Acute Abdomen Flashcards
1
Q
Acute abdominal pain: definition
A
abdominal pain less than one week in duration
2
Q
“Acute abdomen”
A
in reference to severe abdominal pain du eto an intra-abdominal process
(often requiring surgery)
3
Q
Visceral pain: etiology
A
- Stretching of nerve fibers surround viscus
- Ischemia
- Inflammation
4
Q
Describe Visceral Pain
A
- Cramping
- Colicky (unable to find comfortable position)**
- Ill defined*
- Diffuse
- Vague
- Intermittent
5
Q
Intestinal obstruction, early appendicitis or renal colic are examples of what type of pain?
A
Visceral pain
6
Q
Parietal (aka somatic pain): pain description
A
- sharp
- precise
- constant
-Able to lie still and motionless
7
Q
Appendicitis (late) pain is what type of pain?
A
parietal (somatic)
8
Q
Give 3 examples of referred pain
A
- right scapular pain with biliary disease
- Ipsilateral testicle/labia pain with renal colic
- Left neck/jaw/shoulder/arm pain with myocardial ischemia
- Back - pancreatitis
9
Q
Name 3 causes of toxicologic extra-abdominal pain
A
- Strep pharyngitis
- Black widow spider
- Cocaine
10
Q
What is the difference between intra-abdominal and extra-abdominal pain?
A
Both cause abdominal pain but intra or extra refers to the source of the pain in the abdomen.
11
Q
Name a neurogenic extra-abdominal pain source?
A
herpes zoster
12
Q
Name a metabolic extra-abdominal pain source?
A
DKA
Adrenal crisis
13
Q
Guarding
A
voluntary contraction of musculature
14
Q
Rigidity
A
involuntary contraction of musculature
15
Q
What is the name for bruising around the umbilicus (retroperitoneal hemorrhage)?
A
Cullen’s Sign
16
Q
What is the name for bruising on a patient’s lower posterior flank (retroperitoneal hemorrhage)?
A
Grey Turner’s Sign
17
Q
Differential Diagnosis for RUQ pain
A
- Cholecystitis
- Biliary colic
- Hepatic Abscess
- Perforated duodenal ulcer
- Pancreatitis
- Retrocecal appendicitis
- Herpes Zoster
- MI
- RLL pneumonia
18
Q
Differential Diagnosis for LUQ pain
A
- gastritis
- pancreatitis
- splenic rupture/infarction
- MI
- LLL pneumonia
19
Q
Differential Diagnosis for RLQ pain
A
- Appendicitis (late)
- Meckel’s Diverticulum
- Leaking AAA
- Ruptured ectopic
- Ovary torsion
- PID
- Endometriosis
- Urinary calculi
- Psoas abscess
- Hernia
20
Q
Differential diagnosis for LLQ pain
A
- Sigmoid diverticulitis
- Leaking AAA
- Rutured ectopic
- Ovary torsion
- PID
- Endometriosis
- Urinary calculi
- Psoas abscess
- Hernia
21
Q
Differential diagnosis for diffuse abdominal pain
A
- peritonitis
- pancreatitis
- Sickle cell crisis
- Early appendicitis
- DKA
- Mesenteric thrombosis
- Gastroenteritis
- Aortic dissection
- Ruptured AAA
- Intestinal obstruction
22
Q
Appendicitis
A
- Periumbilical pain –>anorexia and N/V
2. Pain localized to the RLQ in about 24 hours
23
Q
Rovsing’s sign
A
pain in the RLQ when palpating the LLQ
24
Q
Iliopsas sign
A
pain when patient flexes right hip with straight leg against resistance
25
Obturator sign
Knee flexed 90 degrees and hip internally/externally rotated
26
An Alvarado Score of 7-8 would mean Appendicitis is ?
probable
27
An Alvarado score of 5-6 would mean appendicitis is?
possible
28
An alvarado score of >9?
very probable appendicitis
29
What is the treatment of choice for appendicitis?
appendectomy
30
Intermittent RUQ pain radiating to right shoulder with N/V associated with ingestion of fatty meal or large meal after fast. Fever/chills and increased temperature
Cholecystitis
31
What is the therapy of choice for diagnosing cholecystitis?
HIDA scan (hepatobiliary iminodiacetic acid)
32
Charcot's Triad
1. Fever
2. Jaundice
3. RUQ pain
33
Reynold's Pentad
Charcot's triad (Fever + Jaundice + RUQ pain) with shock and altered mental status/confusion.
34
What type of organism cause cholangitis?
gram negative
35
Cholangitis treatment
1. IV fluids
| 2. IV antibiotics
36
Mesenteric Ischemia: pain
-poorly localized
-intermittent pain out of proportion to examination findings***
-"intestinal angina" pain after large meal relieved with vomiting
+/- vomiting and diarrhea
37
What is the most common cause of mesenteric ischemia?
arterial embolism to the superior mesenteric artery
38
Mesenteric Ischemia: labs
- Increased WBC
- Increased amylase
- Increased phosphate
- metabolic acidosis (lactic acid)
39
Mesenteric ischemia: Treatment
1. Heparin
| 2. Antibiotics
40
What is the best way to diagnose mesenteric ischemia?
arteriography
41
Where is the most common location for ectopic pregnancy?
isthmus of fallopian tube
42
What is the triad for ectopic pregnancy?
1. Pain
2. Vaginal bleeding
3. Amenorrhea
43
Gastric ulcers account for _____ of peptic ulcers
1/3 gastric
2/3 duodenal
44
Describe the timing, location and character of gastric ulcer pain
Timing: less than 2 hours after meal
Location: localized to epigastrum
Character: gnawing, buring, or aching
45
Gastric ulcer: treatment
1. Fluid
| 2. H2 blockade or PPI
46
What is the most common reason for small bowel obstruction?
- adhesions from previous surgery
| - incarcerated hernia
47
Most common cause of large bowel obstruction?
malignancy (or vovulus)
48
Small bowel obstruction: treatment
1. CMP, CBC, Abdomen imaging (multi-view)
2. Antiemetics, pain medication
3. NG tube decompression
4. IV fluid resuscitation
49
Abdominal Aortic Aneurysm
- Abdominal, back, flank or groin pain (not affected by movement)
- Hypotension
+/- pulsatile abdominal mass, bruit
50
When is there significant chance that an abdominal aortic aneurysm will spontaneously rupture?
>5cm
51
If an AAA is smaller than 5cm how often should it be followed by US?
every 6 months
52
When is AAA rupture suspected?
-Syncope + Over 60 yrs + Abdominal or back pain
53
What is Bell clapper deformity?
High attachment of teste to tunica vaginalis
54
Which side is typically affected in testicular torsion?
Left
55
What reflex will be abest in testicular torsion?
cremateric reflex
56
Testicular torsion: treatment
manually 180 degrees at a time medial to lateral
57
Testicular torsion whould be fixed within what time period?
6 hours
58
Epididymitis: Phren's Sign
Relief of pain with scrotal elevation
59
What is the most common organism to give men under 35 epidiymitis?
Chlamydia
60
What is the most common pathogen to give men over 35 epididymitis?
E. coli
61
Treatment for man <35 with chlamydia causing epidiymitis?
Rocephin and doxycycline
62
Treatment for man >35 with E. coli causing epididymitis?
Fluroquinolone
63
Distinguish the pain in testicular torsion and epidiymitis
Testicular torsion
- Suddent onset
- After sleep or exercise*
- Vomiting**
- Unilateral
- Not positional
- Decreased blood flow (Doppler)
Epididymitis
- Gradual onset
- Fever*
- Bilateral
- Worse standing
- Testicular swelling*
- Increased blood flow (Doppler)
64
What is the most common cause of acute scrotal pain to superior testicle pole in 3-13 years old.
Pathognomonic "blue dot sign"
Torsion of testicular appendix
65
List the 4 types of urogenital tract stones from most common to least common
1. Calcium
2. Struvite (Ammoninum magnesium phosphate)
3. Uric Acid
4. Cystine
66
Most urinary stones will pass on their own if they are what size?
<5mm
67
Urolithiasis: treatment
Toradol**
Morphine
Antiemetics
IV fluids
68
What are the 3 most common reasons for Pancreatitis in the US?
1. Alcohol abuse
2. Cholelithiasis
3. Hypertriglyceridemia
69
Pancreatitis: pain description
- Severe and constant
- epigastric
- Radiates to back
- Worse with lying down
- Better with sitting up and leaning forward
70
What two labs will be elevated in pancreatitis?
1. Amylase
| 2. Lipase
71
Abdominal Xray findings of Pancreatitis?
- localized ileus
- gallstones
- widening duodenal sweep
72
Pancreatitis: Goal of medical therapy
"place the bowel at rest"
- Nothing by mouth
- IV fluids
- Demerol
- Antiemetics
73
What is Ranson's criteria used for?
determining severity of acute pancreatitis
74
Diverticulitis: Pain and lab
- Abrupt pain in LLQ
- Fever
- Leukocytosis with left shift
75
What is the best imaging for diverticultitis?
CT with contrast
76
What is the treatment for diverticulitis?
- Levaquin
- Flagyl (metronidazole)
- Zosyn (tazobactam-pipercillin)
77
DKA definition
1. Blood glucose >250mg/dl
2. Arterial pH <7.3
3. Serum bicarb <15
4. Ketones in the urine
78
What are the most common precipitating factors for DKA
1. Forgetting to take insulin
2. Infection (ex. PNA, UTI)
3. MI
4. Alcohol or drug use
5. Pregnancy
79
5 F's risk factors for gallbladder disease
```
Fat
Forty
Female
Flatulent
Fertile
```
80
What US findings suggest cholecystitis
- Thickened gallbladder wall >3mm
| - Stones
81
What diagnosis shoud be considered in a patient with pain out of proportion to examination?
- Mesenteric ischemia
- Necrotizing fasciitis
- Compartment syndrome
