ABDOMINAL PAIN Flashcards
3 situations where you should worry about abdominal pain
extremes of age
abnormal vital signs
sudden onset of severe abdominal pain
which antiemetic prolongs QT
zofran
3 populations that should definitely be admitted
needs IV meds or special consult or surgery
unstable
cant tolerate PO
describe visceral peritoneal pain
dull, poorly localized from inflammation/stretching of visceral peritoneum
describe parietal peritoneal pain
localized & distinct pain from parietal peritoneum inflammation
describe referral pain
pain felt away from source
- sharp= risk of perforation
- large= risk of ischemia, aspiration, tracheal encroachment
- button batteries = risk of erosion/perf; thermal burn or alkaline injury; fistula formation
esophageal obstruction
what is the condition? first thing to do if suspecting this?
- drooling/refusing PO
- dysphagia
- tracheal involvement= stridor/dyspnea
esophageal obstruction
first get CXR, if not radio-opaque then CT or EGD or gastrograffin swallow study
how is esophageal obstruction managed?
- emergent EGD esp if button battery or sharp or airway compromise
- output xray 24 hrs– no emergent indication, no pain, tolerating po
effort rupture: ++ vomiting, abdominal trauma, defecating
boerhaaves syndromes– can cause esophageal perforation
condition? imaging? tx(4)?
hx of ETOHism, bulimia, recent EGD
severe restrosternal/upper abdominal pain
odynophagia
- esophageal perforation
- imaging: CXR showing mediastinal or free peritoneal air but CT is preferred; gastrograffin esophagram
- tx: NPO, IVF, broad spectrum abx, surgery
what is this? how is it treated (3)?
- risk factors = ETOH use, liver disease
- enlarged veins d/t portal HTN
- upper GI bleed
esophageal varices
tx: ocreotide, intubate, EGD/banding
what is a complication of PUD?
deep ulceration causing upper GI bleed or perforation
2 general signs of upper GI bleed? one specific sign that its d/t PUD?
- hematemesis or melena
- tachycardia, hypotension, LH/syncope, shock
- PUD: abdominal pain/rigidity
what is this? how is it treated (2) ?
- upper GI bleed sx
- abdominal pain/rigidity
- xray shows free air or CT (if stable) shows air, defect
- decreased h/h, increased BUN
PUD induced GI bleed
tx: PPI IV, surgery cautery/omental patching
how are upper GI bleeds generally treated (3)?
- IV
- blood match +/- transfusion
- prophylactic abx
what imaging do you do if the cause of the post-prandial RUQ pain is unclear?
CT
inflammation in the absence of stones; critically ill, long term TPN, elderly
acalculous cholecystitis
choledocholithiasis vs cholangitis
- choledocholithiasis: stone in CBD +/- jaundice
- cholangitis: inflammation/infection of the CBD; SICK
what is charcots triad & reynolds pentad? what condition is it associated with?
RUQ pain, fever/rigors, jaundice, hypotension, altered mental status
associated with cholangitis
dilation of CBD + pneumobilia is seen on US with what condition
cholangitis
choledocholithiasis treatment (4)
- IVF
- pain & nausea tx
- NPO
- ERCP
cholangitis treatment (7)
- IVF
- pain and nausea tx
- NPO
- blood cultures
- IV abx
- ICU
- biliary drainage: ERCP, TR drain placement, surgical drainage
when can you discharge someone with acute pancreatitis (3)
passed PO challenge
pain managed
no stone
majority of small bowel obstructions are caused by?
post op adhesions
condition? dx? tx?
- distention, diffuse crampy pain, N/V, dehydration
- cant pass gas or stool
SBO
dx: CT, XR
if partial, admit; if high grade then surgery consult; if closed loop then its a surgical emergency
+ IVF, NPO, NG tube
- severly painful, tender, non-reducible mass
- SBO presentation too
- hematochezia
- if strangulated– gangrene, peritonitis, shock
incarcerated hernia
dx: clnical, labs (leukocytosis, elevated lactate), SBO on XR, CT
tx: surgery consult if incarcerated, IV abx & surgery emergency if strangulated
- sudden severe onset of pain
- POOP when ischemic, peritoneal when necrotic
- N/V
- forceful bowel evacuation
acute mesenteric ischemia
dx: labs (leukocytosis, elevated lactate), CTAP or CTA,
tx: eary surgery consult
what is rovsing, obturator, iliopsoas signs
- rovsing: RLQ pain w/ palp of LLQ
- obturator: pain w/ R hip Internal rotation
- iliopsoas: RLQ pain w/ passive R hip extension
imaging for appendicitis (3)
CTAP most sensive
US in kids & pregnant
MRI in pregnant
- LLQ pain/tenderness, N/V/D
- hematochezia
- h.o diverticulosis on colonscopy
acute diverticulitis
complications: absecess, perforation
labs: leukocytosis,
CTAP
admit w/ IV abx if complicated; discharge, bowel rest & abx if uncomplicated
perforation through wall of hollow organs (bowels)
PUD, complicated appy, diverc, SBO
sick, septic shock, abdominal distention
ruptured hollow viscus
labs: leukocytosis, elevated lactate
XR: pneumoperitoneum– rigler sign; air crescent
CT
tx: surgery
- ripping/tearing abdominal or flank pain, hypotension, pulsatile abd. mass
- hemorrhagic shock, tachy, hypotension
- retroperitoneal hemorrage: cullens & grey turners
ruptured AAA
US if known AAA; CT if stable
decreased h/h, elevated lactate
surgery
- colicky pain following ureter trajectory
- pacing, vomiting, v painful
- typically in 20s to 50s
- UA shows blood, infection
- CT non con, US if pregnant
septic ureteral stones
only discharge if no infection, baseline renal fxn, pain & nausea manged w/ PO; other wise admit and surgery
red swollen testicle w unilateral absent cremasteric reflex
testicular tosion
emergent urology consult; color US if unsure
severe hepatocellular injury in normal liver; can be toxin or viral induced
AMS, belly pain, jaundice, RUQ tenderness, anorexia
elevated LFT (v high AST, ALT) & prolonged INR
fulminant hepatic failure or acetaminophen OD
- activated charcoal w/in 4 hrs
- N-acetylcysteine to prevent APA metabolites from further damaging cells
- rumack matthew Nomogram
- ICU +/- care at liver transplant facility
- ascites fluid infetion w/o apperent intraabdominal treatable source
- large volume ascites, fever, AMS, diffuse abd pain/ttp/peritoneal signs
- paracentesis w/ fluid analysis
spontaneous bacterial peritonitis
abx, consider albumin infusion, ICU admit
