Acute Abdomen Flashcards
How long does and pain have to last to be considered acute?
less than 1 week
What is visceral pain caused by?
from stretching of anatomic nerve fibers surrounding viscus
-can also result from ischemia and inflammation
What organs are associated w/ visceral pain? Describe visceral pain
intra-peritoneal
- cramping, colicky
- ill-defined, diffuse, vague
- intermittent
- unable to find a comfortable position
How is parietal pain described? What is another name for it? Ex?
- sharp
- precisely located
- constant
- lie still and motionless
Somatic pain
late appendicitis
what is referred pain?
Pain felt at a location distant from the diseased organ
what is guarding vs rigidity??
guarding= voluntary contraction of musculature
rigidity= involuntary contraction
Bruising around the umbilicus is called what?
Cullen’s sign
bruising of the flank area is called what?
Grey Turner’s sign
DDX for and pain in the RUQ
Cholecystitis biliary colic hepatic abscess perforated duodendal ulcer pancreatitis retrocecal appendicitis herpes zoster MI RLL pna
DDX for and pain in the LUQ
gastritis pancreatitis splenic rupture splenic infarction MI LLL pna
DDX for and pain in the RLQ
appendicitis (late) Meckler's diverticulum leaking AAA ruptured ectopic ovary torsion PID endometriosis urinary calculi psoas abscess hernia
DDX for and pain in the LLQ
sigmoid diverticulitis leaking AAA ruptured ectopic ovarian torsion PID endometriosis urinary calculi psoas abscess hernia
DDX for diffuse abdominal pain
peritonitis pancreatitis sickle cell crisis early appendicitis DKA mesenteric thrombosis gastroenteritis aortic dissection ruptured AAA intestinal obstruction
Describe sx of Appendicitis? Only what pt would complain of
periumbilical pain
Anorexia and N/V
Pain localizes to RLQ over 24 hrs
Explain Rovsing’s sign, Iliopsoas sign, and Obturator sign
Rovsing’s= pain in RLQ when palpating LLQ
Illiopsoas= elicited by having supine pt keep R knee extended and flex R hip while examiner resists
Obturator sign= elicited by having supine pt flex R knee to 90 degrees, examiner int/externally rotates hip
What is Alvarado score?
for appendicitis
7-8= probable >9 = very probable
How do you treat appendicitis?
fluid resuscitation
Abx- Ceph
TOC= Appendectomy
How does cholecystitis present?
Intermittent RUQ pain radiating to R shoulder w/ N/V associated w/ ingestion of fatty meal or large meal after fats
fever/chills
What diagnostic tools can be used to see if a pt have cholecystitis?
US- stones, thickened CB wall, distended GB, sonographic Murphy’s sign
HIDA scan- TOC FOR DX CHOLECYSTITIS
What is Charcot’s triad
Reynold’s Pentad? Significance?
fever
jaundice
RUQ pain
(seen in 25% cholangitis)
Reynolds= +confusion and shock
-100% mortality if not tx properly
How does Mesenteric ischemia present?
poorly localized, intermittent pain out of proportion to exam findings
MCC of Mesenteric ischemia? Risk factors?
MCC= arterial embolism to SMA
Risk factors= over 60, AFib, ASVD, decreased ejection fraction, hyper coagulable states, hypotension
What lab values will you see in mesenteric ischemia?
How do you treat?
Increased WBC, amylase, phosphate, and metabolic acidosis
TOC= arteriography, heparin, abx
Triad for ectopic pregnancy?
pain, vaginal bleeding, and amenorrhea
Risk factors for ectopic pregnancy
- PID
- prior ectopic
- women w/ IUD
- in vitro fertilization
- prior tubal surgery
- smoking
- age
Tx for ectopic
fluid resuscitation
(+/- blood products)
preoperative labs
OB/GYN for OR
What are perforated gastric ulcers and how do they MCly occur?
Mucosal breaks of 3 mm or larger
helicobacter pylori infection
Risk factors for perforated gastric ulcer?
steroids or aspirin smoking alcohol or coffee stress delayed gastric emptying duedenogastric bile reflux
Sx of perforated gastric ulcer
Pain occurs <2 hrs after meals
- localized to epigastrium
- gnawing, burning, or aching in nature
anorexia, weight loss, belching, bloating, nausea, heartburn
Tx for perforated gastric ulcer
fluid resuscitation
H2 blocker or PPI
Surgery consult
MCC of SBO?
adhesions from previous surgery, incarcerated hernia
Sx of SBO
- abdominal distention
- constipation
- bowel sounds high pitched at first then go silent
- vomiting
Signs and sx of AAA
- abdominal, back, flank, or groin pain
- usually not affected by movement
- +/- pulsatile abd mass
- hypotension
(may be asymptomatic)
if AAA is > 5 cm then?
Smaller ones?
> 5 cm= significant risk of spontaneous rupture
smaller ones are followed by US every 6 months
What deformity is common in testicular torsion?
What side is more commonly affected?
inappropriately high attachment to tunica vaginalis
L side
What sign when absent, has 99% association w/ testicular torsion?
absent cremasteric reflex
What is tx for testicular torsion?
manually detours 180 degrees at time from medial to lateral
What is Phren’s sign and what dx is it a/w?
Phren’s= relief of pain w/ scrotal elevation
a/w Epididymitis
Testicular torsion: avg age? pain quality? onset? time to presentation? assoc. sx?
neonate, 12-15 yo
sudden onset, unilateral, no positional change
onset after sleep or exercise
present < 6 hrs
vomiting (rare= fever, discharge)
Epididymitis: avg age? pain quality? onset? time to presentation? assoc. sx?
25 yo
gradual onset, b/l, worse w/ standing
rarely after sleep
present > 24 hrs
A/s= fever, testicular swelling (rare= vomiting, discharge)
How will UA for testicular torsion differentiate from epididymitis?
Torsion=
30% have WBC and bacteria
rare voiding complaints
Epididymitis= 50% normal, frequent voiding
MCC of acute scrotal pain in 3-13 yo?
Torsion of testicular appendix
sx of Torsion of testicular appendix? what sign is pathognomonic?
pain to superior testicular pole
N/v rare
Blue dot sign= pathognomonic
What is the basic pathophys of urolithiasis?
involves supersaturation of urine w/ salt, lack of urinary inhibitors of crystalization
MC type of Urolithiasis?
Calcium 70-80%
2nd = Struvite 10%
how are the majority of urinary stones < 5 mm treated?
90-95% pass spontaneously
Management of urolithiasis?
toradol
morphine
antiemetics
IV fluids
MMC of pancreatitis?
alcoholism, cholelithiasis, and hypertriglyceridemia
Sx of pancreatitis?
pain is usually severe, constant
- located in epigastrium and radiates to back
- worse w. lying down, better sitting up and leaning forward
fever, tachy, N/V
What do labs and abd X-ray show in pancreatitis?
elevated amylase, lipase
xray= localized ileum, gallstones, widening of duodenal sweep
Pain and sx a/w diverticulitis
abrupt onset (usually LLQ)
fever
Leukocytosis w/ L shift
Dx and tx of diverticulitis?
CT A/P w/ IV/PO contrast
tx= Levaquin and Flagyl, zosyn
In DKA, blood glucose is?
what about in hyperosmolar hyperglycemic state?
which one has presence of ketones?
DKA= > 250 mg/dl
hyper= > 600 mg/dl
DKA has ketones
Signs and sx of DKA?
- polyuria, polydipsia
- weight loss, N/V, dry mucus membranes
- dizziness, weakness
- Kussmaul breathing
- fruity odor on breath
Tx of DKA?
IV fluids
Insulin
Potassium replacement
bicarbonate
check glucose and electrolytes every 1-2 hrs
