Abdominal Pain Flashcards
What is the correct order of the abdominal exam?
Talk Inspect Auscultate Palpate Percuss (No rectal and vaginal exams)
What are the two emergency/life threatening conditions?
myocardial infarction
ectopic pregnancy
What are you listening for in auscultation?
Bowel sounds (hypo or hyperactive), pitch, NL, in which quadrants (hopefully all) Aortic bruits
What are you looking for in inspection?
Distention, symmetry, color changes, scars, rashes, lesions
What are you palpating for in an abdominal exam?
Masses, discover guarding, rigidity, referred and rebound referred tenderness, Murphys, psoas, obturator signs, PVA
What are you wanting to notice while percussing during an abdominal exam?
Resonance
Organomegaly
What are some key things to remember when taking an abdominal history?
Anatomy knowledge
Take a good history
Remove preconceived ideas
Where could those that have these disorder have pain? Diverticular disease Ectopic pregnancy Ovarian cyst and torsion Endometriosis IBS PID (pelvic inflammatory disease)
Left lower quadrant
Where could those that have these disorders have pain? Appendicitis Diverticular disease IBS IBD (ulcerative colitis and Crohn's Ectopic pregnancy Ovarian cyst and torsion PID
Right lower quadrant
Where could those that have these disorders have pain? Acute cholecystitis Biliary colic Acute hepatitis Duodenal ulcer Right lower lobe pneumonia myocardial infarction
Right upper quadrant associated pain
What region could be in pain if someone had these disorders? Splenic pathology Gastritis GERD AAA Left lower lobe pneumonia
Upper left quadrant pain
What region could be in pain if someone had these disorders? Appendicitis (early) Gastritis GERD AAA (abdominal aortic aneurism) Pancreatitis
Periumbilical Pain
What are these a sign of, and what is the treatment?
Irregular bleeding
Adnexal pelvic pain
Kehr’s sign (left shoulder/supraclavivular pain)
Ectopic pregnancy, treat with surgery or methotrexate if stable
What are these a sign of, and what is the treatment?
Mimics GERD
Presents differently in females
Can be “same belly pain I get all the time.”
Myocardial Infarction - ER!
What are these a sign of, and what is the treatment?
Pain or cramps
Chronic constipation or diarrhea, with change in stool appearance
Irritable bowel syndrome
Pain often relieved with bowel movement
Treat with antispasmodics, anti-constipation agents, SSRI’s, and even placebos “reassurance”
What are these a sign of, and what is the treatment?
Over 60
Fiber-deficient diet
High fat/red meat diet. Hard stools contribute
Diverticulosis (swelling in the colon, very common, 10% of those over 40 have)
Diverticulitis (serious)
Diverticular disease
Diagnose with CBC, treat with antibiotics
What are these a sign of, and what is the treatment?
Periumbilical pain, migrates
Nausea, vomiting, anorexia, diarrhea, obstipation, fever
Cutaneous hyperesthesia (hypersensitive to touch)
Appendicitis Psoas and obturator signs Rovsing's, Markle signs McBurney's sign Diagnose with CBC, MRI, CAT scan Treat with surgery or antibiotics. Complicated with perforation.
What is the point hallway between the belly button and the hip called?
McBurney’s point
What sign do you test for when you punch the bottom of a foot to test for appendicitis?
Markle’s or Rovsing’s sign
What are these a sign of, and what is the treatment? 5 F's (common in cholecystitis) Murphy's sign Cholelithiasis Cancer/tumor gallstone pancreatitis Biliary tract obstruction
-Gallbladder disease
-Murphy’s sign: ultrasound positive sonograph of Murphy’s (CVAT over kidney) - sensitive to pressure
-May resolve if they lose weight, or never work right again
Treatment: Medical or surgical
What are the 5 F’s, and what are they common in?
Female Fertile Forty Flatulence Fat Common in cholecystitis (inflammation of the gallbladder)
What are these a sign of, and what is the treatment? Suprapubic pain Dysuria (pain with urination) Hematuria Fever
Urinary system disorders: Cystitis (UTI in the lower section - bladder infection)
Diagnosis: Urinalysis
Treatment: Antibiotics, fluids
(Not usually in males 5-80: most likely STD or something else)
What are these a sign of, and what is the treatment?
CVA tenderness
fever
hematuria
Urinary system disorders: pyelonephritis (kidney infection)
Diagnosis: Urinalysis
Treatment: Antibiotics, possibly IV
What are these a sign of, and what is the treatment? What do the differences in size mean?
Flank pain, hematuria, CVA tenderness
Renal calculi/nephrolithiasis (kidney stones)
Treatment: <5mm stone: flomax and pain/nausea control - to pass
>5mm stone: surgery (SWL, PCNL, stenting, uretoscopy)
