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Surgery > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

Visceral pain

A

Poorly localized, dull, achy

From distention or spasm in hollow organs (crampy pain during intestinal obstruction)

Mid-epi = stomach, duodenum, hepatobiliary, pancreas

Mid-abd = jejunum, ileum

Lower abd = colon, internal repro organs

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2
Q

Parietal pain

A

Sharp, well-localized, somatic pain from irritation (usually by pus, bile, urine, GI secretions) of parietal peritoneum.

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3
Q

Examples of gradual, steady pain

A

Acute cholecystitis
Acute cholangitis
Hepatic abscess
Diverticulitis

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4
Q

Examples of abrupt, excruciating pain

A

Perforated ulcer
Ruptured aneurysm
Ureteral colic

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5
Q

Examples of intermittent, colicky pain

A

SBO
IBD
Biliary colic

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6
Q

Examples of rapid-onset severe constant pain

A 
Acute pancreatitis
Ectopic pregnancy
Mesenteric ischemia
Stangulated bowel
Acute appendicitis
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7
Q

Kehr’s Sign

A

Pain referred to L shoulder due to irritation of left hemidiaphragm - seen with splenic rupture

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8
Q

Radiation to right shoulder/right scapula

A

Biliary tract pain

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9
Q

Radiation pattern of kidney pain

A

loin to groin

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10
Q

Pancreatic pain radiation

A

back

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11
Q

Most common cause of free air under diaphragm?

A

Perforated peptic ulcer (90%)

Could also be hollow viscus injury secondary to trauma, mesenteric ischemia (L hemidiaphragm) and large bowel perforation

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12
Q

Signs of perforated viscus

A

Scaphoid, tense abdomen
reduced BS (late)
Loss of liver dullness
Guarding or rigidity

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13
Q

Signs of peritonitis

A

Motionless
No BS (late)
Cough and rebound tenderness
Guarding or rigidity

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14
Q

Signs of inflamed mass or abscess

A

Tender mass (ab, rectal, pelvic)
Punch tenderness
Murphy’s, Psoas, Obturator signs

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15
Q

Signs of intestinal obstruction

A 
Distention 
Visible peristalsis (late)
Hyperperistalsis (early) or quiet abdomen (late)
Diffuse pain without rebound tenderness
Hernia or rectal mass (some)
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16
Q

Signs of paralytic ileus

A

Distention
Minimal BS
No localized tenderness

17
Q

Signs of ischemic or strangulated bowel

A 
Not distended (until late)
BS variable
Severe pain but little tenderness
Rectal bleeding (some)
18
Q

Signs of bleeding

A 
Pallor
Shock
Distention
Pulsatile (aneurysm) or tender (ectopic) mass
Rectal bleeding (some)
19
Q

Diagnosis for acute abdomen

A

CBC
lytes
Amylase, Lipase
ECG (rule out MI and as preop baseline cardio assessment)
LFTs for RUQ pain
b-hCG for all women of age
CXR and KUB (look for free air - easier to see in right side since stomach blocks the left)
CT-abd after the above is complete and dx still unclear (young male with clinical signs and symptoms of appendicitis won’t need CT)

Get contrast oral and IV when possible unless allergy or poor renal function. Non contrast will still give info

20
Q

Splenic rupture patient giveaway

A

Elevated WBC in setting of trauma

21
Q

Most common surgical emergency in pregnant woman?

A

Still appendicitis

22
Q

Review: Signs that point to obstruction as source of abdominal pain

A

Vague/general

Colicky pain
Writhing around patient that finds no comfort

No fever

No leukocytosis

Can be gallstones, kidney stones, early SBO

23
Q

Review: Signs that point to inflammation as source of abdominal pain

A

Still visceral pain

Constant pain

Writhing patient with no comfort

(+) fever
(+) WBC

Cholecystitis, cholangitis, diverticulitis, appendicitis

24
Q

Review: Signs that point to perforation as source of abdominal pain

A

Still visceral

Sudden onset, constant pain

Frozen patient - hurts to move

Floridly peritoneal - fever, leukocytosis, guarding, rebound

XR shows free air under diaphragm

PUD
Cancer
Penetrating trauma

25
Q

Review: Signs that point to ischemia as source of abdominal pain

A

Still visceral

Constant pain

Pain out of proportion to physical exam (no peritoneal signs)

PVD
CAD
CVA
AFib
Bloody BM

Can be Mesenteric ischemia or ischemic colitis

26
Q

Review: Signs that point to distention as source of abdominal pain

A

Visceral

Referred pain. Diffuse, extremely vague

Can be constipation, bloating, Gyn

27
Q

RUQ causes of abdominal pain

A 
Lungs
Diaphragm
Liver
Duodenum
Gallbladder

U/S best in upper quadrants

Surgical:
Perforated duodenal ulcer
Acute cholecystitis 
Hepatic abscess
Retrocecal appendix
Appendicitis in pregnant woman
28
Q

RLQ causes of abdominal pain

A

Kidneys/ureters
Colon-appendix
Gyn/testes

CT best in lower quadrants

Surgical:
Appendicitis
Cecal diverticulitis
Meckel’s diverticulitis intussusception

29
Q

LLQ causes of abdominal pain

A

kidneys/ureters
Colon - diverticula
Gyn/testes

Surgical:
Sigmoid diverticulitis
Volvulus

30
Q

LUQ causes of abdominal pain

A

Lungs
Diaphragm
Spleen

Surgical:
Splenic rupture
splenic abscess

31
Q

Causes of diffuse abdominal pain

A

Bowel obstruction
Leaking aneurysm
Mesenteric ischemia

32
Q

Causes of periumbilical abdominal pain

A

Early appendicits

Pain from SBO

33
Q

Fitz-Hugh-Curtis

A

Perihepatitis associated with chlamydial infection of cervix

34
Q

Suprapubic pain

A 
Ectopic
Ovarian torsion
TOA
Psoas abscess
Incarcerated groin hernia
35
Q

Important nonsurgical causes of abdominal pain

A 
MI
Mittelschmerz
Poisoning (Pb, black widow)
Zoster
RLL pneumonia
Endocrine (Addisonian crisis, DKA)
Sickle cell crisis
Porphyrias
Psychological

Surgery (27 decks)

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