Abdominal pain lecture Flashcards
Parietal pain
Sharp
Very well located
D/t stretching or inflammation, tearing of the peritoneum
Visceral
Colicky, poorly localized distension, ischemia, Biliary tract Ureters Bowel obstruction
For OLD CARTS, dont forget to ask about Alleviating/Exacerbating factors
Food Antacids Bowel movements Exertion Position changes Stress
Position changes
Pancreatitis
Imp ROS
heartburn, dysphagia, odynophagia, EARLY SATIETY, n/v/d/c, melena, hematochezia, jaundice, PRURITIS, pallor
GU/GYN
dysuria, frequency, urgency, hematuria, flank pain, d/c, vaginal bleeding, USE OF BIRTH CONTROL, risk of STI
GI Alarm Sx
Blood Iron def anemia Unexpl Weight loss Nocturnal wakening Dysphagia Acute onset Fever/recurrent vomiting Personal/Famhx CA
Meds to consider if pt is taking
NSAIDs Steroids Anticoags Hypomotility Abx Bisphosphonates
Past history
GI
Surgeries
Cardiac risk factors/surgeries
Family hx
IBD- Crohns or UC
Cancer
Social hx
Alc, Tobacco
Afebrile does NOT r/o infectious if pt is
OLD or Immunocompromised
Orthostatic vitals
may be sign of Dehydration
Tachypneic
Hypoxic
may be Heart or Lung cause
Pt writhing in agony
Biliary (gallbladder)
Renal (kidney)
Cullen sign- bellybutton
Grey turner- flank
Pancreatitis
necrotizing
Order of Abd exam
Inspection
Listen (auscultate)
Percuss
Palpate
What am I inspecting for on an abdominal exam?
Distention
Pulsation
Scars
Hernias
Tinkling high pitched
early obstruction
Percussion: Tympany
distended bowel
Percussion: Dull sound
Mass/fluid?
If blood was present or suspect obstruction
Rectal exam
All lower abdominal pain should have Rectal/GU exam
not necessarily RUQ though
Alk phos
Renal and Hepatic function (kidney and liver)
electrolytes
Lactic acid
concern for:
- Ischemic Bowel or
- DKA (diabetic ketoacidosis)
Concern for Perforation
perfed ulcer
need to order CXR!!
Concerned for obstruction
Abdominal X Ray
CT A/P
Appendicitis
Pancreatitis
Diverticulitis
Abd US
Hepatobiliary (liver or gallbladder)
Pancreas
What to do for
- Obstruction
- Perf
- Peritonitis
- Ischemic bowel
- Dissection
- Strangulated bowel
IMMEDIATE surgical consult
What do I need to add to Pt education along with plan?
RETURN precautions
ED precautions
worried about Biliary cause (gallbladder)
get US
Tx for Acute Cholecystitis
Imaging: gallstones and GB wall thickening
Admit, NPO, IVF Pain meds Abx Surgical consult Pt education
Epigastric pain better with sitting up and leaning forward
Pancreatitis
Hx of gallstones and alcohol use
Pancreatitis
Complications of PUD (gastric or duodenal ulcer)
Hemorrhage
Perforation
Obstruction
What labs are indicative of dehydration?
Elevated Hct, BUN, and SG
Most common cause of SBO
Adhesions (past surgery scar tissue)
Most common cause of LBO
Cancer
After finding Bowel obstruction on CXR with free air fluid levels, what next?
Need to get a CT to further assess where the obstruction is
Choledocholithiasis often leads to —>
Acute CHOLANGITIS
Jaundice, elevated Alk Phos, AST/ALT elevated
Fever
Jaundice
RUQ pain
Charcot triad
Cholangitis
Asymmetric pulses and
CXR with widened mediastinum
Aortic dissection
Elderly Hx of A-fib Hx of Valvular/ atherosclerosis Abrubt onset Pain out of proportion Increased LDH (lactate dehydrogenase)
Acute Mesenteric Ischemia
Elevated lactate means
Lactic acid is accumulating, often d/t LACK OF OXYGEN
Crohns
Transmural (deeper)
skip lesions
mouth –> anus anywhere
What things can cause Splenic abscess/infarct/rupture
other than trauma
Endocarditis
A-fib
Hypercoagulable state
Most common Volvulus
Sigmoid
requires immediate decompression
Tamponade and Beck’s Triad
Becky was wearing a Tampon
Hypotension
Muffled heart sounds
JVD
Plan
Disposition Meds/therapy Future diagnostic Pt education F/u rec ED PRECAUTIONS
