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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
tx acute perforation
fluid resuscitation, abx, surgical repair; mortality is high
26
abd pain, tenderness, and anorexia
appendicitis; acute inflammation of vermiform appendix
27
dx appendicitis
ct or us
28
tx appendicitis
surgical removal
29
hernias
protrusion of abd contents through acquired or congenital area of weakness or defect in abd wall
30
gradually inc pain, n/v, tender at site; guarding, rebound
incarcerated hernias that can't be reduced
31
tx incarcerated or strangulated hernia
urgent surgical repair
32
temporary arrest of intestinal peristalsis
ileus; mc after abd surgery; peritoneal inflammation, metabolic disturbances, drugs
33
n/v, vague abd discomfort, minimal peristalsis, nontender
ileus
34
dx ileus
xray; may need contrast ct to differentiate from obstruction
35
tx ileus
NGT and IVFs, NPO, replace electrolytes
36
what is someone dx w an ileum has it for >1wk
more likely to be mechanical obstruction and should undergo laparoscopy
37
intestinal obstruction
mechanical impairment or complete arrest of passage of intestinal contents
38
cramping pain, vomiting, obstipation and not passing flatus
intestinal obstruction
39
dx intestinal obstruction
abd xray
40
tx intestinal obstruction
ngt, ivfs, bowel rest
41
mc causes of intestinal obstruction
adhesions, hernias, tumors (sbo w/out prior abd surgery)
42
what causes volume depletion w intestinal obstruction
vomiting and 3rd spaced
43
intra abd abscess
suspect in pt w previous abd trauma or surgery or prev h/o of crowns ds, diverticulitis or pancreatitis
44
abd pain, fever, malaise
intra abd abscess
45
dx intra abd abscess
abd ct
46
tx intra abd abscess
percutaneous or surgical drainage and abx
47
ischemic colitis
transient reduction of blood flow to the colon; usually >60yo caused by small vessel atherosclerosis or can be complication of AAA repair
48
symp milder and slower than acute mesenteric ischemia; llq pain followed by rectal bleedign
ischemic colitis
49
dx ischemic colitis
ct or colonoscopy
50
tx ischemic colitis
supportive w ivfs, abx, bowel rest
51
visceral pain
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
slow onset, vague, dull, nauseating, poorly localized
visceral pain
53
somatic (parietal) pain
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
more acute and sharp, well localized
somatic (parietal) pain
55
referred pain
pain perceived distant from its source; results from convergence of nerve fibers at the spinal cord
56
peritonitis
results from any abdominal condition that causes marked inflammation
57
cc of peritonitis
acute perf, appendicitis, diverticulitis, intestinal obstruction, pancreatitis, PID, acute mesenteric ischemia, ectopic pregnancy
58
causes of infectious peritonitis
ascitic fluid or indwelling shun, drain, or catheter in peritoneal cavity
59
effects of peritonitis
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
BS for ileus vs obstruction
ileus has dec and obstruction being normal then inc to loud borborygmi
61
signs of shock
tachycardia, hypotension, diaphoresis, confusion
62
severe pain, silent abdomen, pt lying as still as possible
suggests peritonitis
63
ecchymosis of CVA (grey turner) or umbilicus (cullen)
suggests hemorrhagic pancreatitis
64
back pain w shock
suggests ruptured AAA; helpful if tender pulsatile abdominal mass
65
shock and vaginal bleeding
may suggest ruptured ectopic pregnancy
66
test of choice
ct
67
mesenteric ischemia
interruption of intestinal blood flow by embolism, thrombosis, or low flow state; leads to mediator release, inflammation, and ultimately infarction
68
abdominal pain out of proportion to PE
mesenteric ischemia
69
tx mesenteric ischemia
embolectomy, revascularization of viable segments or resection; sometimes vasodilators helpful; high mortality
70
acute perforation
any part of GI tract; can release gastric or intestinal contents into peritoneal space
71
symptoms are sudden w severe pain quickly followed by peritonitis and sings of shock
acute perforation
72
dx of acute perforation
imaging study showing free air in abdomen
73
tx acute perforation
fluid resuscitation, abx, surgical repair; mortality is high
74
abd pain, tenderness, and anorexia
appendicitis; acute inflammation of vermiform appendix
75
dx appendicitis
ct or us
76
tx appendicitis
surgical removal
77
hernias
protrusion of abd contents through acquired or congenital area of weakness or defect in abd wall
78
gradually inc pain, n/v, tender at site; guarding, rebound
incarcerated hernias that can't be reduced
79
tx incarcerated or strangulated hernia
urgent surgical repair
80
temporary arrest of intestinal peristalsis
ileus; mc after abd surgery; peritoneal inflammation, metabolic disturbances, drugs
81
n/v, vague abd discomfort, minimal peristalsis, nontender
ileus
82
dx ileus
xray; may need contrast ct to differentiate from obstruction
83
tx ileus
NGT and IVFs, NPO, replace electrolytes
84
what is someone dx w an ileum has it for >1wk
more likely to be mechanical obstruction and should undergo laparoscopy
85
intestinal obstruction
mechanical impairment or complete arrest of passage of intestinal contents
86
cramping pain, vomiting, obstipation and not passing flatus
intestinal obstruction
87
dx intestinal obstruction
abd xray
88
tx intestinal obstruction
ngt, ivfs, bowel rest
89
mc causes of intestinal obstruction
adhesions, hernias, tumors (sbo w/out prior abd surgery)
90
what causes volume depletion w intestinal obstruction
vomiting and 3rd spaced
91
intra abd abscess
suspect in pt w previous abd trauma or surgery or prev h/o of crowns ds, diverticulitis or pancreatitis
92
abd pain, fever, malaise
intra abd abscess
93
dx intra abd abscess
abd ct
94
tx intra abd abscess
percutaneous or surgical drainage and abx
95
ischemic colitis
transient reduction of blood flow to the colon; usually >60yo caused by small vessel atherosclerosis or can be complication of AAA repair
96
symp milder and slower than acute mesenteric ischemia; llq pain followed by rectal bleedign
ischemic colitis
97
dx ischemic colitis
ct or colonoscopy
98
tx ischemic colitis
supportive w ivfs, abx, bowel rest

Surgery (21 decks)

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