1.7 Differential diagnosis of acute abdomen (with particular attention to urologic diseases) Flashcards
what is acute abdoment?
sudden onset of severe abdominal pain developing over a short time period.
urological etiology of acute abdomen?
- Renal colic (eg. due to stones)
- UTI
- Testicular torsion
- Acute urinary retention
- Cystitis
_______________________________________________ - Renal vein thrombosis
- Kidney infarction
- Pyelonephritis
- Renal abscess
- Ureteral stone
- Retroperitoneal bleeding or hematoma
- Acute prostatitis
- Congenital disorders of the upper UT
gastroIntestinal etiology of acute abdomen?
- Perforated peptic ulcer
- Acute appendicitis
- Mesenteric adenitis
- Diverticulitis
- meckel’s diverticulitis
- Gastroenteritis
- Intestinal obstruction
- Strangulated hernia
hepatobilliary etiology of acute abdomen?
- Biliary colic
- Cholecystitis
- Cholangitis= inflammation of the bile duct system
- Pancreatitis
- Hepatitis
vascular etiology of acute abdomen?
- Ruptured AAA
- Acute mesenteric ischemia
- Ischemic colitis
gynecological etiology of acute abdomen?
- Ectopic pregnancy
- Ovarian cyst (rupture, hemorrhage, torsion)
- Salpingitis
- Endometriosis
urological acute abdomen diagnosis?
- Medical history and physical examination
- Urine sediment
- Laboratory tests
- ECG
- Imaging
- Laparoscopy / laparotomy if acute intestinal or vascular disease is suspected
- Gastroscopy if melena or blood vomiting is present
characteristics of pain in acute abdomen?
location
urological diseases often in
* hypogastrium
* groin
* inner thigh
characteristics of pain in acute abdomen?
onset
Sudden (seconds)
Rapid (minutes-hours)
Gradual (hours)
what can be behind sudden onset of pain in acute abdomen?
SECONDS
- perforated ulcer
- mesenteric infarction
- ruptured AAA
- ruptured ectopic pregnancy
- ovarian torsion or ruptured cyst
what can be behind rapid pain in acute abdomen?
MINUTES-HOURS
- acute pancreatitis,
- biliary colic
- diverticulitis
- ureteral and renal colic
- strangulated hernia
- volvulus
- intussusception
Basically ALL COLICS
what can be behind gradually raising pain in acute abdomen?
MANY HOURS
- urinary retention
- cystitis,
- salpingitis
- prostatitis
- epididymitis
- orchitis
________________________________ - PUD
- appendicitis
- IBD
- strangulated hernia
- chronic pancreatitis
other symp. in acute abdomen to pay attention to?
- fever
- urgency
- difficulity voiding
- dysurea
- nausea, vomiting
- swelling
- scrotal erythma
physical signs of acute abdomen?
cullen’s sign
grey-turner’s sign
kehr’s sign
mcburney’s sign
iliopsoas sign
obturator sign
rovsing sign
murphy’s sign
chandelier’s sign
what does cullen’s sign indicates?
- periumbilical hematoma
- retroperitoneal hemorrhage:
-> hemorrhagic pancreatitis
-> ruptured AAA)
what does grey-turner’s sign indicates?
- flank hematoma
- retroperitoneal hemorrhage
Necrotizing pancreatitis
what does kehr’s sign indicates?
- severe L.shoulder pain
- splenic rupture
- ectopic pregnancy rupture
due to diaphragm irritation phrenic nerve signals at left shoulder
what does iliopsoas, obturator, rovsing signs indicate?
- iliopsoas: right hip hyperflexion -> pain
- obturator: internal rotation of the flexed hip -> pain
- rovsing: RLQ pain when palpating LLQ
all indicating appendicitis
what does murphy’s sign indicate?
abbrupt interruption of inspiration on RUQ palpation
acute cholecystitis
what does chandelier’s sign mean?
cervix manipulation induces pain
-PID
urological acute abdomen diagnosis?
laboratory tests
- CBC
- GOT, GPT, gamma-GT, CK, CRP
- electrolytes
- creatinine
- urea
- lipase
urological acute abdomen diagnosis?
imaging
depending on the symptoms and severity:
US imaging
doppler US
abdomen X-ray
chest X-ray and/or abdominal CT
endoscopy
colonoscopy
cytoscopy
angio.graphy
IV pyelo.graphy
testicular scinte.graphy
what can you see on the abd. Xray in acute abdomen?
free air, stones
what can you see on US?
cholelithiasis
bile duct obstruction
AAA
renal stones and pyelon distention
urinary retention
what can you see on abd. CT?
AAA
abdominal abscess
severe diverticulitis,
stones
cause of urinary retention
what can you see on endoscopy?
perforated peptic ulcer
gastric cancer
what can you see in colonoscopy?
carcinoma of colon
what can you see on angiography?
mesenteric ischemia
what can you see on IV pyelography?
stones
obstruction in UT
what can you see on testicular scintegraphy?
testicular torsion
what can you see on doppler US?
insufficient arterial flow in testicular torsion
