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acute abdomen Flashcards

1
Q

time range of gangrene and bowel perforation that causes symptoms from interruption of intestinal blood supply secondary to strangulation or arterial embolus

A
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2
Q

time range of gangrene and bowel perforation that causes symptoms from interruption of intestinal blood supply secondary to strangulation or arterial embolus

A
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3
Q

visceral pain

A

from abd viscera innervated by autonomic nerve fibers; caused by distention, inflammation, or ischemia by stimulating the receptor neurons or by direct involvement (tumor infiltration) of sensory nerves

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4
Q

slow onset, vague, dull, nauseating, poorly localized

A

visceral pain

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5
Q

somatic (parietal) pain

A

from parietal peritoneum which is innervated by somatic nerves; caused by direct irritation of parietal peritoneum by pus, bile, urine, or gi secretions from infx, chemical or inflammatory process

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6
Q

more acute and sharp, well localized

A

somatic (parietal) pain

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7
Q

referred pain

A

pain perceived distant from its source; results from convergence of nerve fibers at the spinal cord

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8
Q

peritonitis

A

results from any abdominal condition that causes marked inflammation

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9
Q

cc of peritonitis

A

acute perf, appendicitis, diverticulitis, intestinal obstruction, pancreatitis, PID, acute mesenteric ischemia, ectopic pregnancy

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10
Q

causes of infectious peritonitis

A

ascitic fluid or indwelling shun, drain, or catheter in peritoneal cavity

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11
Q

effects of peritonitis

A

causes fluid to shift into peritoneal cavity causing severe dehydration and electrolyte imbalances; ARDS can develop rapidly; liver failure, kidney failures and DIC often follow, death can occur within days

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12
Q

BS for ileus vs obstruction

A

ileus has dec and obstruction being normal then inc to loud borborygmi

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13
Q

signs of shock

A

tachycardia, hypotension, diaphoresis, confusion

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14
Q

severe pain, silent abdomen, pt lying as still as possible

A

suggests peritonitis

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15
Q

ecchymosis of CVA (grey turner) or umbilicus (cullen)

A

suggests hemorrhagic pancreatitis

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16
Q

back pain w shock

A

suggests ruptured AAA; helpful if tender pulsatile abdominal mass

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17
Q

shock and vaginal bleeding

A

may suggest ruptured ectopic pregnancy

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18
Q

test of choice

A

ct

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19
Q

mesenteric ischemia

A

interruption of intestinal blood flow by embolism, thrombosis, or low flow state; leads to mediator release, inflammation, and ultimately infarction

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20
Q

abdominal pain out of proportion to PE

A

mesenteric ischemia

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21
Q

tx mesenteric ischemia

A

embolectomy, revascularization of viable segments or resection; sometimes vasodilators helpful; high mortality

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22
Q

acute perforation

A

any part of GI tract; can release gastric or intestinal contents into peritoneal space

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23
Q

symptoms are sudden w severe pain quickly followed by peritonitis and sings of shock

A

acute perforation

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24
Q

dx of acute perforation

A

imaging study showing free air in abdomen

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25
Q

tx acute perforation

A

fluid resuscitation, abx, surgical repair; mortality is high

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26
Q

abd pain, tenderness, and anorexia

A

appendicitis; acute inflammation of vermiform appendix

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27
Q

dx appendicitis

A

ct or us

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28
Q

tx appendicitis

A

surgical removal

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29
Q

hernias

A

protrusion of abd contents through acquired or congenital area of weakness or defect in abd wall

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30
Q

gradually inc pain, n/v, tender at site; guarding, rebound

A

incarcerated hernias that can’t be reduced

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31
Q

tx incarcerated or strangulated hernia

A

urgent surgical repair

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32
Q

temporary arrest of intestinal peristalsis

A

ileus; mc after abd surgery; peritoneal inflammation, metabolic disturbances, drugs

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33
Q

n/v, vague abd discomfort, minimal peristalsis, nontender

A

ileus

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34
Q

dx ileus

A

xray; may need contrast ct to differentiate from obstruction

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35
Q

tx ileus

A

NGT and IVFs, NPO, replace electrolytes

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36
Q

what is someone dx w an ileum has it for >1wk

A

more likely to be mechanical obstruction and should undergo laparoscopy

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37
Q

intestinal obstruction

A

mechanical impairment or complete arrest of passage of intestinal contents

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38
Q

cramping pain, vomiting, obstipation and not passing flatus

A

intestinal obstruction

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39
Q

dx intestinal obstruction

A

abd xray

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40
Q

tx intestinal obstruction

A

ngt, ivfs, bowel rest

41
Q

mc causes of intestinal obstruction

A

adhesions, hernias, tumors (sbo w/out prior abd surgery)

42
Q

what causes volume depletion w intestinal obstruction

A

vomiting and 3rd spaced

43
Q

intra abd abscess

A

suspect in pt w previous abd trauma or surgery or prev h/o of crowns ds, diverticulitis or pancreatitis

44
Q

abd pain, fever, malaise

A

intra abd abscess

45
Q

dx intra abd abscess

A

abd ct

46
Q

tx intra abd abscess

A

percutaneous or surgical drainage and abx

47
Q

ischemic colitis

A

transient reduction of blood flow to the colon; usually >60yo caused by small vessel atherosclerosis or can be complication of AAA repair

48
Q

symp milder and slower than acute mesenteric ischemia; llq pain followed by rectal bleedign

A

ischemic colitis

49
Q

dx ischemic colitis

A

ct or colonoscopy

50
Q

tx ischemic colitis

A

supportive w ivfs, abx, bowel rest

51
Q

visceral pain

A

from abd viscera innervated by autonomic nerve fibers; caused by distention, inflammation, or ischemia by stimulating the receptor neurons or by direct involvement (tumor infiltration) of sensory nerves

52
Q

slow onset, vague, dull, nauseating, poorly localized

A

visceral pain

53
Q

somatic (parietal) pain

A

from parietal peritoneum which is innervated by somatic nerves; caused by direct irritation of parietal peritoneum by pus, bile, urine, or gi secretions from infx, chemical or inflammatory process

54
Q

more acute and sharp, well localized

A

somatic (parietal) pain

55
Q

referred pain

A

pain perceived distant from its source; results from convergence of nerve fibers at the spinal cord

56
Q

peritonitis

A

results from any abdominal condition that causes marked inflammation

57
Q

cc of peritonitis

A

acute perf, appendicitis, diverticulitis, intestinal obstruction, pancreatitis, PID, acute mesenteric ischemia, ectopic pregnancy

58
Q

causes of infectious peritonitis

A

ascitic fluid or indwelling shun, drain, or catheter in peritoneal cavity

59
Q

effects of peritonitis

A

causes fluid to shift into peritoneal cavity causing severe dehydration and electrolyte imbalances; ARDS can develop rapidly; liver failure, kidney failures and DIC often follow, death can occur within days

60
Q

BS for ileus vs obstruction

A

ileus has dec and obstruction being normal then inc to loud borborygmi

61
Q

signs of shock

A

tachycardia, hypotension, diaphoresis, confusion

62
Q

severe pain, silent abdomen, pt lying as still as possible

A

suggests peritonitis

63
Q

ecchymosis of CVA (grey turner) or umbilicus (cullen)

A

suggests hemorrhagic pancreatitis

64
Q

back pain w shock

A

suggests ruptured AAA; helpful if tender pulsatile abdominal mass

65
Q

shock and vaginal bleeding

A

may suggest ruptured ectopic pregnancy

66
Q

test of choice

A

ct

67
Q

mesenteric ischemia

A

interruption of intestinal blood flow by embolism, thrombosis, or low flow state; leads to mediator release, inflammation, and ultimately infarction

68
Q

abdominal pain out of proportion to PE

A

mesenteric ischemia

69
Q

tx mesenteric ischemia

A

embolectomy, revascularization of viable segments or resection; sometimes vasodilators helpful; high mortality

70
Q

acute perforation

A

any part of GI tract; can release gastric or intestinal contents into peritoneal space

71
Q

symptoms are sudden w severe pain quickly followed by peritonitis and sings of shock

A

acute perforation

72
Q

dx of acute perforation

A

imaging study showing free air in abdomen

73
Q

tx acute perforation

A

fluid resuscitation, abx, surgical repair; mortality is high

74
Q

abd pain, tenderness, and anorexia

A

appendicitis; acute inflammation of vermiform appendix

75
Q

dx appendicitis

A

ct or us

76
Q

tx appendicitis

A

surgical removal

77
Q

hernias

A

protrusion of abd contents through acquired or congenital area of weakness or defect in abd wall

78
Q

gradually inc pain, n/v, tender at site; guarding, rebound

A

incarcerated hernias that can’t be reduced

79
Q

tx incarcerated or strangulated hernia

A

urgent surgical repair

80
Q

temporary arrest of intestinal peristalsis

A

ileus; mc after abd surgery; peritoneal inflammation, metabolic disturbances, drugs

81
Q

n/v, vague abd discomfort, minimal peristalsis, nontender

A

ileus

82
Q

dx ileus

A

xray; may need contrast ct to differentiate from obstruction

83
Q

tx ileus

A

NGT and IVFs, NPO, replace electrolytes

84
Q

what is someone dx w an ileum has it for >1wk

A

more likely to be mechanical obstruction and should undergo laparoscopy

85
Q

intestinal obstruction

A

mechanical impairment or complete arrest of passage of intestinal contents

86
Q

cramping pain, vomiting, obstipation and not passing flatus

A

intestinal obstruction

87
Q

dx intestinal obstruction

A

abd xray

88
Q

tx intestinal obstruction

A

ngt, ivfs, bowel rest

89
Q

mc causes of intestinal obstruction

A

adhesions, hernias, tumors (sbo w/out prior abd surgery)

90
Q

what causes volume depletion w intestinal obstruction

A

vomiting and 3rd spaced

91
Q

intra abd abscess

A

suspect in pt w previous abd trauma or surgery or prev h/o of crowns ds, diverticulitis or pancreatitis

92
Q

abd pain, fever, malaise

A

intra abd abscess

93
Q

dx intra abd abscess

A

abd ct

94
Q

tx intra abd abscess

A

percutaneous or surgical drainage and abx

95
Q

ischemic colitis

A

transient reduction of blood flow to the colon; usually >60yo caused by small vessel atherosclerosis or can be complication of AAA repair

96
Q

symp milder and slower than acute mesenteric ischemia; llq pain followed by rectal bleedign

A

ischemic colitis

97
Q

dx ischemic colitis

A

ct or colonoscopy

98
Q

tx ischemic colitis

A

supportive w ivfs, abx, bowel rest

surgery (21 decks)

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