13 - Abd Pain and Constipation Flashcards
abdominal referred pain:
cholecystitis >
pancreatitis and perf GU >
chole > shoulders/scapula
pancreatitis and perf > back
3 signs of peritonitis
rigid abdomen
rebound tenderness
absent bowel sounds
Murphy’s sign
push on RUQ and tell pt to take deep breath. if it hurts, they probably have biliary dz
typical biliary dz pain desc
postpraindial RUQ pain
4 Fs of biliary dz
fat, forty, female, fertile
95% of acute cholecystitis is due to
cholelithiasis
choledocholithiasis
stone in common bile duct - can cause pancreatitis
cholangitis - 2 eponyms for constellation of sx
Charcot’s triad - pain, jaundice, fever
Reynold’s pentad - Charcot’s + hypotension + altered mental status
desc of PUD pain
epigastric, improved after eating
MC causes (2) of acute pancreatitis
alcohol, gallstones
desc of acute pancreatitis pain
epigastric pain radiating to back
+N/V
lab test that indicates pancreatitis
elevated lipase or amylase
tx of acute pancreatitis
NPO, IVF, opiates
MCC acute abdominal pain in US
appendicitis
desc of appendicitis pain
periumbilical pain + anorexia +/- vomiting
migrates to RLQ
presentation of diverticulitis
LLQ pain, fever, obstipation, leukocytosis
presentation of mesenteric ischemia
sudden severe abd pain (diffuse)
vomiting
pain is out of proportion to exam findings
presentation of small bowel obstruction
crampy, intermittent, midabdominal pain
vomiting
distension
obstipation
imaging of small bowel obstruction
dilated loops of small bowel w/ air fluid levels
conditions that can cause diarrhea
metab - hypercalcemia, hypothyroid, diabetes
neuor - parkonsonism, SC lesions
meds - antacids, opiates, iron, CCBs
alarm symptoms related to constipation
blood in stool, wt loss, sudden onset of sx
when do you do a colonoscopy for constipation?
alarm sx or age > 50
Sitz marker study
capsule w/ markers ingested and do serial xrays to determine if constipation is due to slow transit or pelvic floor dysfunction
types of laxatives and examples
bulk - fiber
emollient (softener) - docusates
osmotic - MgOH, PEG
stimulants - senna, bisacodyl
lubiprostone
chloride secretagogue used for constipation
inc luminal fluid secretion
methylnaltrexone
blocks opioid receptors in gut - dec opiate induced constipation
