acute abdomen and referred pain

Question 1

what is an acute abdomen

Answer 1

acute abdominal pain so severe that the patient seeks medical attention (NOT the same as surgical abdomen)

Question 2

what are peritoneal signs

Answer 2

signs of peritoneal irritation; extreme tenderness, percussion tenderness, rebound tenderness, voluntary guarding, motion pain, INVOLUNTARY guarding/rigidity (late)

Question 3

rebound tenderness

Answer 3

pain upon releasing the palpating hand pushing on the abdomen

Question 4

motion pain

Answer 4

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

Question 5

voluntary guarding

Answer 5

abdominal muscle contraction with palpation of the abdomen

Question 6

involuntary guarding

Answer 6

rigid abdomen as the muscles guard involuntarily

Question 7

colic

Answer 7

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

Question 8

what conditions can mask abdominal pain

Answer 8

steroids, DM, paraplegia

Question 9

what is the most common cause of acute abdominal surgery in the US

Answer 9

acute appendicitis (7% of the population)

Question 10

what is the classic position of the patient with peritonitis

Answer 10

motionless, usually w/knees bent

Question 11

what is the classic position of a patient with a kidney stone

Answer 11

cannot stay still, restless, writhing in pain

Question 12

what is the best way to examine a scared child or histrionic adult’s abdomen

Answer 12

use stethoscope to palpate abdomen

Question 13

what lab tests are used to evaluate the patient with an acute abdomen

Answer 13

CBC with differential, chem-10, amylase, type and screen, urinalysis, LFTs

Question 14

what is a left shift on CBC differential

Answer 14

sign of inflammatory response, immature neutrophils (bands)

Question 15

which x-rays are used to evaluate the patient with an acute abdomen

Answer 15

upright CXR, upright AXR, supine AXR (if patient cannot stand), left lat decubitus abdominal film

Question 16

how is free air ruled out if the patient cannot stand

Answer 16

left lat decubitus - free air collects over the liver and does not get confused with the gastric bubble

Question 17

what diagnosis must be considered in every patient with an cute abdomen

Answer 17

APPENDICITIS

Question 18

what is the DDX of RUQ pain

Answer 18

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)

Question 19

what is the DDX of LUQ pain

Answer 19

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

Question 20

what is the DDX of LLQ pain

Answer 20

diverticulitis, sigmoid volvulus, perforated colon, colon CA, UTI