

A

Upright ABD or upright chest

50
Q

Plain radiographs to check for:

A

Obstruction
Sigmoid volvulus
Perforation
Severe constipation

51
Q

Contrast options:

A

PO
PR
IV

Protocols vary

52
Q

Preferred imaging modality for dx’ing kidney and urethral stones

A

Noncontrast CT

53
Q

Slides 44 through 49

A

The super mega chart (don’t need to memorize)

But it helps

54
Q

If dx is unclear, you should have the pt follow up:

A

Within 12 hrs

55
Q

Any woman of reproductive age c hemodynamic collapse?

A

R/o ectopic pregnancy

56
Q

Slide 55

A

Common GYN causes of lower abdominal or pelvic pain

Some of them potentially life-threatening

57
Q

MC surgical entity in elderly c ABD pain?

A

Cholecystitis

58
Q

Concern for bariatric surgery patients?

A

Enteric leak -> sepsis

59
Q

Air fluid levels may suggest but don’t confirm:

A

Obstruction

60
Q

I’m sorry to hear about your abdominal pain

A

If you could put down the mountain dew and wipe the Cheetos dust off your hands i’ll be happy to jump right into your emergency

Senior - Emed 3 (7 decks)

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