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PSP > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

Differential diagnoses for abdominal pain

A 
. Cholecystitis
. Small bowel obstruction
. Appendicitis 
. Abdominal aortic aneurysms (AAA)
. IBS
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2
Q

Abdominal pain

A

. Acute or chronic

. Localized or diffuse pain in abdominal cavity

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3
Q

Visceral pain

A

. Hollow organs forcefully contract or are distended or stretched
. Caused by distension or organ capsule, stomach, or appendix
. Vague, dull, poorly localized
. Starts diffuse/midline stemming from embryological bilateral innervation or organs

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4
Q

Parietal pain

A

. Initiates from inflammation of parietal peritoneum (peritonitis)
. More severe then visceral pain
. Sharp, Localized over involved structure
. Patient prefers to lay still, pain worse w/ moving/coughing
. Causes: ruptured appendix, hemoperitoneum, perforated viscous

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5
Q

Referred pain

A

. Pain referred to distant site innervated by same spinal level
. Localized
. Starts as initial pain
. Duodenal/pancreatic referred to back
. Pleurisy/inf. Wall MI to epigastric region
. Gallbladder pain to shoulder

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6
Q

Aggravating and relieving factors for abdominal pain

A

. Body position
. Association w/ eating
. Med use
. Stress levels

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7
Q

Temporal factors to look into with abdominal pain

A

. Time of day
. Activity that aggravates pain
. Pain waking patient up at night

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8
Q

Retroperitoneum

A

. Part of abdominal cavity

. Kids btw post. Parietal peritoneum and an. To transversalis fascia

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9
Q

Organs in retroperitoneum

A 
. Suprarenal 
. Aorta/IVC
. Duodenum (2-3rd segments)
. Pancreas
. Ureters
. Colon (ascending/descending)
. Kidney
. Esophagus
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10
Q

Right upper quadrant

A

. Lower margin of liver or liver edge palpable at right costal margin
. Kidney 12th rib, lat. and deep, palpable if thin
. Xiphoid process medially
. Abdominal aorta

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11
Q

Organs not palpable in right upper quadrant

A

. Gallbladder
. Inf. Aspect of liver
. Duodenum

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12
Q

Left upper quadrant

A

. Spleen in left midaxillary line
. 9-11th ribs protect spleen
. Tip of spleen may be palpable at left costal margin
. Pancreas, not palpable

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13
Q

Left lower quadrant

A

. Sigmoid colon (palpable as firm narrow structure)
. Transverse and descending colon (pay be palpable if constipated)
. Lower mid-line bladder, sacral promontory, and uterus

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14
Q

Right lower quadrant

A

. Bowel loops

. Appendix (not palpable if healthy)

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15
Q

Pelvic cavity

A 
. Contiguous w/ abdominal cavity 
. Angulated post. 
. Terminal ureters
. Bladder
. Pelvic genital organs 
. Bowel
. Protected by surrounding pelvic bones
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16
Q

GI disorders common, concerning symptoms

A

. Abdominal pain, acute and chronic
. Indigestion’s, nausea, vomiting w/ blood
. Difficulty swallowing/painful swallowing
. Change in bowel function
. Diarrhea, constipation
. Jaundice

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17
Q

GU disorder common and concerning symptoms

A 
. Suprapubic pain 
. Difficulty urinating, urgency, frequency
. Hesitancy
. Urinary incontinence 
. Blood in urine 
. Flank pain and ureteral colic
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18
Q

Hematochezia vs. melena

A

. Hematochezia: fresh blood per rectum, in or mixed w/ stool
. Melena: dark feces containing partly digested blood

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19
Q

Reg flag symptoms w/ abdominal pain

A

. Early satiety
. Unintentional weight loss w/ abdominal pain
. Jaundice
. Unexplained anemia

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20
Q

Peritonitis

A 
. Inflammation of parietal peritoneum 
. Dec. bowel sounds
. Patients prefer to lie still
. Exquisite pain throughout abdomen 
. Rebound tenderness
. Rigidity of abdomen 
. Pain on coughing or heel tap 
. Involuntary guarding
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21
Q

Ascites

A

. Accumulation of fluid in peritonealcavity
. Exceeds 25 mL
. Seen in cirrhosis of liver, liver cancer
. Access for abdominal distension, fluid eave, and shifting dullness

22
Q

Causes of ascites

A 
. Cirrhosis
. Sinusoidal obstruction syndrome 
. Bud-Chiari syndrome 
. Alcoholic hepatitis 
. HF
. Nephrotic syndrome 
. Pancreatitis
. Myxedema 
. Cancer
. Postoperative lymph leak
23
Q

Murphy’s sign

A

. Press down on abdomen in RUQ
. Breathe in, abdomen does down, gallbladder hits hand
. Inspiratory arrest on deep palpation of RUQ

24
Q

Auscultation in abdomen

A

. Listen before palpation
. Use diaphragm except for aorta and spleen
. Listen for bruits at midline and L and R renal aa.

25
Q

Inspection of abdomen

A

. Note contour, hernias, umbilicus, rashes, pulsation

. Stretch marks (Cushing syndrome)

26
Q

Cullen’s sign

A

Periumbilical darkening

27
Q

Turner’s sign

A

Flank darkening

. Intra or retroperitoneal bleed

28
Q

Types of bowel sounds

A

. Normal
. Hyperactive
. Absent
. Hyperactive

29
Q

Shifting dullness vs fluid wave

A

. Dullness: percussions midline lat. to flank for dullness changes (tympany is ascites)
. Fluid wave: patient put hand at midline, tap one side to see if transmission occurs as thrill sensation (if it does ascites)

30
Q

Types of percussion sounds

A 
. Tympanic 
. Hyper-resonant
. Normal resonant
. Impaired resonant 
. Dull
. Stony dull
31
Q

Aaron sign

A

Epigastric pain while doing McBurney’s point

32
Q

Rovsing sign

A

. RLQ pain w/ LLQ against examiner’s hand causing RLQ

33
Q

Obturator sign

A

. Patient supine

., examiner rotates the thigh flexed internally and externally causing pain in the RLQ

34
Q

Blumberg sign

A

. Rebound tenderness

. Sounds peritonitis

35
Q

Guarding is a sign of ___

A

Intra-abdominal inflammation

. Can be voluntary or involuntary

36
Q

Cholecystitis, acute

A

. RUQ pain worsens w/ fatty meal
. Murphy sign
. Courvoiser sign: oval mass felt in RUQ and is painless, could be obstruction from cancer of head of pancrea
. Pain radiates to right scapula, right shoulder, or right post. Thorax

37
Q

Hernias

A

. Ventral/indirect vv scrotal/direct vs femoral/crura hernias
. Patient lay flat w/ head lifted, look for swelling
. Reducible, incarcerated (difficult to replace) or strangulated (does not replace)
. Typically bowel

38
Q

Pyelonephritis

A

. UTI-like symptoms w/ extra features
. Systemic symptoms (fever/chills/rigor)
. Costovertebral angle tenderness on infected kidney side
. Murphy punch/pasternacki/goldflam sign (punch over kidney causing pain)

39
Q

Pancreatitis

A

. Palpation pain at R/LUQ, epigastric, diffuse pain, pain into back
. IV fluids mainstay treatment and pain control
. Caused by alcoholism and gallstone

40
Q

Ransom criteria for acute. Pancreatitis

A

. Severe and prognosis: 0-2 pts 0-3%, 3-5 pts, 11-15%, 6-11 pts, over 40%
. 6 hrs. Presentation (1 pt each): over 55 y/o, WBCs over 16k, glucose over 200, LDH over 350, AST over 250
. 48 hrs presentation (1 pit each): Hct less than 10%, BUN ride over 5, Ca under 8, pO2 less than 60, base deficit over 4

41
Q

Differentials for RUQ

A

. Cholecystitis (4Fs), hepatitis,

42
Q

RLQ differentials

A

. Appendicitis (can b fooled w/ mesenteric adenitis/lymphadenitis)

43
Q

Epigastric differentials

A

. Pancreatitis
. Gastritis
. Gastric ulcer/PUD

44
Q

LUQ differentials

A

. Gas distension, trauma to spleen

45
Q

LLQ differentials

A

. Diverticulitis, acute

46
Q

Suprapubic differentials

A

. UTI, STI

47
Q

Diffuse/midline abdominal differentials

A

. Mesenteric ischemia, AAA/dissection

48
Q

Abdominal Fs

A 
. Fatt
. Fibroid
. Full bladder
. Feces
. Fetus
. Flatus
. Fatal tumor
49
Q

Child specific abdominal pain differentials

A 
. Meckel’s diverticulum 
. Hirschsprung disease
. Malrotation
. Volvulus
. Intussusception
. necrotizing enterocolitis
. Meconium ileus
. Familial adenomatous polyposis (FAP)
. Gardner syndrome
. Turbot syndrome
. Peutz-Jeghers syndrome 
. Juvenile polyposis syndrome
50
Q

Testing for abdominal pain

A

. Ultrasounds (fast)
. X-ray (fasT)
. Labs: fast but can get expensive
. Digital rectal exam or occult stool for blood: fast
. CT scan of abdomen and pelvis : fast (contrast for organs, no contrast for kidney stones,IV dye w/ special speed for PE)
. MRI: slow and expensive: solid masses/tumors

PSP (35 decks)

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