ABD pain Flashcards
ABD pain and surgery - most important thing?
Dont delay surgery for imaging
High pitched bowel sounds suggests?
Mechanical Bowel obstruct
Intra-abd bleeds req what intervention?
FAST U/S
Abd Masses may indicate
Hernia, Aneurysm, Distended bladder, Tumor
Abd pain labs
BMP, CBC, Coag, T/S XM prn
Visceral pain in relation to epigastric pain includes what structures?
(Foregut) Liver, GB, Stomach, Pancreas, 1st half duodenum
Undx ABD pain TXT
Opioids
Anti-emetics
NG tube
UA cath PRN
Signs of parietal pain?
Rigidity, Rebound TTP, guarding, Lying completely still
Bowels sounds are increased w/?
SBO
When D/C a patient what should be considered?
If Dx unclear (even if CT neg) F/U 12hr PCM/ER
Location of visceral pain?
Apprx at spinal level
Felt midline
CT is SOC for?
Kidney/ureteral stones (No contrast)
DX is driven by -
location of S/S or S/S groupings
SBO is MC due to?
Adhesions
When to perform pelvic exam?
Female - reproductive
Lower abd pain
No hystercetomy
Surgical scars may indicate what w/in the abd?
Adhesions
Where is parietal pain found?
Localized to dermatomes/anterior wall
Visceral pain in relation to periumbilical pain includes what structures?
(Midgut) 2nd half of duodenum, jejunum, ileum, cecum, appendix, 1st half colon
How much blood loss before SBP drops?
30-40 percent
Abd Distention may indicate
Ascites, Ileus, Obstruct, Volvulus
NG tube can confirm what?
Upper GI Bld and decompress bowel obstruct
CT (PR) contrast is useful for?
Distal LRG bowel obstruct
ABD U/S is good for?
Assessing biliary tree, Pancreas, KUB, Aoritc dimensions
ABD XR series is good for?
SBO Incarcerated hernia Sigmoud volvulus Perf Severe constipation
What study confirms acute urinary retention?
Bladder U/S
2nd line to ABD U/S for acute cholecysticis/biliary dyskinesia?
CHolescintography
Rapid Circulatory collapse + acute abd pain is usually due to?
Intra-abdominal bleed (U/S) for Aortic aneuyrsm
When is ABX indicated for ABD pain?
Abdominal sepsis or peritonitis
Abd pain - critically ill Resus steps?
Cardiac monitor
O2 (2-4L/min)
Lrg bore IV - Isotonic Bolus
Tympany on percussion of the abdomen may indicate?
Dilated bowel loops
ABd pain and Tachycardia is good for assessing what?
Volume depletion (NL BP/Pulse - get orthostatics)
Parietal pain also known as?
Somatic pain
Woman w/ RLQ pain and Clinical setting suggests GYN etiology what image to use?
Transvaginal U/S
Referred pain describes?
Pain distant from the site of involvement and usually ipsilateral. (midline pain only if structure is midline)
Visceral pain in relation to suprapubic pain includes what structures?
(Hindgut) 2nd half of colon, sigmoid, rectum
SOC ofor Roux-enY leak?
CT - extravasations
Rovsing sign is?
Palpitations in one quad that causes pain in another quad
Where do leaks most commonly occur after ROux-enY?
Gastrojejunostomy anastomosis
Fluid wae may indicate?
Ascities
Abd pain and tachypnea may indicate?
Cardiopulm process
Metabolic acidosis
Anxiety/pain
SBO w/ no complications is TXT how?
Observation
3 categories of abd pain?
Parietal
Visceral
Referred
What suggests peritoneal irritation (peritonitis)?
- Rigidity,
- Rovsing sign,
Remaining still,
Rebound TTP, - pain w/ cough
When to admit for ABD pain?
High risk pts
Refrac pain/vomit
CT (IV) contrast is useful for?
LBO/SBO and AAA/mesenteric ischemia
OLD and diarrhea may correlate
mesenteric ischemia
VIsceral pain pathophys
Obstuct/Ischemia/Inflam stretches unmylelinated fibers on organ caplsules
CT (PO) contrast is useful for?
GI abscess
Perf
Fistula
What does visceral pain evolve to?
Parietal pain
Visceral pain feels like?
Crampy, dull, achey, (Constant or colicky)
When is an EKG req for abd pain?
Elderly
Visceral pain and ass/w S/S?
Pallor, vomit, sweat
After Roux-enY gastric bypass, what is a important concern?
Bowel obstruction = Surg ER and leaks
Due to- Int hernia, Stenosis, adhesion
MC ED CC?
Abd pain
Pts w/ leaks after ROux-enY present how?
Sepsis S/S (Fever, ABD pain, Tachycardic)
ABD U/S is best for?
Assessing biliary tree
MC surgical etiology for elderly presenting w/ ABD pain?
Cholecystitis (then SBO, Perf, appendicitis, LBO)
Parietal pain pathophys?
Irritation to myelinated fibers innervating parietal peritoneum (Anterior wall)
Bowels sounds are decreased w/?
Ileus, Mesenteric infarct, Narcotics, peritonitis
Appendicitis is what type of pain where?
Visceral periumbilical at T10 dermatome
Purpose of DRE?
Detect gross bld, maroon, melatonic stool (No useful for Dx)
Woman w/ RLQ pain and Clinical setting suggests GI disease/appendicitis etiology what image to use?
ABD CT
