Abdominal Pain Flashcards
بیماری که با درد حاد شکمی اومده که میگیره ول مبکنه بعد ثابت مبشه،
در ناحیه اطراف ناف و RLQ و به پشتش هم میزنه.
تشخیص؟
Appendicitis
بیماری که با درد حاد شکمی اومده که متناوبه و بعد ثابت میشه ، در ناحیه اپیگاستر و RUQ و به کتف راست هم میزنه.
تشخیص؟
Cholecystitis
بیماری که با درد حاد شکمی اومده که که ثابته ، در ناحیه epigastric و periumblical حس میشه و به پشتش هم میزنه،
تشخیص؟
Pancreatitis
بیماری که با درد حاد شکمی اومده که ناگهانی و شدیده، در ناحیه اپیگاستریک و به کل شکم میزنه. تشخیص؟
Perforation
بیماری که با درد حاد شکمی اومده که میگیره ول میکنه، در ناحیه periumblical و به پشت هم میزنه. تشخیص؟
Obstruction
بیماری که با درد حاد شکمی اومده که که شدیده و diffuse، در ناخیه periumbilical و به کل شکم هم میزنه.
برای مسائل عروقی هم ریسک فاکتور داره.
تشخیص؟
Infarction
بیماری که با درد مزمن شکمی اومده که حالت سوزشی داره و رترواسترناله و به پشت و بازوی چپ میزنه.
Esophagitis
بیماری که با درد مزمن شکمی اومده که میگه احساس صعف و گشنگی داره، در ناحیه اپیگاستریک حس میشه و به پشت میزنه.
Peptic ulcer
بیماری که با درد مزمن شکمی اومده که همراه با نفخ و آروغ و احساس موندن سر دل که مبهمه، در ناحیه اپیگاستره و به جایی نمیرنه.
Dyspepsia
بیماری که با درد مزمن شکمی اومده که میگیره ول میکنه، در LLQ و RLQ که با استرس و تغییر اجابت مراج مرتبطه.
IBS
در بیماری که به چی شک میکنیم؟:
who is writhing in bed and unable to find a comfortable position
obstruction
روده ها
در بیماری که به چی شک میکنیم؟:
a patient lying with the lower extremities flexed and avoiding any motion
peritonitis
because movement makes peritoneal pain worse.
Abdominal distention
در معاینه معنیش چیه؟
یا آسیت یا انسداد
کاربرد Visual inspection for peristalsis ؟( یعنی پریستالتیس افزایش یافته)
is helpful for the diagnosis of small bowel obstruction
but this sign is present only in the early stages.
Focal areas of distention may indicate hernias
اگر در سمع شکم صداهای روده ای رو نشنویم؟
Absence of bowel sounds suggests ileus
اگر در سمع روده ها hyperactive, high-pitched sounds باشن؟
obstruction
اگر در سمع Multiple bruits باشه؟
Vascular diseases
Ischemia
وجود rebound tenderness نشان دهنده چیه؟
درگیری پریتوئن
Pain on percussion of the abdomen indicates peritoneal reaction, as does severe rebound tenderness.
اگر در TR بیمار تندرنس شدید داشت به چی شک میکنیم؟
Appendicitis
چرا در خانوم ها pelvic examination باس انجام بدیم؟
to rule out pelvic inflammatory disease, or masses.
علل acute abdomen?
sudden inflammation
perforation
obstruction
or infarction of an intra-abdominal organ.
علل خارج شکمی درد حاد و ناگهانی شکم؟
pneumonia
myocardial infarction
nephrolithiasis
and metabolic disorders like DKA
در بیمار شکم حاد، چه لب تست هایی رو درخولست میدیم؟
CBC with diff U/A Serum amylase Lipase Bilirubin Electrolytes
اگر در بیماری که با شکم‌حاد اومده WBCش extremely high باشه، به چی شک میکنیم؟
Typical of acute intestinal ischemia
Ddx of high serum amylase?
usually indicates acute pancreatitis,
2-perforated ulcer
3-mesenteric thrombosis
یافته تشخیصی abdominal film?
abdominal film is important to reveal the intra-abdominal gas pattern
کاربرد سونو در شکم حاد؟
Ultrasonography can be helpful in the diagnosis of acute cholecystitis or appendicitis.
در درد مزمن شکم وجود nausea vomit بعد از غذا معنیش چیه؟ 3
chronic peptic ulcer
disorders of gastric emptying
outlet obstruction.
اگر بیمار با درد شکمی مزمن و کاهش وزن اومده باشه؟
Documentation of weight loss mandates the search for an organic cause, such as inflammatory bowel disease or celiac
در درد مزمن شکم وجود کاهش وزن و انورکسی در فرد پیر معنیش چیه؟
If anorexia accompanies weight loss, particularly in elderly patients, cancer must be excluded
در بیماری با درد شکم مزمن که کنسر رد شده و تمامی تست ها نرماله، چه تشخیصی محتمله؟
the possibility of chronic depression must be entertained.
What is dyspepsia?
Dyspepsia is characterized by chronic intermittent epigastric discomfort, sometimes accompanied by nausea or bloating.
These symptoms are not always relieved by acid suppression and may be the result of an underlying motor disorder.
علایم IBS?
abdominal distention,
flatulence: نفخ
and disordered bowel function
تغییر اجابت مزاج
وجود چه علایمی alarm featuresدر بیماری که درد شکم مزمن داره RO کننده ی IBSعه؟
weight loss anemia nocturnal symptoms steatorrhea onset of symptoms after age 50 years
should be evaluated carefully for organic disease because these symptoms are not associated with IBS.
درد IBS به کجا میزنه؟
The abdominal pain of IBS tends to be in the left lower quadrant, but it can be located elsewhere or be more generalized.
ویژگی های
The pain of parietal peritoneal inflammation
محل؟
is steady and aching in character
and is located directly over the inflamed area, its exact reference being possible because it is transmitted by somatic nerves supplying the parietal peritoneum.
شدت درد ناشی از parietal peritoneal inflammation به چی بستگی داره؟
on the type and amount of material to which the peritoneal surfaces are exposed in a given time period.
مثلا اسید داشته باشه یا انزیم دردش خیلی رزیاد میشه
2-the rate at which any inflammatory material irritates the peritoneum is important.
چیا اگ بریزن تو حفره پریتوئن خیلی محرک نیستن، مگه این که massive باشن؟ ۲
Blood is normally only a mild irritant and the response to urine is also typically bland, so exposure of blood and urine to the peritoneal cavity may go unnoticed unless it is sudden and massive.
عفونت باکتریال پروتیون در چه صورت درد شدید میده؟
Bacterial contamination, such as may occur with pelvic inflammatory disease or perforated distal intestine, causes low-intensity pain until multiplication causes a significant amount of inflammatory mediators to be released.
مشخصات درد peritoneal inflammation؟
1-invariably accentuated by pressure or changes in tension of the peritoneum: by palpation, or by movement such as with coughing or sneezing.
2-The patient with peritonitis characteristically lies quietly in bed, preferring to avoid motion.
3-tonic reflex spasm of the abdominal musculature, localized to the involved body segment.
این ویژگی رو کدم بیماران میبینیم؟ 4
Catastrophic abdominal emergencies may be associated with minimal or no detectable pain or muscle spasm
1-in obtunded
2-seriously ill
3-debilitated
5, immunosuppressed
4, or psychotic patients.
مشخصات درد ناشی از obstruction؟
1-intermittent or colicky abdominal pain that is not as well localized as the pain of parietal peritoneal irritation.
ایا درد steady رد کننده ی obstruction هست؟
the absence of cramping discomfort can be misleading because distention of a hollow viscus may also produce steady pain with only rare paroxysms.
مشخصات درد ناشی از Small-bowel obstruction ؟
1-poorly localized
2, intermittent
(As the intestine progressively dilates and loses muscular tone, the colicky nature of the pain may diminish. )
3-periumbilical, or supraumbilical pain.
درد obstruction روده به کجا ممکنهه بزنه و چرا ؟
With superimposed strangulating obstruction, pain may spread to the lower lumbar region if there is traction on the root of the mesentery.
مشخصات colonic obstruction?
از روده باریک دردش بیشتزه یا کم تر؟
به کجا میزنه؟
1-colicky pain
2- lesser intensity
3- commonly located in the infraumbilical area
4- and may often radiate to the lumbar region.
مشخصات درد های biliary obstruction؟
1-Sudden distention of the biliary tree produces a steady rather than colicky type of pain; hence, the term biliary colic is misleading.
2- Acute distention of the gallbladder typically causes pain in the right upper quadrant with radiation to the right posterior region of the thorax or to the tip of the right scapula, but discomfort is also not uncommonly found near the midline.
مشخصات درد CBD obstruction?
1-Distention of the common bile duct often causes epigastric pain
2-that may radiate to the upper lumbar region.
(Considerable variation is common, however, so that differentiation between gallbladder or common ductal disease may be impossible.)
در کدوم حالت، distention بیلیاری تدریجی عه؟
مشخصات درد؟
🐬 Gradual dilatation of the biliary tree, as can occur with carcinoma of the head of the pancreas
🐬may cause no pain or only a mild aching sensation
🐬 in the epigastrium or right upper quadrant.
مشخصات درد distention of the pancreatic ducts؟
is similar to distention of the common bile duct but, in addition, is very frequently accentuated by recumbency and relieved by the upright position.
درد انسداد مجاری پانکراس در چه پزیشنی بدتر میشه؟
با دراز کشیدن زیاد می شود و با حالت عمودی تسکین می یابد.
مشخصات درد Obstruction of the urinary bladder ؟
usually causes dull, low intensity pain
2-in the suprapubic region.
Restlessness, without specific complaint of pain, may be the only sign of a distended bladder in an obtunded patient.
مشخصات درد ناشی از acute obstruction of the intravesicular portion of the ureter ؟
2- characterized by severe
2-suprapubic and flank pain
3-radiates to the penis, scrotum, or inner aspect of the upper thigh.
مشخصات درد ناشی از Obstruction of the ureteropelvic junction
بقیه ی ureter?
🎄manifests as pain near the costovertebral angle
🎄 obstruction of the remainder of the ureter is associated with flank pain that often extends into the same side of the abdomen.
کدوم مشکلات عروقی شکم diffuse, severe pain میدن؟
1-embolism or thrombosis of the superior mesenteric artery
2-impending rupture of an abdominal aortic aneurysm, can certainly be associated with diffuse, severe pain.
Yet, just as frequently, the patient with occlusion of the superior mesenteric artery only has mild continuous or cramping diffuse pain for 2 or 3 days before vascular collapse or findings of peritoneal inflammation appear. The early, seemingly insignificant discomfort is caused by hyperperistalsis rather than peritoneal inflammation.
چه نوع دردی بزای انسداد شریان sup mesenteric، کرکتریستیک عه؟
1-absence of tenderness and rigidity
2-in the presence of continuous, diffuse pain (e.g., “pain out of proportion to physical findings”)
3-in a patient likely to have vascular disease
درد ناشی ار پارگی abdominal aortic aneurysm به کجا میزنه؟
Abdominal pain with radiation to
1-the sacral region
2, flank
3, genitalia
This pain may persist over a period of several days before rupture and collapse occur.
مشخصات Abdominal Wall Pain ؟
با چیا بدتر میشه؟
Abdominal Wall Pain arising from the abdominal wall is usually constant and aching.
Movement, prolonged standing, and pressure accentuate the discomfort and associated muscle spasm.
برای پیدا کردن منشا درد، در بیماری که با درد شکم اومده اولین چیری که بررسب میکنیم چیه؟
✅ A most important, yet often forgotten, dictum is that the possibility of intrathoracic disease must be considered in every patient with abdominal pain, especially if the pain is in the upper abdomen.
کدوم دردهاای گوارشی با intrathoracic complications همراهن و مارو گمراه ممکنه کنن؟
diseases of the upper part of the abdominal cavity such as acute cholecystitis or perforated ulcer
کدام بیماری های خارج شکمی میتونن با درد شکم حاد تظاهر پیدا کنن؟
myocardial or pulmonary infarction
pneumonia
pericarditis
esophageal disease
در درد RUQ ای به شونه میزنه تشخیص افتراقی هاش؟
Diaphragmatic pleuritis resulting from pneumonia or pulmonary infarction may cause pain in the right upper quadrant and pain in the supraclavicular area, the latter radiation to be distinguished from the referred subscapular pain caused by acute distention of the extrahepatic biliary tree.
در افتراق بین منشا شکمی یا ریفرال ،اسپاسم عضلات شکم که با دم بهتر میشه چه کمکی میمنه بهمون؟
apparent abdominal muscle spasm caused by referred pain will diminish during the inspiratory phase of respiration,
whereas it persists throughout both respiratory phases if it is of abdominal origin.
در افتراق بین منشا شکمی یا ریفرال، ایا palpation کمکی بهمون میکنه؟
Palpation over the area of referred pain in the abdomen also does not usually accentuate the pain and, in many instances, actually seems to relieve it.
درد شکم اگر چه مشخصاتی داشته باشه به درد ارجاعی از مشکلات نخاعی و فشرده شدن عصب و فلان فکر مبکنیم؟
Referred pain from the spine, which usually involves compression or irritation of nerve roots, is characteristically intensified by cer- tain motions such as cough, sneeze, or strain and is associated with hyperesthesia over the involved dermatomes.
درد شکم اگر چه مشخصاتی داشته باشه به درد ارجاعی testis و سمینار وزیکل فکر مبکنیم ؟
Pain referred to the abdomen from the testes or seminal vesicles is generally accentuated by the slightest pressure on either of these organs.
The abdominal discomfort experienced is of dull, aching character and is poorly localized.
مشخصات درد C1 esterase deficiency?
Gg
چه زمانی به علل متابولیک درد شکم فمر میکنیم؟
تت
کدوم بیماری های متابولیک درد شکم میدن؟ ۶
1-hyperlipidemia
2-C1 esterase deficiency
3-The pain of porphyria and of lead colic
4- uremia
5-or diabetes is nonspecific, and the pain and tenderness frequently shift in location and intensity.
6-Black widow spider bites produce intense pain and rigidity of the abdominal muscles and back, an area infrequently involved in intraabdominal disease.🕷🕸
کدوم منشا متابولیک تابلوی بالینی ش شبیه intestinal obstruction عه?
The pain of porphyria and of lead colic
because severe hyperperistalsis is a prominent feature of both.
اگر بیمار DKA بعد از در اومدنش ازDKA درد شکمش بدتر نشد نشونه چیه؟
Diabetic acidosis may be precipitated by acute appendicitis or intestinal obstruction, so if prompt resolution of the abdominal pain does not result from correction of the metabolic abnormalities, an underlying organic problem should be suspected.
کدوم درد شکم ها باید اصطلا must be rushed to the OR?
Only patients with exsanguinating intraabdominal hemorrhage (e.g., ruptured aneurysm)
در بین اون ۷ ویژگی درد که باید بپرسبم کدوم مهم تره و تشخیص هامونو محدود میکنه؟
the chronological sequence of events in the patient’s history is often more important than the pain’s location.
در اورژانس، بیماری که با درد شکم اومده بهش ارام بخش یا مسکن بهش میزنیم یا نه؟
Narcotics or analgesics should not be withheld until a definitive diagnosis or a definitive plan has been formulated; obfuscation of the diagnosis by adequate analgesia is unlikely.
میگه بعیده که مسکن و‌نبود درد بتونه تشخیص رو با مشکل رو به رو کنه و اوکیه ک بدیم مسکن
خانوم بارداری با درد شکم و لوکوسیتوز اومده. چی میاد به ذهنمون؟
some otherwise noteworthy laboratory values (e.g., leukocytosis) may represent the normal physiologic changes of pregnancy.
در بیماری که با دزد شکم تومده سه چیری که‌توی inspection باید بهش توجه کنیم چیه؟
facies, position in bed, and respiratory activity, provides valuable clues.
یکی اومده با درد حاد شکم و میخوایم معاینه کنیم ولی نمیذاره دست بزنیم به شکمش. چیکار کنیم بفهمبم که درگیری پریتوئن بوده یا نه؟
Asking the patient to cough will elicit true rebound tenderness without the need for placing a hand on the abdomen.
برای شواهد peritoneal inflammation از چه معاینه ای استفاده میکنیم؟
Percussion
❌Eliciting rebound tenderness by sudden release of a deeply palpating hand in a patient with suspected peritonitis is cruel and unnecessary.
✅ The same information can be obtained by gentle percussion of the abdomen (rebound tenderness on a miniature scale), a maneuver that can be far more precise and localizing.
چه خطایی در معاینه شکم باعث میشه palpable gallbladder میس شه؟
A palpable gallbladder will be missed if palpation is so aggressive that voluntary muscle spasm becomes superimposed on involuntary muscular rigidity.
چرا هاریسون میگه هر کی با درد شکم میاد باید pelvic examination هم انجام بدیم؟
Abdominal signs may be virtually or totally absent in cases of pelvic peritonitis, so careful pelvic and rectal examinations are mandatory in every patient with abdominal pain.
تشخیص افتراقی های تندرنس در رکتال اگزم؟ 3
Tenderness on pelvic or rectal examination in the absence of other abdominal signs can be caused by operative indications such as perforated appendicitis, diverticulitis, twisted ovarian cyst, and many others.
چه Catastrophes هایی در سمع شکم نرمالن؟
strangulating small- intestinal obstruction or perforated appendicitis may occur in the presence of normal peristaltic sounds.
Conversely, when the proximal part of the intestine above obstruction becomes markedly distended and edematous, peristaltic sounds may lose the characteristics of borborygmi and become weak or absent, even when peritonitis is not present.
کدوم حالت truly silent abdominal میده؟
It is usually the severe chemical peritonitis of sudden onset that is associated with the truly silent abdomen.
اگر در معاینه درد شکم marked leukocytosis داشتیم چه تشخیص افتراقی هایی مطرحه؟ 5
A white blood cell count >20,000/μL may be observed with
1-perforation of a viscus 2, pancreatitis 3- acute cholecystitis 4, pelvic inflammatory disease 5, intestinal infarction
A normal white blood cell count is not rare in cases of perforation of abdominal viscera.
چه lab tests رو درخواست مبدیم در اپروچ ب درد شکم؟
1-CBC 2-The urinalysis 3-Blood urea nitrogen, 4-glucose, 5-and serum bilirubin levels 6-and liver function tests
یورین انالیز رو در درد شکم برای چی میخوایم؟
may reveal the state of hydration or rule out severe renal disease, diabetes, or urinary infection.
تشخیص افتراقی های بالا بودن امیلاز؟ 4
1-pancreatitis
2-perforated ulcer
3, strangulating intestinal obstruction
4, acute cholecystitis
thus, elevations of serum amylase do not rule in or rule out the need for an operation.
اکر در بیماری که با درد شکم اونده نیاز یه یه مدوالیته تصویر برداری داشته باشیم که تصمیم بگیریم چه مدالیته جراحی یا مدیکالی لازمه انتخابمون چیه؟
computed tomography is preferred to abdominal radiography when evaluating non-traumatic acute abdominal pain.
کنترایندیکیشن باریوم سوآلو؟
در این مواقع چه مدالیتی ای تشخیصی عه؟
If there is any question of obstruction of the colon, oral administration of barium sulfate should be avoided.
On the other hand, in cases of suspected colonic obstruction (without perforation), a contrast enema may be diagnostic.
کاربرد اسکن هایدا؟
Radioisotopic hepatobiliary iminodiacetic acid scans (HIDAs) may help differentiate acute cholecystitis or biliary colic from acute pancreatitis.
