15- abdominal pain Flashcards
psoas sign
Passive extension of patient’s thigh as s/he lies on his/her side with knees extended, or asking the patient to actively flex his/her thigh and hip causes abdominal pain, often indicative of appendicitis.
obturator sign
Examiner has patient supine with right hip flexed to 90 degrees; takes patient’s right ankle in his right hand as he uses his left hand to externally/internally rotate patient’s hip by moving the knee back and forth. Elicitation of pain in the abdomen implies acute appendicitis.
biliary colic
right upper quadrant pain, epigastric pain or chest pain that is constant typically lasts 4-6 hours or less, and often radiates to the back (classically under the right shoulder blade).
It is often accompanied by nausea or vomiting and often follows a heavy, fatty meal.
These symptoms are a result of a stimulated gallbladder (e.g., from a fatty meal) contracting when a gallstone obstructs the outlet of the cystic duct.
The hallmark of biliary colic is that the stone is mobile and eventually moves away from the outlet allowing resumption of normal gallbladder function and resolution of symptoms.
cholecystitis
right upper quadrant pain with associated nausea and vomiting and also classically occurs following a large, fatty meal.
The pathophysiology of cholecystitis is similar to biliary colic but is caused by a stone that is not dislodged from the cystic duct outlet. In contrast to biliary colic, the symptoms of cholecystitis typically persist, are more severe, and are often associated with fever. An elevated white blood cell count is often present from inflammation of the distended gallbladder wall. It should be noted that these inflammatory changes found with cholecystitis can be acute or chronic.
murphy sign indicates
cholecystitis
duodenal ulcer
typically causes epigastric pain (possibly right or left upper quadrant pain) that is relieved rather than worsened by food and is relieved by antacids.
nausea common
hepatitis
While RUQ pain, nausea, and vomiting are frequently encountered, there is often associated malaise, anorexia, itching, and icterus/jaundice. Hepatomegaly is often present.
acute pancreatitis
Nausea, vomiting and epigastric pain
abdominal tenderness on exam and there is unlikely to be resolution of symptoms without prolonged bowel rest, and jaundice may be seen if there is obstruction of the common bile duct.
Grey Turner sign
ecchymotic discoloration in the flank
seen in acute pancreatitis
Cullen sign
ecchymotic discoloration in the periumbilical region
seen in acute pancreatitis
simple KUB (kidney, ureter, bladder) film would indeed be helpful in ruling in or ruling out
kidney or ureter stone
BNP (Brain natriuetic peptide) (J) is primarily useful in distinguishing
chronic obstructive pulmonary disease from congestive heart failure, especially in the evaluation of shortness of breath
the preferred study to evaluate the right upper quadrant is
abdominal US
management of biliary colic
Surgical consultation for cholecystectomy (non-emergent)
ursodiol
an agent that is sometimes effective in dissolving gallstones and preventing future gallstone
If the patient is having more atypical symptoms with visible stones, which may or may not account for the symptoms, then such a medical trial might be warranted.
If there was jaundice and/or gallstone pancreatitis suggestive of a common duct stone (choledocholelithiasis), what might be warranted
ERCP
Moderate Drinking means
patient’s alcohol consumption is up to one drink per day for women and up to two drinks per day for men.
Binge Drinking is defined by
consumption of five or more alcoholic beverages on one occasion on one or more days in a 30-day period.
Heavy Drinking is defined by
consuming five or more alcoholic drinks on a single occasion, five or more days in a 30-day period.
Alcohol Use Disorder
2 of following: More than once wanted to cut down or stop drinking, or tried to, but couldn’t.
Spent a lot of time drinking, being sick from drinking, or getting over the after-effects of drinking.
Experienced craving - a strong need, or urge, to drink.
Found that drinking - or being sick from drinking - often interfered with taking care of his/her home or family; has caused job troubles or school problems.
Continued to drink even though it was causing trouble with family or friends.
Given up or cut back on activities that were important or interesting to the patient or gave him/her pleasure, in order to drink.
More than once gotten into situations while or after drinking that increased the patient’s chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex).
Continued to drink even though it was making the patient feel depressed or anxious or adding to another health problem, or after having had a memory blackout.
Had to drink much more than he/she once did to get the effect he/she wanted, or found that his/her usual number of drinks had much less effect than before.
Found that when the effects of alcohol were wearing off, the patient had withdrawal symptoms, such as trouble sleeping; shakiness; irritability; anxiety; depression; restlessness; nausea; or sweating, or r sensed things that were not there.
