Abdominal CCP (king-2) Flashcards by Marina Mesiha

characteristics of visceral pain

stimuli results in tension, stretching, ischemia
tissue congestion and ifm lower threshold for stimuli (sensitive n. ends)
B/L pain fibers
unmyelinated fibers
enter spinal cord at multiple levels (can’t localize)

How well did you know this?

Not at all

Perfectly

visceral pain description

dull
poorly localized
felt midline

How well did you know this?

Not at all

Perfectly

parietal pain characteristics

noxious stimulit to parietal peritoneum:
ischemia, ifm, stretching
transmitted via myelinated afferents to specific DRG:
on same side and same dermatomal level as original pain

How well did you know this?

Not at all

Perfectly

parietal pain description

sharp
intense
localized
coughing/moving aggravates it

How well did you know this?

Not at all

Perfectly

referred pain characteristics

like parietal pain but felt in remote area
supplied by same dermatome as affected organ
shares central pathway for afferent neurons from different sites

How well did you know this?

Not at all

Perfectly

mesenteric lymphadenitis

inflammation of mesenteric LN (LN in stomach)
CCP: difficult to differentiate from acute appendicitis
caused by:
beta hemolytic strep
staph species
e. coli
strep viridans
yersinia species (COMMON)
mycobac TB
viruses (EBV, rubella)

How well did you know this?

Not at all

Perfectly

mes lymphadenitis epidemiology

misdx as appendicitis and pt undergo appy when they have mesenteric adenitis
benign
equal in genders, more yesinia in male
common in children <15

How well did you know this?

Not at all

Perfectly

mes lymphadenitis tx

supportive care: hydration and pain mgmt
no antibiotics in mild cases
surgery if peritonitis dev, or is appy

How well did you know this?

Not at all

Perfectly

direct/conjugated hyperbilirubinemia

uncommon

primarily biliary obs and metabolic disorders

How well did you know this?

Not at all

Perfectly

indirect/unconjugated hyperbilirubinemia

more common (prehepatic like anemia)

How well did you know this?

Not at all

Perfectly

neonatal hyperbilirubinemia

inc bili load from:
dec bili conjugation
impaired bili excretion

How well did you know this?

Not at all

Perfectly

causes of inc bili load

hemolysis
non hemolytic:
extravascular sources
polycythemia
exaggerated enterohepatic circulation

How well did you know this?

Not at all

Perfectly

causes of hemolysis

RH incomp
ABO incomp
minor Ags (D type)
RBC cell mem defects
RBC enz defects
Rxa
Hb-opathies
sepsis

How well did you know this?

Not at all

Perfectly

RBC cell membrane defects

spheroctosis

elliptocytosis

How well did you know this?

Not at all

Perfectly

RBC enz defects

G6PD

How well did you know this?

Not at all

Perfectly

hemoglobinopathies

sickle cell anemia

causes of extravascular sources

cephlohematoma
CNS hemorrhage
swallowed blood
bruising

causes of polycythemia

fetal-maternal transfusion
delayed cord clamping
twin-twin transfusion

causes of exaggerated enterohepatic circulation

CF
ileal atresia
pyloric stenosis
breast milk jaundice
Hirschsprung's disease (megacolon)

causes of dec bili conjugation

physiologic jaundice from breast feeding
breast milk
Gilbert's
Criglar-Najar T1&2
hypothyroidism

causes of impaired bili excretion

biliary obstruction (Rotor’s, Dubin-Johnson, gall stones, biliary atresia, choledochal cyst, cancer, neoplasm, primary scleorsingcholangitis)
infection (sepsis, UTI, toxoplasmosis, syph, TB, rubella, herpes)
metabolic disorders (alpha 1 antitrypsin, CF, galactosemia, glycogen storage diseases, wilson’s)
chromosomal abnormalities (turner’s, trisomy 18 and 21)
drugs (ASA, acetaminophen, sulfa, EtOH, ery, tetracycline, steroids)

Coombs test

aka antiglobulin test (AGT)
tests for hemolytic anemia
pt’s blood sample is taken, plasma is washed away, then antihuman globulin is added, if RBC aggregation occurs, test is (+)

newborn bili production

6-8 mg/d
2x adult rate
declines in 10-14 d

why is hyperbilirubinemia more common in neonates?

RBCs have shorter life spans (80 days)
Hct is declining
immature liver uptake and conj of bili
inc enterohepatic circ increases intestinal reabs of bili and intestinal bac can de-conj bili allowing for reabs of bili into circulation

Heme deg pathway

RBC dies Mph engulfs it, frees heme Heme via heme oxidase to Fe and biliverdin Biliverdin via reducatase to bilirubin unconj bili bound to albumin into hepatocytes conjugated with UDPGT into soluble form

jaundice clinically detected at?

5 mg/dL

inc direct and indirect bili (-) coombs test normal retic count

``` ddx: hepatitis metabolic disorder obs disorder sepsis ```

inc indirect bili (-) coombs test normal retic count

ddx: physiologic breast milk jaundice familial non hemolytic jaundice (gilbert, crig-na)

inc indirect bili | inc retic count

ddx: hemolysis due to ABO/Rh incomp RBC defects (cell membrane or enzymatic)

physiologic jaundice

``` immaturity of liver b/w 24-72 hours peaks b/w 4-5 d (7 d in premies) gone by 10-14 days predom indirect levels never >12 mg/dl [those w/ risk factors, may rise to 17) ```

breast feeding jaundice

b/w 24-72 hrs, peaks 5-15 d of life, gone by week 3 | cause: not enough mi;k intake=inadequate excretion of bile in stool

breast milk jaundice

appears d3-4, peaks d6-14 cause: idio, may be component of milk dx if serum bili predom unconj

pathological jaundice

``` within 24 hrs inc in serum bili beyond 5 mg/dl/d peak above expected nml jaundice of >5mg/dl/d beyond 2 wks elevated conj bili ```

bili toxicity

unconj bili in brain | XS unconj is unable to bind albumin, crosses BBB, leads to asphyxia, acidosis, hypoxia, hypoperfusion, hyperosm, sepsis

toxic level of bili

>25 mg/dl in term neo

kernicterus

irreversible signs: 3-4d postnatal, lethargy, poor feeding, hypotonia late signs: week 1, irritable, seizure, apnea, hypertonia, fever chronic signs: encephalopathy (at age 3), cerebral palsy, high freq hearing loss, mild MR

tx for unconj hyperbili

1. Monitoring: inc feeding, repeat levels frequently 2. phototherapy: 1-2 d, conj bili into isomers to be excreted 3. exchange transfusion: reduce bili in blood quickly, has risks