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Clinical Prep > Abdominal pain lecture > Flashcards

Abdominal pain lecture Flashcards

1
Q

Parietal pain

A

Sharp
Very well located
D/t stretching or inflammation, tearing of the peritoneum

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2
Q

Visceral

A 
Colicky, poorly localized
distension, ischemia, 
Biliary tract
Ureters
Bowel obstruction
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3
Q

For OLD CARTS, dont forget to ask about Alleviating/Exacerbating factors

A 
Food
Antacids
Bowel movements
Exertion
Position changes
Stress
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4
Q

Position changes

A

Pancreatitis

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5
Q

Imp ROS

A

heartburn, dysphagia, odynophagia, EARLY SATIETY, n/v/d/c, melena, hematochezia, jaundice, PRURITIS, pallor

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6
Q

GU/GYN

A

dysuria, frequency, urgency, hematuria, flank pain, d/c, vaginal bleeding, USE OF BIRTH CONTROL, risk of STI

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7
Q

GI Alarm Sx

A 
Blood
Iron def anemia
Unexpl Weight loss
Nocturnal wakening
Dysphagia
Acute onset 
Fever/recurrent vomiting
Personal/Famhx CA
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8
Q

Meds to consider if pt is taking

A 
NSAIDs
Steroids
Anticoags
Hypomotility
Abx
Bisphosphonates
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9
Q

Past history

A

GI
Surgeries
Cardiac risk factors/surgeries

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10
Q

Family hx

A

IBD- Crohns or UC

Cancer

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11
Q

Social hx

A

Alc, Tobacco

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12
Q

Afebrile does NOT r/o infectious if pt is

A

OLD or Immunocompromised

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13
Q

Orthostatic vitals

A

may be sign of Dehydration

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14
Q

Tachypneic

Hypoxic

A

may be Heart or Lung cause

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15
Q

Pt writhing in agony

A

Biliary (gallbladder)

Renal (kidney)

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16
Q

Cullen sign- bellybutton

Grey turner- flank

A

Pancreatitis

necrotizing

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17
Q

Order of Abd exam

A

Inspection
Listen (auscultate)
Percuss
Palpate

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18
Q

What am I inspecting for on an abdominal exam?

A

Distention
Pulsation
Scars
Hernias

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19
Q

Tinkling high pitched

A

early obstruction

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20
Q

Percussion: Tympany

A

distended bowel

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21
Q

Percussion: Dull sound

A

Mass/fluid?

22
Q

If blood was present or suspect obstruction

A

Rectal exam

23
Q

All lower abdominal pain should have Rectal/GU exam

A

not necessarily RUQ though

24
Q

Alk phos

A

Renal and Hepatic function (kidney and liver)

electrolytes

25
Q

Lactic acid

A

concern for:

  • Ischemic Bowel or
  • DKA (diabetic ketoacidosis)
26
Q

Concern for Perforation

perfed ulcer

A

need to order CXR!!

27
Q

Concerned for obstruction

A

Abdominal X Ray

28
Q

CT A/P

A

Appendicitis
Pancreatitis
Diverticulitis

29
Q

Abd US

A

Hepatobiliary (liver or gallbladder)

Pancreas

30
Q

What to do for

  • Obstruction
  • Perf
  • Peritonitis
  • Ischemic bowel
  • Dissection
  • Strangulated bowel
A

IMMEDIATE surgical consult

31
Q

What do I need to add to Pt education along with plan?

A

RETURN precautions

ED precautions

32
Q

worried about Biliary cause (gallbladder)

A

get US

33
Q

Tx for Acute Cholecystitis

Imaging: gallstones and GB wall thickening

A 
Admit, NPO, IVF
Pain meds
Abx
Surgical consult
Pt education
34
Q

Epigastric pain better with sitting up and leaning forward

A

Pancreatitis

35
Q

Hx of gallstones and alcohol use

A

Pancreatitis

36
Q

Complications of PUD (gastric or duodenal ulcer)

A

Hemorrhage
Perforation
Obstruction

37
Q

What labs are indicative of dehydration?

A

Elevated Hct, BUN, and SG

38
Q

Most common cause of SBO

A

Adhesions (past surgery scar tissue)

39
Q

Most common cause of LBO

A

Cancer

40
Q

After finding Bowel obstruction on CXR with free air fluid levels, what next?

A

Need to get a CT to further assess where the obstruction is

41
Q

Choledocholithiasis often leads to —>

A

Acute CHOLANGITIS

Jaundice, elevated Alk Phos, AST/ALT elevated

42
Q

Fever
Jaundice
RUQ pain

A

Charcot triad

Cholangitis

43
Q

Asymmetric pulses and

CXR with widened mediastinum

A

Aortic dissection

44
Q 
Elderly
Hx of A-fib 
Hx of Valvular/ atherosclerosis
Abrubt onset
Pain out of proportion
Increased LDH (lactate dehydrogenase)
A

Acute Mesenteric Ischemia

45
Q

Elevated lactate means

A

Lactic acid is accumulating, often d/t LACK OF OXYGEN

46
Q

Crohns

A

Transmural (deeper)
skip lesions
mouth –> anus anywhere

47
Q

What things can cause Splenic abscess/infarct/rupture

other than trauma

A

Endocarditis
A-fib
Hypercoagulable state

48
Q

Most common Volvulus

A

Sigmoid

requires immediate decompression

49
Q

Tamponade and Beck’s Triad

Becky was wearing a Tampon

A

Hypotension
Muffled heart sounds
JVD

50
Q

Plan

A 
Disposition
Meds/therapy
Future diagnostic
Pt education
F/u rec
ED PRECAUTIONS

Clinical Prep (41 decks)

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