ACUTE ABDOMEN Flashcards
Acute Abdomen
Denotes any sudden, spontaneous, nontraumatic, severe abdominal pain, typically of less than 24 hours duration
Visceral Pain
Vague and poorly localized to the epigastrium, periumbilical region, or hypogastrium
usually the result of distention of a hollow viscus
mediated primarily by AFFERENT C FIBERS located in the walls of hollow viscera and in the capsules of solid organs
Parietal Pain
Corresponds to the segmental nerve roots innervating the peritoneum
Sharper and better localized
mediated by:
C delta nerve
A delta nerve fibers
Referred Pain
Perceived at a site distant from the source of stimulus
Rebound Tenderness
Pain upon releasing the palpating hand pushing on the abdomen
Motion Pain
Abdominal pain upon moving, pelvic rocking, moving of stretcher, or heel strike
Voluntary Guarding
Abdominal muscle contraction with palpation of the abdomen
Involuntary Guarding
Rigid abdomen as the muscles “guard” involuntarily
Colic
Intermittent severe pain (usually because of intermittent contraction of a hollow viscus against an obstruction)
Classic position patient with peritonitis
Motionless
Classic position of a patient with a kidney
stone
Cannot stay still, restless, writhing in pain
RUQ pain differentials
Cholecystitis hepatitis PUD perforated ulcer pancreatitis liver tumors gastritis hepatic abscess choledocholithiasis cholangitis pyelonephritis nephrolithiasis appendicitis (especially during pregnancy) thoracic causes (e.g., pleurisy/pneumonia) PE pericarditis MI (especially inferior MI)
LLQ pain differentials
Diverticulitis sigmoid volvulus perforated colon colon cancer urinary tract infection small bowel obstruction inflammatory bowel disease nephrolithiasis pyelonephritis fluid accumulation from aneurysm or perforation referred hip pain gynecologic causes appendicitis (rare)
RLQ pain differentials
Appendicitis same as LLQ mesenteric lymphadenitis cecal diverticulitis Meckel’s diverticulum intussusception
DDx epigastric pain
PUD gastritis MI pancreatitis biliary coli gastric volvulus Mallory-Weiss
DDx of gynecologic pain
Ovarian cyst ovarian torsion PID mittelschmerz tubo-ovarian abscess (TOA) uterine fibroid necrotic fibroid pregnancy ectopic pregnancy endometriosis cancer of the cervix/ uterus/ovary endometrioma gynecologic tumor torsion of cyst or fallopian tube
DDx of thoracic causes of abdominal pain
MI (especially inferior) pneumonia dissecting aorta aortic aneurysm empyema esophageal rupture/tear PTX esophageal foreign body
DDx of scrotal causes of abdominal pain
Testicular torsion epididymitis orchitis inguinal hernia referred pain from nephrolithiasis or appendicitis
Nonsurgical causes of abdominal pain
Endocrine and Metabolic Causes
- uremia
- diabetic crisis
- Addisonian crisis
- acute intermittent porphyria
- hereditary Mediterranean fever
Hematologic Causes
- sickle cell crisis
- acute leukemia
- other blood dyscrasis
Toxins and Drugs
- lead poisoning
- other heavy metal poisoning
- narcotic withdrawal
- black widow spider poisoning
Causes pain limited to
specific dermatomes
Early zoster before vesicles erupt
Cholecystitis
Right subscapular pain (also epigastric)
Appendicitis
Early: periumbilical
Diaphragmatic irritation
from spleen, perforated ulcer, or abscess
Shoulder pain ( (+) Kehr’s sign on the left)
Pancreatitis/cancer
Back pain
Rectal disease
Pain in the small of the back
Nephrolithiasis
Testicular pain/flank pain
Rectal pain
Midline small of back pain
Small bowel
Periumbilical pain
Uterine pain
Midline small of back pain
