ABD pain Flashcards

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1
Q

ABD pain and surgery - most important thing?

A

Dont delay surgery for imaging

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2
Q

High pitched bowel sounds suggests?

A

Mechanical Bowel obstruct

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3
Q

Intra-abd bleeds req what intervention?

A

FAST U/S

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4
Q

Abd Masses may indicate

A

Hernia, Aneurysm, Distended bladder, Tumor

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5
Q

Abd pain labs

A

BMP, CBC, Coag, T/S XM prn

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6
Q

Visceral pain in relation to epigastric pain includes what structures?

A

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

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7
Q

Undx ABD pain TXT

A

Opioids
Anti-emetics
NG tube
UA cath PRN

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8
Q

Signs of parietal pain?

A

Rigidity, Rebound TTP, guarding, Lying completely still

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9
Q

Bowels sounds are increased w/?

A

SBO

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10
Q

When D/C a patient what should be considered?

A

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

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11
Q

Location of visceral pain?

A

Apprx at spinal level

Felt midline

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12
Q

CT is SOC for?

A

Kidney/ureteral stones (No contrast)

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13
Q

DX is driven by -

A

location of S/S or S/S groupings

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14
Q

SBO is MC due to?

A

Adhesions

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15
Q

When to perform pelvic exam?

A

Female - reproductive
Lower abd pain
No hystercetomy

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16
Q

Surgical scars may indicate what w/in the abd?

A

Adhesions

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17
Q

Where is parietal pain found?

A

Localized to dermatomes/anterior wall

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18
Q

Visceral pain in relation to periumbilical pain includes what structures?

A

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

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19
Q

How much blood loss before SBP drops?

A

30-40 percent

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20
Q

Abd Distention may indicate

A

Ascites, Ileus, Obstruct, Volvulus

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21
Q

NG tube can confirm what?

A

Upper GI Bld and decompress bowel obstruct

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22
Q

CT (PR) contrast is useful for?

A

Distal LRG bowel obstruct

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23
Q

ABD U/S is good for?

A

Assessing biliary tree, Pancreas, KUB, Aoritc dimensions

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24
Q

ABD XR series is good for?

A
SBO
Incarcerated hernia
Sigmoud volvulus
Perf
Severe constipation
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25
Q

What study confirms acute urinary retention?

A

Bladder U/S

26
Q

2nd line to ABD U/S for acute cholecysticis/biliary dyskinesia?

A

CHolescintography

27
Q

Rapid Circulatory collapse + acute abd pain is usually due to?

A

Intra-abdominal bleed (U/S) for Aortic aneuyrsm

28
Q

When is ABX indicated for ABD pain?

A

Abdominal sepsis or peritonitis

29
Q

Abd pain - critically ill Resus steps?

A

Cardiac monitor
O2 (2-4L/min)
Lrg bore IV - Isotonic Bolus

30
Q

Tympany on percussion of the abdomen may indicate?

A

Dilated bowel loops

31
Q

ABd pain and Tachycardia is good for assessing what?

A

Volume depletion (NL BP/Pulse - get orthostatics)

32
Q

Parietal pain also known as?

A

Somatic pain

33
Q

Woman w/ RLQ pain and Clinical setting suggests GYN etiology what image to use?

A

Transvaginal U/S

34
Q

Referred pain describes?

A

Pain distant from the site of involvement and usually ipsilateral. (midline pain only if structure is midline)

35
Q

Visceral pain in relation to suprapubic pain includes what structures?

A

(Hindgut) 2nd half of colon, sigmoid, rectum

36
Q

SOC ofor Roux-enY leak?

A

CT - extravasations

37
Q

Rovsing sign is?

A

Palpitations in one quad that causes pain in another quad

38
Q

Where do leaks most commonly occur after ROux-enY?

A

Gastrojejunostomy anastomosis

39
Q

Fluid wae may indicate?

A

Ascities

40
Q

Abd pain and tachypnea may indicate?

A

Cardiopulm process
Metabolic acidosis
Anxiety/pain

41
Q

SBO w/ no complications is TXT how?

A

Observation

42
Q

3 categories of abd pain?

A

Parietal
Visceral
Referred

43
Q

What suggests peritoneal irritation (peritonitis)?

A
  • Rigidity,
  • Rovsing sign,
    Remaining still,
    Rebound TTP,
  • pain w/ cough
44
Q

When to admit for ABD pain?

A

High risk pts

Refrac pain/vomit

45
Q

CT (IV) contrast is useful for?

A

LBO/SBO and AAA/mesenteric ischemia

46
Q

OLD and diarrhea may correlate

A

mesenteric ischemia

47
Q

VIsceral pain pathophys

A

Obstuct/Ischemia/Inflam stretches unmylelinated fibers on organ caplsules

48
Q

CT (PO) contrast is useful for?

A

GI abscess
Perf
Fistula

49
Q

What does visceral pain evolve to?

A

Parietal pain

50
Q

Visceral pain feels like?

A

Crampy, dull, achey, (Constant or colicky)

51
Q

When is an EKG req for abd pain?

A

Elderly

52
Q

Visceral pain and ass/w S/S?

A

Pallor, vomit, sweat

53
Q

After Roux-enY gastric bypass, what is a important concern?

A

Bowel obstruction = Surg ER and leaks

Due to- Int hernia, Stenosis, adhesion

54
Q

MC ED CC?

A

Abd pain

55
Q

Pts w/ leaks after ROux-enY present how?

A

Sepsis S/S (Fever, ABD pain, Tachycardic)

56
Q

ABD U/S is best for?

A

Assessing biliary tree

57
Q

MC surgical etiology for elderly presenting w/ ABD pain?

A

Cholecystitis (then SBO, Perf, appendicitis, LBO)

58
Q

Parietal pain pathophys?

A

Irritation to myelinated fibers innervating parietal peritoneum (Anterior wall)

59
Q

Bowels sounds are decreased w/?

A

Ileus, Mesenteric infarct, Narcotics, peritonitis

60
Q

Appendicitis is what type of pain where?

A

Visceral periumbilical at T10 dermatome

61
Q

Purpose of DRE?

A

Detect gross bld, maroon, melatonic stool (No useful for Dx)

62
Q

Woman w/ RLQ pain and Clinical setting suggests GI disease/appendicitis etiology what image to use?

A

ABD CT