Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Essentials - General surgery > 4. Acute abdominal pain > Flashcards

4. Acute abdominal pain Flashcards

1
Q

Describe: Visceral pain (2)

A
  • originates from triggering the autonomic nervous system innervating the visceral peritoneum.
  • It is typically characterized as dull, vague, and deep.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe: Parietal pain (2)

A
  • originates from triggering the spinal somatic nerves innervating the parietal peritoneum.
  • It is typically characterized as localized and sharp/stabbing.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name ABDOMINAL causal conditions of abdominal pain (25)

A
  • Rectus muscle hematoma
  • Abdo muscle spasm
  • Abdo aortic aneurysm
  • Perforated viscus
  • Small bowel obstruction
  • Bacterial peritonitis
  • Gastroenteritis
  • Ulcer (gastric or duodenal)
  • Inflammatory bowel disease
  • Irritable bowel syndrome
  • Constipation
  • Pancreatitis
  • Hepatitis
  • Biliary tree disease (biliary colic, cholangitis, cholecystitis)
  • Splenic infarct
  • Appendicitis
  • Diverticulitis
  • Pelvic inflammatory disease
  • Ovarian torsion
  • Ectopic pregnancy
  • Hemorrhagic ovarian cyst
  • Endometriosis
  • Nephrolithiasis
  • Hydronephrosis
  • Urinary tract infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name GENITOURINARY causal conditions of abdominal pain (1)

A

Testicular torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name INFECECTIOUS causal conditions of abdominal pain (1)

A

Herpes zoster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name METABOLIC causal conditions of abdominal pain (3)

A
  • Ketoacidosis (alcoholic or diabetic)
  • Porphyria
  • Sickle cell disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name THORACIC causal conditions of abdominal pain (4)

A
  • Myocardial infarction
  • Pneumonia
  • Pulmonary embolism
  • Radiculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name TOXIC causal conditions of abdominal pain (3)

A
  • Heavy metal poisoning
  • Methanol poisoning
  • Venom (scorpion or black widow spider)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name causes of abdo pain in ELDERLY patients (5)

A
  • Biliary tract disease
  • Malignancy
  • Bowel obstruction
  • Complications of peptic ulcer disease
  • Hernia-related pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name causes of abdo pain in IMMUNOCOMPROMISED patients (3)

A
  • Graft-versus-host disease
  • Cytomegalovirus infection
  • Neutropenic enterocolitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe HX of abdo pain (2)

A
  • Determine the onset, duration, character, localization, relieving and exacerbating factors, and Hx of similar pain.
  • Determine the medical history with an emphasis on Hx of infection, cancer, metabolic abnormalities, recent travel, and any other medical or surgical Hx.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe physical exam of abdo pain (5)

A
  • Begin the exam by obtaining the patient’s vital signs. A hypotensive, tachycardic, or febrile patient in the setting of abdo pain is concerning for ischemic bowel, a rupturing abdo aortic aneurysm, or a septic process.
  • Inspect the abdomen for surgical scars, rashes, or a pulsating abdo mass.
  • Auscultate the abdomen for hyperactive bowel sounds suggestive of mechanical bowel obstruction.
  • Palpate the abdomen for any signs of guarding or rebound tenderness. Assess for hepatosplenomegaly, hernias, and pelvic masses.
  • Examine the chest, precordium, flanks, back, and genitalia (in a male).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe approach to patient with: Ruptured aneurysm

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: Sudden
  • Other signs: Tearing abdo and lumbar pain, pulsating periumbilical mass, hypotension
  • Worksup: CT. Aortogram if stable
  • Management: Urgent vascular surgery referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe approach to patient with: Perforated viscusPeritoneal sign

  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: Severe sudden or gradual colicky abdo pain, *or diverticular disease. Hx of ulcer, *occult blood stool
  • Other signs: May present with SIRS/shock
  • Worksup: AXR. abdo CT if stable
  • Management: Urgent general surgery referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe approach to patient with: Small bowel obstruction

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: Intermittent, colicky, postprandial
  • Other signs: Recurring cramps every 3–10 min, vomiting, crescendo– decrescendo rushes of high- pitched peristalsis sounds coincident with pain onset. Hx of surgery
  • Worksup: Abdo x-ray and usually abdo CT
  • Management: Urgent general surgery referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe approach to patient with: Bacterial peritonitis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: Sharp, constant
  • Other signs: Pain worsened by movement, presence of ascites, Hx of cirrhosis, fever, altered mental status
  • Worksup: Paracentesis of ascitic fluid
  • Management:
    • Treat cause
    • Broad-spectrum antibiotics initially
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe approach to patient with: Irritable bowel syndrome

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Episodic crampy pain in at least 12 wk, which need not be consecutive in the preceding 12 mo
  • Other signs: 2/3 of the following:
    • relieved by defecation
    • onset associated with changes in stool frequenc
    • onset associated with changes in stool form
  • Worksup: None
  • Management: Education, reassurance, dietary/lifestyle changes. Gastroenterology if condition worsens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe approach to patient with: Constipation

  • Peritoneal sign
  • Clinical onset
  • Other signs
A
  • Peritoneal sign: -
  • Clinical onset: Sudden or gradual
  • Other signs: Hx of infrequent bowel movement < 3/wk, difficulty during defecation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe approach to patient with: Ketoacidosis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset:
    • More common in DM1
    • often insidious in onset
    • often associated with intercurrent illness or physiological stress
  • Other signs: No/vo, polydipsia, polyuria, abdominal pain, hyperglycemia, hypotension, tachycardia. Fruity breath, Kussmaul breathing
  • Worksup: Urinalysis, blood work—CBC, electrolytes, creatinine, glucose. Investigate for underlying cause
  • Management: Treat cause
20
Q

Describe approach to patient with: Cholangitis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: RUQ pain
  • Other signs: Jaundice, fever (Charcot triad), signs of CNS depression, hypotension (Reynold’s Pentad)
  • Worksup:
    • Abdo U/S
    • liver chemistries (AST, ALT, ALP, GGT)
    • bilirubin
    • lipase
    • CBC
    • CRP
  • Management: Gastroenterology referral
21
Q

Describe approach to patient with: Cholecystitis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: RUQ pain rising over 2–3 min to an intense plateau that is maintained for > 20 min, radiates to shoulder or back
  • Other signs: Recurrent attacks 1–6 h after meals lasting > 12 h, positive Murphy sign May feel like biliary colic type pain that does not resolve
  • Worksup: Abdo U/S, liver chemistries (AST, ALT, ALP, GGT), bilirubin, lipase, CBC, CRP
  • Management: General surgery referral
22
Q

Describe approach to patient with: Appendicitis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: Dull ache and tenderness along McBurney point (migratory Hx)
  • Other signs: Anorexia, N/V, guarding, positive Rovsing, psoas, and obturator signs
  • Worksup: U/S or abdo CT
  • Management: General surgery referral
23
Q

Describe approach to patient with: Peptic ulcer disease/gastritis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Burning epigastric pain after eating, relieved by food and antacid
  • Other signs: Hx of belching, bloating, abdo distension, food intolerance, chronic NSAID/aspirin use
  • Worksup: CBC, gastroscopy. Test for H. pylori (breath test, serology, stool antigen test, biopsy)
  • Management: Treat cause
24
Q

Describe approach to patient with: Acute hepatitis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: RUQpain
  • Other signs: Hepatomegaly, jaundice, Hx of anorexia, N/V, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, and/ or coryza
  • Worksup:
    • Liver chemistries—AST, ALT, ALP, GGT. INR/PTT, albumin, bilirubin
    • Investigations for possible underlying cause.
  • Management: Gastroenterology referral. Hepatology if synthetic dysfunction/ acute liver failure.
25
Q

Describe approach to patient with: Biliary colic

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Progressive aching, cramping epigastric, or RUQ pain a few hours after a meal and lasting 0.5–6 h
  • Other signs: No signs of systemic disease
  • Worksup: Abdo U/S, liver chemistries (AST, ALT, ALP, GGT), bilirubin, lipase, CBC, CRP
  • Management: Supportive treatment. General surgery referral if condition worsens
26
Q

Describe approach to patient with: Splenic rupture

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: LUQ pain
  • Other signs: Hx of Trauma, positive Kehr sign (acute pain in tip of left shoulder)
  • Worksup:
    • FAST
    • U/S in trauma
    • Abdo CT
  • Management: General surgery referral
27
Q

Describe approach to patient with: Splenic infarction

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: LUQ pain and tenderness
  • Other signs: Fever, splenomegaly, Hx of hypercoagulable state, embolic disease, trauma, malignant hematologic conditions, hemoglobinopathy, or immunosuppression
  • Worksup: Abdo CT
  • Management: General surgery referral
28
Q

Describe approach to patient with: Gastroesophageal reflux
disease

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Epigastric pain
  • Other signs: Hx of heartburn, regurgitation of digested food, angina-like chest pain
  • Worksup:
    • Treat empirically
    • Endoscopy if concerning Sx
    • Ph monitoring + esophageal impedance if empirical therapy fails
  • Management: Education, reassurance, dietary/ lifestyle changes, trial PPI; gastroenterology referral if condition worsens
29
Q

Describe approach to patient with: Hepatic abscess

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: RUQ pain
  • Other signs: Fever, chills, nausea, anorexia, and weight loss
  • Worksup: Abdo CT, CBC, liver chemistries, INR/PTT, albumin, bilirubin
  • Management: IR for drainage of abscess if accessible. General surgery referral
30
Q

Describe approach to patient with: Diverticulitis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: Persistent LLQ pain
  • Other signs: Abdo distension, N/V, constipation, anorexia, fever
  • Worksup: Abdo CT
  • Management: General surgery referral
31
Q

Describe approach to patient with: Incarcerated hernia

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Lower abdo pain
  • Other signs: Painful enlargement of previous hernia, abdo distension, N/V, obstipation, anorexia
  • Worksup: U/S or CT abdo although not always necessary
  • Management: General surgery referral
32
Q

Describe approach to patient with: Ectopic pregnancy

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: +
  • Clinical onset: Sudden cramping genital pain in pregnant female patient
  • Other signs: Vaginal bleeding, hemodynamic instability
  • Worksup: Pelvic U/S, b-hCG
  • Management: Urgent OB/GYN referral
33
Q

Describe approach to patient with: Pelvic inflammatory disease/ salpingitis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: ±
  • Clinical onset: Lower Abdo, bilateral adnexal, and cervical motion tenderness
  • Other signs: Temperature > 38°C, cervical/vaginal discharge
  • Worksup: Pelvic U/S, pap smear, CBC
  • Management: Urgent OB/GYN referral
34
Q

Describe approach to patient with: Ovarian torsion

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: ±
  • Clinical onset: Sudden, severe unilateral lower abdo pain that worsens intermittently, breast tenderness, N/V, fatigue, abdo distension
  • Other signs: N/V, fever, Hx of recent strenuous physical activity
  • Worksup: Pelvic U/S (transabdominal/ transvaginal with Doppler)
  • Management: Urgent OB/GYN referral
35
Q

Describe approach to patient with: Mesenteric lymphadenitis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: −
  • Clinical onset: Mild RLQ pain
  • Other signs: N/V before pain onset, fever, diarrhea, anorexia, current or Hx of URTI
  • Worksup: Abdo CT
  • Management: General surgery referral
36
Q

Describe approach to patient with: Psoas abscess

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Lower abdo pain
  • Other signs: Fever, limitation of hip movement (patient prefers to be supine, knee flexed, hip externally rotated), Hx of Crohn disease, diverticulitis, or appendicitis
  • Worksup: Abdo CT
  • Management: General surgery referral (drainage and Abx[most common pathogen is S. aureus])
37
Q

Describe approach to patient with: Inflammatory bowel disease

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Crampy RLQ pain
  • Other signs: Diarrhea, rectal bleeding, tenesmus, occult blood loss, anemia, weight loss, fever
  • Worksup: Abdo CT
  • Management: Gastroenterology referral
38
Q

Describe approach to patient with: Renal colic

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: −
  • Clinical onset:
    • Lower abdo aching pain
    • Intermittent sudden onset of severe flank pain originating at the costovertebral angle and radiating anteriorly in waves to the groin
  • Other signs: Dysuria, urgency, urge incontinence, hematuria, CVA tenderness, N/V. With obstruction may have infection/py- elonephritis and associated Sx such as fever
  • Worksup: Urinalysis, creatinine urine culture, and abdo CT KUB
  • Management: Urology referral
39
Q

Describe approach to patient with: UTI

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Subrapubic tenderness
  • Other signs: Dysuria, urgency, frequency, hematuria
  • Worksup: Urine analysis, creatinine, urine culture
  • Management: Nephrology consult
40
Q

Describe approach to patient with: Pyelonephritis

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign: -
  • Clinical onset: Flank tenderness
  • Other signs: Pyelonephritis also has fever, Costovertebral angle tenderness, and nausea/vomiting.
  • Worksup: CT Abdo/U/S in pediatric population
  • Management:
    • Surgical consult for abscess, calculi- related UTI, renal papillary necrosis, Xanthogranuloma- tous pyelonephritis
41
Q

Describe investigation: Abdo pain (5)

A
  • Routine blood work: serum hemoglobin, white cell count, platelets, electrolytes, liver enzyme tests (AST, ALT, ALP, and GGT), liver function tests (bilirubin, INR, albumin), as well as lipase (amylase is less useful in modern clinical practice).
  • Consider obtaining lactate and arterial blood gases in a hemodynamically unstable patient.
  • Every female patient within childbearing age should have a b-hCG test to exclude ectopic pregnancy.
  • Routine imaging: three-view abdo x-rays to inspect for subdiaphragmatic free air, air-fluid levels, small bowel dilatation, colonic volvulus, or fecal impaction.
  • If a patient is hemodynamically stable, then an abdo U/S is the next imaging modality of choice to assess for cholecystitis, choledocolithiasis, appendicitis, hydronephrosis, and ectopic pregnancy. CT scans offer a greater sensitivity and specificity for differentiating abdo pathology with the drawback of radiation exposure. Typically oral and IV contrast will be administered.
42
Q

Describe approach to patient with:

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign:
  • Clinical onset:
  • Other signs:
  • Worksup:
  • Management:
43
Q

Describe approach to patient with:

  • Peritoneal sign
  • Clinical onset
  • Other signs
  • Worksup
  • Management
A
  • Peritoneal sign:
  • Clinical onset:
  • Other signs:
  • Worksup:
  • Management:
44
Q
A
45
Q

Describe management unstable hemodynamically patients: Abdo pain (4)

A
  • Hemodynamically unstable patients require prompt resuscitation with crystalloid intravenous solutions
  • broad-spectrum antibiotics (if sepsis is suspected)
  • and transfer to a monitored setting in the emergency department or intensive care unit.
  • A surgical consult should be promptly obtained in an unstable patient with acute abdo pain.

Essentials - General surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions