Abdominal Pain Lecture Powerpoint Flashcards
3 basic causes of abdominal pain
- muscular contraction/distention of hollow viscus (crescendo/decrescendo type pain that comes and goes, described as sharp or crampy or colic)
- Visceral pain (dull, achy, diffuse poorly localized pain)
- Parietal peritoneum (sharp and localized, increased by coughing, etc)
4 questions always listed in a GI history
- Does eating make it better or worse
- does defecating make it better or worse
- last menstrual cycle?
- did something trigger this episode?
Benign causes of appearing melena or hematochezia (2)
- pepto bisthmol
- beets
Melena vs hematochezia
Melena is dark black tarry stool indicative of a deeper bleed while hematochezia is bright red blood indicative of colon bleed
Recall the physical exam for the abdomen order
Inspection, auscultation, perussion, palpation (in all 4 quadrants)
Diabetic and female patients with MI may present with…
….abdominal pain
Perforated viscus (peptic ulcer often) common presentation (4)
- sudden onset severe abdominal pain
- worse with movement
- pain with breathing
- abdominal series x ray showing free air below the diaphragm
Most common surgical emergency of abdomen
Acute appendicitis
Acute appendicitis presentation (5)
- right lower quadrant pain
- nausea and vomiting
- periumbilical/epigastric migrates to RLQ
- symptoms <48 hours, often resolve very quickly
- rovsing, obturator, psoas signs
Tenderness to percussion with abdominal exam raises concern for…
…more serious etiology
Acute appendicitis imaging (2)
- Abdominal CT
- Ultrasound second line
Mesenteric infarction definition
-clot in the mesenteric vasculature with bloody diarrhea, fever, low BP, tachycardia, and N/V often presenting with pain out of proportion to the exam and unresponsive to anelgesics, surgical emergency to remove ischemic portion and revascularize
Ruptured abdominal aortic aneurysm (AAA) definition
Rupture that may present with frank shock, is diagnosed with ultrasound, often have high pre hospital mortality rate requiring surgical repair and rarely is the patient stable
Ectopic pregnancy definition
Pregnancy implanted out of the uterus, presents with positive hCG with ultrasound showing absence of intrauterine pregnancy, or presence of adnexal mass, surgical emergency for treatment
Ectopic pregnancy classic triad
- abdominal pain
- amenorrhea
- vaginal bleeding
GERD/esophagitis most common symptom
burning pain that is worse with lying down
Biliary colic presentation
1-5 hours constant right upper quadrant/epigastric pain hours after meal (often specific meal) that may radiate to the right scapula, has associated with N/V and may awake the patient from sleep
Acute cholecystits definition and presentation
Develops in 20% of patients with untreated biliary colic, presents with right upper pain radiating to the right scapula and is initially colicky before becoming constant
Complications of untreated cholecystitis (3)
- jaudnice
- empyema
- peritonitis
Choledocholithiasis/ascending cholangitis charcot’s triad
- fever
- right upper quadrant pain
- jaundice
Biliary dyskinesia presentation and treatment (1)
Recurrent right upper quadrant pain in absence of gallstones that occurs typically 30-60 min after eating food lasting 1-4 hours, does not radiate and causes nausea, treated by a c cholecystectomy
IBD (UC/crohn’s) presentation symptoms (3)
Bloody diarrhea, abdominal pain, weight loss
Ischemic colitis cause, presentation, diagnostic study
A self limiting transient lack of blood flow to the colon causing transient pain and bloody diarrhea, diagnosed via colonoscopy
Most common cause of small bowel osbtruction
Intra-abdominal adhesions
