Acute Abdomen Lecture Flashcards
Visceral pain
- vague and poorly localized (epigastrium, periumbilical, hypogastrium)
- usually result of distension of hollow viscous
Parietal pain
- corresponds to segmental nerve roots innervating peritoneum
- tends to be sharper and better localized
Pathophysiology of appendicitis pain
- Early on > lumen obstructed > bacterial overgrowth > secretion of mucus leads intraluminal distension (distension of hollow viscous) > visceral pain (i.e. dull, periumbilical pain)
- Later > lumen distends until lymph and venous flow impaired > impaired arterial inflow with subsequent mucosal ischemia > inflammation > adjacent peritoneum becomes inflamed > parietal pain (i.e. sharp, RLQ pain with rebound tenderness @ McBurney’s)
Sudden onset, excruciating pain
Rapid flooding of peritoneal cavity w/ blood, pus, etc. or embolization w/ resultant ischemia (ruptured aneurysm, bleeding diverticulum, perforated ulcer, volvulus)
Pain that begins/develops and worsens over several hours
Progressive inflammation (any “-itis”)
Crampy, intermittent, or “colicky” pain
Cholelithiasis (gallstones), nephroliths, SBO d/t adhesions
what is abdominal percussion best for?
Testing for rebound pain in cases of peritonitis
what part of the PE provides more information than any other component of the abdominal exam?
Palpation
Murphy’s sign
Pain caused by inspiration while applying pressure to RUQ indicates cholecystitis
Rovsing’s sign
Pain @ McBurney’s point when compressing LLQ indicates appendicitis
Lab studies for abdominal pain
- CBC (doesn’t really say anything)
- electrolytes with creatinine (assess volume depletion and electrolyte disturbances from vomiting/diarrhea/3rd space losses)
- amylase and lipase (pancreatitis)
- LFTs (biliary tree)
- Lactate and ABG (ischemia and degree of sepsis)
- urinalysis (cystitis, pyelonephritis, ureterolith)
- pregnancy testing
- stool (blood and pathogens)
Imaging for abdominal pain
- XR (air - bowel obstruction, perforated ulcer)
- US (biliary tree - gallstones, gallbladder wall thickness, sometimes appendix
- CT (confirm most difficult diagnostic dilemmas, NOT for biliary disease, useful for “itis”)
CCK-HIDA (hepatobiliary iminodiacetic acid)
- Rapidly taken up by liver
- Excreted into intrahepatic then extrahepatic bile ducts > sphincter of Oddi > fills gallbladder in retrograde fashion > slowly drips into duodenum
- CCK can be administered to cause GB contraction and measure EF
