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SURGERY > ACUTE ABDOMEN > Flashcards

ACUTE ABDOMEN Flashcards

1
Q

Acute Abdomen

A

Denotes any sudden, spontaneous, nontraumatic, severe abdominal pain, typically of less than 24 hours duration

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2
Q

Visceral Pain

A

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

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3
Q

Parietal Pain

A

Corresponds to the segmental nerve roots innervating the peritoneum

Sharper and better localized

mediated by:
C delta nerve
A delta nerve fibers

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4
Q

Referred Pain

A

Perceived at a site distant from the source of stimulus

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5
Q

Rebound Tenderness

A

Pain upon releasing the palpating hand pushing on the abdomen

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6
Q

Motion Pain

A

Abdominal pain upon moving, pelvic rocking, moving of stretcher, or heel strike

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7
Q

Voluntary Guarding

A

Abdominal muscle contraction with palpation of the abdomen

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8
Q

Involuntary Guarding

A

Rigid abdomen as the muscles “guard” involuntarily

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9
Q

Colic

A

Intermittent severe pain (usually because of intermittent contraction of a hollow viscus against an obstruction)

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10
Q

Classic position patient with peritonitis

A

Motionless

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11
Q

Classic position of a patient with a kidney

stone

A

Cannot stay still, restless, writhing in pain

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12
Q

RUQ pain differentials

A 
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)
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13
Q

LLQ pain differentials

A 
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)
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14
Q

RLQ pain differentials

A 
Appendicitis
same as LLQ
mesenteric lymphadenitis
cecal diverticulitis
Meckel’s diverticulum
intussusception
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15
Q

DDx epigastric pain

A 
PUD
gastritis
MI
pancreatitis
biliary coli
gastric volvulus
Mallory-Weiss
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16
Q

DDx of gynecologic pain

A 
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
17
Q

DDx of thoracic causes of abdominal pain

A 
MI (especially inferior)
pneumonia
dissecting aorta
aortic aneurysm
empyema
esophageal rupture/tear
PTX
esophageal foreign body
18
Q

DDx of scrotal causes of abdominal pain

A 
Testicular torsion
epididymitis
orchitis
inguinal hernia
referred pain from nephrolithiasis or appendicitis
19
Q

Nonsurgical causes of abdominal pain

A

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
20
Q

Causes pain limited to

specific dermatomes

A

Early zoster before vesicles erupt

21
Q

Cholecystitis

A

Right subscapular pain (also epigastric)

22
Q

Appendicitis

A

Early: periumbilical

23
Q

Diaphragmatic irritation

from spleen, perforated ulcer, or abscess

A

Shoulder pain ( (+) Kehr’s sign on the left)

24
Q

Pancreatitis/cancer

A

Back pain

25
Q

Rectal disease

A

Pain in the small of the back

26
Q

Nephrolithiasis

A

Testicular pain/flank pain

27
Q

Rectal pain

A

Midline small of back pain

28
Q

Small bowel

A

Periumbilical pain

29
Q

Uterine pain

A

Midline small of back pain

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