Abdominal pain in the ER Flashcards
(39 cards)
What are the three types of abdominal pain and how to they present? what causes each of these?
- Visceral - poorly localized and 2/2 stretching of unmyelinated fibers
- Parietal (somatic) - localized and 2/2 irritation of myelinated fibers of the parietal pleura covering peritoneum
- Referred - pain felt at a location distant to underlying cause. MC on ipsilateral side.
which type of pain begins as tenderness and guarding and progresses to rigidity and rebound tenderness.
parietal (somatic)
remember 2/2 myelinated fibers of parietal pleura.
what are the MC extra-abdominal etiologies
- DKA
- Alcoholic ketoacidosis
- Pneumonia
- PE
- Herpes Zoster
is genitourinary considered extra-abdominal or intraabdominal?
extra-abdominal
who is more likely to have less severe or atypical presentations of abdominal pain?
elderly population.
How much is mortality increased for abdominal complaints in elderly
6-8 fold
what etiologies should you consider for elderly population who have abdominal pain
- ischemic heart disease
- vasculopathies
- coagulopathies
pain with maximal intensity at onset is a red flag for what diagnoses
- ischemia
- dissection
- perforation
a gradual onset of abdominal pain is more suggestive of what types of diagnoses
- inflammatory
- infectious
- obstructive
if pain is constant or worsening over 6 hours what type of etiology is it likely
surgical
What diagnosis relates to each of the following aggravating/alleviating factor?:
- pain improves after meals
- pain worse after meals
- pain improves when upright and worse when supine
- pain worse with sudden movements and improves with stillness
- PUD
- Biliary Colic
- pancreatitis
- peritonitis
Vomiting AFTER the onset of pain suggests what type of etiology
surgical
bilious vomiting suggests what etiology
obstruction distal to pylorus
note: Vomitus is considered bilious if it has a green or bright yellow color, indicating larger amounts of bile in the stomach
from google^ just cuz idk what bilious meant.
coffee-ground or hematemesis suggests what etiologies
- PUD
- Varices
- aortoenteric fistula in pts with aortic aneurysm repair.
What etiologies are associated with the following diarrheal types:
1. loose/watery
2. mucoid
3. bloody
4. small scant amounts
- loose/watery - infectious or diverticulitis
- mucoid - infectious or inflammatory
- bloody - mesenteric ischemia or infectious
- small scant amounts - bowel obstruction
what may suggest infectious etiology in elderly and neonatal populations
lower body temperature
what do the following auscultations suggest:
* absence
* periodic high-pitched
* hyperactive medium pitch
* bruit
- absence - peritonitis or bowel obstruction
- periodic high-pitched - bowel obstruction
- hyperactive medium pitch - blood or inflammation within the GI tract
- bruit - abdominal aortic aneurysm
What tests peritoneal pain and who are these tests not reliable in?
- rebound
- heel tap
- jumping
- not reliable in elderly or pregnant population
what do the following signs indicate?
- Carnett’s sign¹
- Murphy’s sign²
- Psoas sign³
- Obturators sign⁴
- Rovsing sign⁵
- CVA percussion
- Carnett’s sign¹ - indicates abdominal wall pathology
- Murphy’s sign² - indicative of cholecystitis
- Psoas sign³ - indicative of a retrocecal appendicitis
- Obturators sign⁴ - indicative of appendicitis
- Rovsing sign⁵ - indicative of appendicitis
- CVA percussion - indicative of pyelonephritis
who has physiologic leukocytosis?
pregnant people (elevated WBC = normal)
what can be visualized with an ultrasound
- GB
- pancreas
- kidneys
- ureters
- urinary bladder volume
- uterus/fallopian tubes
- aortic dimensions
What is the preferred study for undifferentiated abdominal pain
CT scan
what are indications for NON contrast CT’s
- nephrolithiasis
- trauma
- hemoperitoneum
- bowel obstruction
what are indications for oral vs IV contrast for CT abdomen
