Abdominal Pain

Question 1

What are the primary causes of immediate life-threatening causes of abdominal pain?(A.S.EP.BI.PV.AMI) (S.AMI.PV.BI.EP.)

Answer 1

1-ruptured abdominal aortic aneurism(AAA)
2-rupture of the spleen
3-ruptured ectopic pregnancy
4-bowel infarction
5-perforated viscus(perforated hollow organ)
6-acute myocardial infarction

Question 2

What is not a sign/symptom of ruptured ectopic pregnancy?

Answer 2

Missed period

Question 3

What are the lab findings of bowel infarction?

Answer 3

High WBC
Severe lactic acidosis(anion gap>18)

Question 4

What are the X-ray finding of bowel infarction?

Answer 4

Free air under the diaphragm,
air in portal vein,
air in bowel wall(pneumatosis intestinalis)

Question 5

What are the causes of perforated viscus?

Answer 5

Blunt, penetrating trauma
tumors, inflammaory bowel disease, typhoid fever, amebiasis, other parasites

Question 6

what do you typically see in a perforated viscus?

Answer 6

free air under diaphragm (on X-ray)

Question 7

bowel infarctions occurs due to clot embolus or thrombosis in which artery?

Answer 7

mesenteric artery; superior is most life-threatening

Question 8

what are the signs that show in physical exam of bowel infarction?

Answer 8

[H.I! M.P.G.]
-peritonitis,
-hypoactive bowel sounds (no bowel sounds))
-blood in rectum (MELENA)
-ischemia
-guaiac positive stool (looks for hidden (occult) blood in a stool sample. It can find blood even if you cannot see it yourself.)

Question 9

which type of abdominal pains causes “pain out of proportion”?

Answer 9

abdominal pain caused by BOWEL INFARCTION

Question 10

what is the best diagnosis for unstable and stable patient in ruptured abdominal aortic aneurism?

Answer 10

bedside ultrasound for unstable patient
&
CT scan for stable patient

Question 11

how does ruptured abdominal aortic aneurism pain present as?

Answer 11

** present in shock from intraperitoneal rupture

back or groin pain
+typically epigastric or periumbilical pain radiating to back
+pulsating supraumbilical mass

Question 13

Neurological inn of the abdominal pain

Answer 13

Sphlanchnic nerve

Question 14

What is the general approach to a pt with abdominal pain?

Answer 14

1-check: ABC; airway, breathing and circulation
2-determine if situation is life threatening
3-start resuscitation and consult surgeon
4-treat pain

Question 15

**What is the affected nerve during ruptured spleen or liver?

Answer 15

***Phrenic nerve(supplies diaphragm and some vague parts of liver and spleen +shoulder and back i.e like in Kehr’s sign)

Question 16

What is the sign present in a pt with ruptured spleen or liver?

Answer 16

Reffered pain to shoulders; KEHR’s SIGN(especially for liver trauma)

Question 17

What is the dx and tx for ruptured spleen or liver?

Answer 17

(Same for ruptured AAA);
+IV fluid,
+Blood type &cross matching for blood Transfusion
+U/S or CT scan,
+call surgeon

Question 18

***What is the diagnostic test for ruptured ectopic pregnancy?

Answer 18

Pelvic U/S (on fallopian tube)
+HCG test

Question 19

Which type of abdominal pain etiologies present with coronary artery disease?

Answer 19

Bowel infarction

Question 20

Why must bowel infarction be operated within minutes?

Answer 20

Bcz unlike muscles, which can endure hypoxia for hours, the bowel organs can sustain only minutes of hypoxia before ischemia occurs

Question 21

In which etiology of abdominal pain is the pain considered mild regardless of the severe findings(s.a lactic acidosis and high WBC)?

Answer 21

Bowel infarction

Question 22

what is an ex of pregnancy related cause of abdominal pain?

Answer 22

Abruptio placentae(premature separation of placental from uterus)

Question 23

what are the genitourinary tract causes of abdominal pain?

Answer 23

cystitis
pyelonephritis
UTI
renal infarction
testicular torsion
ureterolithiasis

Question 24

what is the key Rx of Peritonitis causing abdominal pain?

Answer 24

early pain relief with narcotics

Question 25

what are the most common causes of abdominal pain in adults?

Answer 25

acute gastritis/peptic ulcer
acute diverticulitis
acute appendicitis
uretherolithiasis
inflammatory bowel disease
bowel obstruction
ovarian cyst

Question 26

what are the organs more likely to rupture during trauma?

Answer 26

spleen
liver
bladder

Question 27

what q’s to ask a STABLE pt with abdominal pain?

Answer 27

[To Care for Symptoms and Signs of bleeding the Patient Lies about Medication, Alcohol consumption or ingestion of foreign material]

time and rapidity of inset
character of pain
symptoms related
signs of bleeding
prior surgeries/illnesses
Last menstrual cycle
Medication
alcohol consumption
ingestion of foreign material

Question 28

describe abdominal exam

Answer 28

1-inseption
2-auscultaion
3-palpation & percussion

Question 29

what does absent bowel sounds interpreted as?

Answer 29

ileus or peritonitis (listen for 1 min)

Question 30

what does high pitched or tinkling bowel sounds interpreted as?

Answer 30

bowel obstruction

Question 31

each percussion of abdomen implies what:
tympanitic:..
dull:..
tender:..

Answer 31

tympanitic: implies bowel obstruction

dull: implies intrabdominal bleeding or fluid(ascites)

tender: implies pain in tender areas

Question 32

what are the “secondary” aspects to rmmbr for abd pain?

Answer 32

*give O2 if any major systemic compromise

if any prior anesthetic complications present

*pain meds as needed and early on +repeat physical exam

*tetanus vaccine in skin injury

Abx

*update patient’s family

Question 33

complications of peritonitis ?

Answer 33

[HIF]

hypovolemic shock

fluid-electrolyte disorders

ileus

Question 34

causes of of peritonitis ?

Answer 34

exposure of peritoneum to bile, urine, gastric acid, blood