acute abdomen and referred pain Flashcards
what is an acute abdomen
acute abdominal pain so severe that the patient seeks medical attention (NOT the same as surgical abdomen)
what are peritoneal signs
signs of peritoneal irritation; extreme tenderness, percussion tenderness, rebound tenderness, voluntary guarding, motion pain, INVOLUNTARY guarding/rigidity (late)
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 (usuallys because of intermittent contraction of a hollow viscus against an obstruction)
what conditions can mask abdominal pain
steroids, DM, paraplegia
what is the most common cause of acute abdominal surgery in the US
acute appendicitis (7% of the population)
what is the classic position of the patient with peritonitis
motionless, usually w/knees bent
what is the classic position of a patient with a kidney stone
cannot stay still, restless, writhing in pain
what is the best way to examine a scared child or histrionic adult’s abdomen
use stethoscope to palpate abdomen
what lab tests are used to evaluate the patient with an acute abdomen
CBC with differential, chem-10, amylase, type and screen, urinalysis, LFTs
what is a left shift on CBC differential
sign of inflammatory response, immature neutrophils (bands)
which x-rays are used to evaluate the patient with an acute abdomen
upright CXR, upright AXR, supine AXR (if patient cannot stand), left lat decubitus abdominal film
how is free air ruled out if the patient cannot stand
left lat decubitus - free air collects over the liver and does not get confused with the gastric bubble
what diagnosis must be considered in every patient with an cute abdomen
APPENDICITIS
what is the DDX of RUQ pain
cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumors, gastritis, hepatic abscess, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis (esp. pregnant), thoracic causes (e.g. pneumonia, pleuricy), PE, pericarditis, MI (esp. inferior)
what is the DDX of LUQ pain
PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissection aortic aneurysm, thoracis causes, pyelonephritis, nephrolithiasis, hiatal hernia (strangulated paraesophageal hernia), Boerhaave’s syndrome, mallory-weiss tear, splenic artery aneurysm, colon disease
what is the DDX of LLQ pain
diverticulitis, sigmoid volvulus, perforated colon, colon CA, UTI
