23. Abdo pain Flashcards
2 deadly conditions in the elderly causing abdo pain
AAA
acute mesenteric ischemia
MC 3 organ systems causing abdo pain
GI tract
GU
reproductive organs
Name 4 abdo structures that came from the foregut
stomach
duodenum
liver
gallbl
pancreas
assoc with upper abdo pain
Name 3 abdo structures that came from the midgut
small bowel
proximal colon
appendix
periumbilical pain
Name 2 abdo structures that came from the hindgut
distal colon
GU tract
assoc lower abdo pain
Name 5 populations at high risk for abdo pain badness
age >60
pregnant
previous surgery (esp bariatric)
recent instrumentation of GI tract
Immunocomp
known vascular disease
known abdo/pelvic malignancy
Name 8 causes of diffuse abdo pain
peritonitis
pancreatits
sickle cell crisis
early appy
mesenteric thrombosis
gastroenteritis
dissecting/rupt aneurysm
intestinal obstruction
dm
ibd
irritable bowel
Name 8 causes of RUQ abdo pain
Biliary colic
Cholecystitis
Gastritis
GERD
Hepatic abscess
Acute hepatitis
Hepatomegaly due to CHF
Perforated ulcer Pancreatitis
Retrocecal appendicitis
Myocardial ischemia
Appendicitis in pregnancy
RLL pneumonia
Name 8 causes of LUQ abdo pain
Gastritis
Pancreatitis
GERD
Splenic pathology
Myocardial ischemia
Pericarditis Myocarditis
LLL pneumonia
Pleural effusion
Name 8 causes of RLQ abdo pain
Appendicitis
Meckel’s diverticulum
Cecal diverticulitis
Aortic aneurysm
Ectopic pregnancy
Ovarian cyst
Pelvic inflammatory disease
Endometriosis
Ureteral calculi
Psoas abcess
Mesenteric adenitis Incarcerated/strangulated hernia
Ovarian torsion
Tubo-ovarian abscess
Urinary tract infection
Mittleschmerz
Name 8 causes of LLQ abdo pain
Aortic aneurysm
Sigmoid diverticulitis Incarcerated/strangulated hernia
Ectopic pregnancy
Ovarian torsion
Mittelschmerz
Ovarian cyst
Pelvic inflammatory disease
Endometriosis
Tubo-ovarian abscess
Ureteral calculi
Psoas abscess
Urinary tract infection
Name referred pain spot for ruptured spleen
L posterior shoulder
Name referred pain spot for perforated duodenal ulcer
R posterior sh
Name referred pain spot for acute pancreatitis or renal colic
flank/mid back
Name referred pain spot for biliary colic
just below scapula/true mid back pain
Name referred pain spot for uterine/rectal pain
low back, above sacrum
Name the syndrome:
The diffuse, severe, colicky pain, occurring at regular (“timeable”)
intervals associated with severe nausea
SBO
Name the syndrome:
The “pain out of proportion to examination” (i.e., severe pain that
is not readily reproduced with palpation) observed in patients with
mesenteric ischemia
mes ischemia
Name the syndrome:
The radiation of pain from the epigastrium straight through to the
midback, almost invariably accompanied by nausea and vomiting
pancreatitis
Name the syndromes (3):
The radiation of pain to the left shoulder, or independent pain in
the left shoulder
splenic path
diaphragmatic irritation
free intraperitoneal fluid
Name the syndromes (2):
The onset of pain associated with syncope
AAA rupture
ruptured ectopic
RF in perforated peptic ulcer, chronic mes ischemia
more common in smokers
RF gastritis, PUD, pancreatitis, liver disease
aud
cocaine use - what two abdo conditions is this RF for?
vascular path
pud
How is true peritonitis determined?
Discomfort with releasing the peritoneum is visually noted, rather than asking the patient if their symptoms were worse with pressure or with release of pressure.
cough
drop heels to ground after being on toes
Ancillary tests for abdo pain
BG
urinalysis
pregnancy test
POCUS
wbc
lipase
lactate
imaging studies on 270
Name 6 critical causes of abdo pain
ruptured ectopic
ruptured AAA
acute mesenteric ischemia
perforated viscus
massive GIB
acute MI
Key decision points in diagnostic algorithm for abdo pain
?are they pregnant
?signs of shock
?high risk vascular disease/MI
?peritonitis
?tender upper/diffuse/lower abdo
High risk features of a patient that may require further w/u in the ED
immunosuppression
advanced age
worsening abdo exam
continued pain requiring analgesia
inability to tolerate oral hydration
unstable living condition
poor access to f/u care
Name 8 diagnoses of emergent abdo pain
gastric/esophageal or duodenal inflammation
acute appy
biliary tract disease
ureteral colic
diverticulitis
acute gastroenteritis
constipation and obstipation
intestinal obstruction
acute pancreatitis
