Abdominal Pain Flashcards
1 condition that presents with EPIGASTRIC pain?
Abdominal Aortic Aneurysm (AAA)
What are some risk factors for AAA?
Atherosclerosis, Male, Smoker
AAA are usually found incidentally and are asymptomatic. As they expand, what presents?
Pulsations in abdomen
Pain in chest/back/scrotum
For AAA, what is a precursor to rupture?
PAIN
What is a diagnostic test to screen and to document size of AAA?
Abdominal US
The risk of rupture for AAA increases as the AAA > __
5 cm
AAA rupture occurs spontaneously and presents with what symtpoms?
Hypotension
Pain
If an AAA causes Aortic Dissection, what will be seen on CT?
False lumen
Symptoms of Aortic Dissection?
Tearing chest pain and widened mediatsinum
Tearing chest pain with a widened mediastinum suggests?
Aortic Dissection
Hypotension and epigastric abdominal pain suggests?
AAA rupture
5 DDX for RLQ pain?
Appendicitis Ectopic Pregnancy Ovarian Torsion Ogilvie Syndrome Meckel's Diverticulum
Appendicitis is usually initiated by?
Obstruction of appendix – fecalith, neoplasm, etc.
What are 2 times when appendicitis can have atypical presentation?
Elderly = mild pain and symptoms Pregnancy = uterus displaces appendix
What is the most common cause of maternal death during 1st trimester?
Ectopic pregnancy
3 risk factors for an ectopic pregnancy?
PID
Ruptured appendix
Prior tubal surgery – most common site
Symptoms of an ectopic pregnancy?
Sudden, severe lower quadrant pain
- blood accumulates in peritoneum = hypotension
Diagnostic results with an ectopic pregnancy?
(+) pregnancy test with NO intrauterine pregnancy on transvaginal US
What is Ovarian Torsion associated with and what side is commonly affected?
Ovarian enlargement
- RIGHT side
Symptoms of Ovarian Torsion?
Sudden, severe unilateral abdominal pain AFTER EXERTION
Sudden, severe pain after exertion could indicate?
Ovarian Torsion
Ovarian Torsion is an ischemic condition, what diagnostic test can diagnose it?
Transvaginal US with doppler
Acute Colonic Pseudo-obstruction is known as?
Ogilvie Syndrome
Ogilvie Syndrome
SPONTANEOUS massive dilation of cecum or right colon
What parts of the colon and what patients are usually affect with Ogilvie Syndrome?
Right colon/cecum
ICU patients
Ogilvie syndrome involves massive dilation of colon without obstruction. A diameter greater than ___ is at risk for perforation
10-12 cm
Ogilvie syndrome should start with conservative treatment. Describe it.
- Place rectal tube
- STOP drugs that slow GI motility
= monitor size every 12 hours
Once Ogilvie syndrome involves the colon diameter > 12 cm, what should the treatment be?
Colonoscopic decompression
Surgery
Meckel’s Diverticulum can mimc?
Appendicitis
How do you diagnose Meckel’s Diverticulum?
Meckel’s scan
= Technetium-99m scan
What is a Technetium - 99m scan and what does it diagnose?
Nuclear medicine up-taken in tissue
= Meckel’s Diverticulum
1 condition that can cause LLQ pain?
Diverticulitis
Symptoms of Diverticulitis?
LLQ pain, N/V, constipation that progresses to loose stools due to the inflammation
What diagnostic tests should you NOT do for Diverticulitis and why?
Endoscopy or Barium Enema
= risk of perforation
4 complications of Diverticulitis?
Abscess
Perforation
Fistula
Stricture
2 conditions that can cause Periumbilical pain?
Acute Mesenteric Ischemia
Chronic Mesenteric Ischemia
Acute Mesenteric Ischemia arises how?
Inadequate blood flow through the mesenteric A.’s
–> ischemia and gangrene of bowel wall
Main sign of Acute Mesenteric Ischemia?
Pain out of proportion to tenderness
Pain that is out of proportion to tenderness could indicate?
Acute Mesenteric Ischemia
Chronic Mesenteric Ischemia arises how?
Long-standing Atherosclerotic disease
–> gradual reduction in blood flow
Symptoms of Chronic Mesenteric Ischemia?
Abdominal Angina - pain after eating
- Food fear
Acute and Chronic Mesenteric Ischemia can be diagnosed how?
CT angiography with IV contrast
3 DDx for Diffuse abdominal pain?
Peritonitis
Toxic Megacolon
Volvulus
How does Peritonitis arise?
Intraabdominal viscus
–> leakage of bacteria that then contaminates peritoneum
How does Peritonitis arise?
Intraabdominal viscus
–> leakage of bacteria that then contaminates peritoneum
With Peritonitis, describe the microbiology
Mixed flora
- gram (-) bacilli and anaerobes predominate
Signs of Peritonitis?
Patients lie with their knees to their chest to prevent stretching of the nerve fibers
Diagnostic test for Peritonitis?
CT to find source of contamination
What 2 things can cause Toxic Megacolon?
IBD
C. Difficile
Volvulus arises how?
Twisted bowel around its mesentary
Obstruction
Infarction
Sigmoid Volvulus usually occurs in who?
Pregnant
Constipated older adults
Cecum Volvulus usually occurs in who?
Younger adults
What will be seen on X-ray with a Volvulus?
Bent Coffee Bean
A Bent Coffee Bean on X-ray indicates?
Volvulus
What will be seen on Barium Enema with a Volvulus?
Bird’s beak
