Abdomen/Pelvis Flashcards
- Epigastric region
- umbilical region
- hypogastric or suprapubic region
- right hypochondriac region
- left hypochondriac region
- right lumbar region
- left lumbar region
- right inguinal region
- left inguinal region
What are the 5 categories of abdominal pain?
Colic
Viseral
Ischemia
Inflammation
Referred
What is Colic pain?
Infection w/ bacteria/virus
forceful peristaltic contraction or body attempt to force contents through obstruction
What is visceral pain?
hollow organs contract or are distended, may be difficult to localize.
typically palpable near the midline.
How is visceral pain described?
gnawing
burning
cramping
aching
With severe visceral pain what associated symptoms can we see?
sweating
pallor
nausea
vomiting
restlessness
What is ischemia pain?
intense and continuous often related to strangulation/obstruction
What is parietal/inflammation pain?
originates from inflammation in the parietal peritoneum.
How is parietal pain described/localized?
What aggravates the pain?
Steady aching pain usually more severe, more precisely localized over the involved structure. Usually aggravated by movement or coughing.
What is Referred pain?
felt in more distant sites, often develops as the initial pain becomes more intense and seems to radiate.
May be felt superficially or deeply but is localized.
What is voluntary guarding?
pt consciously flinches when you touch him
What is involuntary guarding?
muscles spasm when you touch the patient, but he cannot control the reaction
What are the details of the health history we want to know for abdominal pain?
timing of the pain
acute vs chronic
describe in the patients own words
point to the pain site
difficulty swallowing
food intolerances
changes in bowel function, diarrhea, constipation, characteristics
any remedies tried
What additional health history for abdominal pain do we want to know?
rank the severity of the pain
factors that aggravate or relieve the pain
appetite changes
any indigestion, nausea, vomiting
past surgical history especially abdominal (adhesions)
Okay, last health history for abdomen?
Changes in urine color/odor
recent travel, blood transfusions, ETOH intake, environmental exposures
Family hx
urinary symptoms
screening for colon cancer
Females: menstrual/reproductive hx
Males: urinary, prostate issues
History Taking of Problems of the Abdomen:
GI Tract
How is the patient’s appetite?
Any symptoms of the following?
Heartburn
Excessive gas
abdominal fullness or early satiety
anorexia
What are the symptoms of heartburn?
a burning sensation in the epigastric area radiating into the throat; often associated with regurgitation/reflux
What are the symptoms of excessive gas?
needing to belch or pas gas by the rectum; patients often state they feel bloated
What is anorexia?
lack of an appetite
What is regurgitation?
the reflux of food and stomach acid back into the mouth; brine-like taste
What questions do we ask when pt c/o vomiting?
Amount?
type of vomit?
What types of vomit are there?
food
green- or yellow colored bile
mucus
blood
coffee ground emesis
What is blood or coffee ground emesis known as?
hematemesis
Questions to ask the patient about bowel movements?
Frequency?
Consistency?
Pain?
blood/black tarry stool?
color?
Ask about prior medical problems related to the abdomen such as?
hepatitis
cirrhosis
gallbladder problems
pancreatitis
Ask about what for abdomen history?
prior surgeries
foreign travel and occupational hazards
tobacco, alcohol, illicit drugs
hereditary d/o affecting the abdomen in family history
Questions to ask the patient about urinary history?
frequency
urgency
pain
color/smell
difficulty starting to urinate
leakage of urine
back pain at costovertebral angle (kidney) and lower back in men (prostate)
ask men about symptoms in the penis and scrotum
Pain in the RUQ could be?
Duodenal ulcer
hepatitis
hepatomegaly
pneumonia
cholecystitis
Pain in the LUQ can be?
Ruptured spleen
Gastric ulcer
aortic aneurysm
perforated colon
Pneumonia
Pain the RLQ could be?
Appendicitis
Salpingitis
Ovarian cyst
ruptured ectopic pregnancy
renal or uretal stone
strangulated hernia
Meckel diverticulitis
regional ileitis
perforated cecum
Pain in the LLQ could be?
Sigmoid diverticulitis
salpingitis
ovarian cyst
ruptured ectopic pregnancy
renal or ureteral stones
strangulated hernia
perforated colon
regional ileitis
ulcerative colitis
Periumbilical pain could be?
Intestinal obstruction
acute pancreatitis
early appendicitis
mesenteric thrombosis
aortic aneurysm
diverticulitis
Abdominal emergency
Subjective information
Progressive intractable vomiting
Lightheadedness w/ standing
Acute onset of pain
Pain that is becoming more intense over time
Abdominal Emergency
Objective information
Involuntary guarding
progressive distention
orthostatic hypotension
fever
leukocytosis and granulocytosis
decreased urine output
Acute Pain Surgical Emergency
Perforation or rupture of appendix leads to?
Peritonitis
Acute Pain Surgical Emergency
sudden onset spotting and persistent cramping lower quadrant shortly after missed period
female childbearing age think of?
ruptured ectopic pregnancy
Acute Pain Surgical Emergency
Sudden onset crampy umbilical (usually) pain could be?
Obstruction
Acute Pain Surgical Emergency
Sudden onset excruciating pain in chest or abdomen, radiates to legs and back
rupture/dissection of abdominal aortic aneurysm
What history supports AAA?
age > 65 y/o
hx of smoking
male gender
1* relative with hx of AAA with/without repair
Acute Abdominal Pain - Differentials
Steady pain unrelieved by position, LUQ into back
Acute pancreatitis
Acute Abdominal Pain - Differentials
Sudden onset colicky pain that progresses into constant, involuntary guarding
Appendicitis
Acute Abdominal Pain - Differentials
Colicky pain progressing into constant RUQ radiating to right scapular area
cholecystitis or cholelithiasis
Acute Abdominal Pain - Differentials
Sudden onset, crampy pain in umbilical area
Obstruction
Acute Abdominal Pain - Differentials
Constant severe pain RLQ or LLQ which increases with coughing or straining
Incarcerated hernia
Acute Abdominal pain - Differentials
Additional differentials
MI
Peritonitis
Mesenteric adenitis
Ureterolithiasis
UTI
Pyelonephritis
PID
Salpingitis
Intussusception
malrotation
volvulus
Pneumonia
Henoch-Schonlein purpura
Chronic Abdominal Pain Differentials - Lower
Crampy hypogastric pain that is variable, infrequent duration with gas, bloating, distention present 3 mo or more (functional)
IBS