ABD pain Flashcards by E *

ABD pain and surgery - most important thing?

Dont delay surgery for imaging

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High pitched bowel sounds suggests?

Mechanical Bowel obstruct

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Intra-abd bleeds req what intervention?

FAST U/S

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Abd Masses may indicate

Hernia, Aneurysm, Distended bladder, Tumor

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Abd pain labs

BMP, CBC, Coag, T/S XM prn

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Visceral pain in relation to epigastric pain includes what structures?

(Foregut) Liver, GB, Stomach, Pancreas, 1st half duodenum

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Undx ABD pain TXT

Opioids
Anti-emetics
NG tube
UA cath PRN

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Signs of parietal pain?

Rigidity, Rebound TTP, guarding, Lying completely still

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Bowels sounds are increased w/?

SBO

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When D/C a patient what should be considered?

If Dx unclear (even if CT neg) F/U 12hr PCM/ER

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Location of visceral pain?

Apprx at spinal level

Felt midline

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CT is SOC for?

Kidney/ureteral stones (No contrast)

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DX is driven by -

location of S/S or S/S groupings

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SBO is MC due to?

Adhesions

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When to perform pelvic exam?

Female - reproductive
Lower abd pain
No hystercetomy

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Surgical scars may indicate what w/in the abd?

Adhesions

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Where is parietal pain found?

Localized to dermatomes/anterior wall

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Visceral pain in relation to periumbilical pain includes what structures?

(Midgut) 2nd half of duodenum, jejunum, ileum, cecum, appendix, 1st half colon

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How much blood loss before SBP drops?

30-40 percent

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Abd Distention may indicate

Ascites, Ileus, Obstruct, Volvulus

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NG tube can confirm what?

Upper GI Bld and decompress bowel obstruct

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CT (PR) contrast is useful for?

Distal LRG bowel obstruct

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ABD U/S is good for?

Assessing biliary tree, Pancreas, KUB, Aoritc dimensions

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ABD XR series is good for?

SBO
Incarcerated hernia
Sigmoud volvulus
Perf
Severe constipation

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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