Acute Abdomen and Reffered pain Flashcards
Abdominal pain so severe that the patient seeks medical attention.
Acute abdomen
No requiring surgery
What are the signs of peritoneal irritation?
extreme tenderness percussion tenderness rebound tenderness voluntary guarding motion pain involuntary guarding rigidity (late)
Intermittent severe pain
Colic
What conditions can mask abdominal pain?
steroids
diabetes
paraplegia
Classic position of a patient with peritonitis
motionless (knees flexed)
Classic position of a patient with kidney stone
Cannot stay still, restless, writhing in pain
What is “Left shift” on CBC differential?
Sign of inflammatory response:
Immature neutrophils (bands)
Many call >80% of WBCs as neutrophils a left shift
LLQ pain Differentials
Diverticulitis
sigmoid volvulus
perforated colon
colon CA
Differential Dx of EPIgastric pain
PUD gastritis MI pancreatitis biliary colic gastric volvulus Mallor-weiss tear
Nonsurgical causes of abdominal pain
Gastroenteritis DKA sickle cell crisis rectus sheath hematoma acute porphyria PID kidney stone
What is the unique differential dx for the patient with AIDS and abdominal pain
in addition to all common abdominal contidions: CMV (most common) Kaposi's sarcoma lymphoma TB MAI (M. avium Intracellulare)
Possible causes of SUPRAPUBIC pain
cystitis
colonic pain
gynecologic
appendicitis
pain limited to specific dermatomes
early Zoster before vesicular rupture
“great imitator”
Constipation
“abdominal pain out of proportion to exam
Rule out mesenteric ischemia
