Acute Abdomen Lecture Powerpoint

Question 1

Different types of abdominal pain (3)

Answer 1

• visceral (dull, poor localization, cramping, burning, gnawing, often perceived around the dermatome corresponding to the nerve fiber origins, often 2ndary autonomic effects)
• somatic (sharp, intense, well localized, often retroperitoneal)
• referred (distant from organ of origin resulting from convergence of visceral afferent and somatic afferent fibers from different anatomic regions)

Question 2

Extra-abdominal causes of abdominal pain (5)

Answer 2

• MI
• herpes zoster
• women or diabetics unusual presentations of MI and others
• pneumothorax
• nerve root compression

Question 3

Acute onset abdomen pain within seconds to minutes is often due to ___, within hours is often due to ___

Answer 3

infarct or rupture, inflammation or obstruction

Question 4

Migration vs radiation

Answer 4

The pain begins in one area and functionally moves to another area alleviating in the origin vs the pain moves thru to another organ but maintains its pain at the site of origin

Question 5

Positioning in abdominal pain (5)

Answer 5

• lying perfectly still (peritonitis worsens with movement)
• leg flexed (relaxes iliopsoas)
• fetal position
• cannot get comfortable
• writhing in pain (ischemic bowel)

Question 6

Pathognomotic finding of ischemic bowel

Answer 6

pain out of proportion of physical exam - pressing on abdomen doesn’t worsen

Question 7

Appendicitis common features

Answer 7

Hour to days onset, periumbilical early and right lower quadrant late, dull ache, radiates to right lower quadrant

Question 8

Cholecystitis common features

Answer 8

Onset over minutes to hours, right upper quadrant pain that is sharp and radiates to scapula

Question 9

Pancreatitis common features

Answer 9

Onset minutes to hours, locatted in the epigastric back area and described as boring pain that radiates to midback

Question 10

Diverticulitis common features

Answer 10

Onset hours to days causing left lower quadrant aching with no radiation

Question 11

Perforated peptic ulcer common features

Answer 11

Onset within minutes located in the epigastrium causing sharp burning pain

Question 12

Small bowel obstruction common features

Answer 12

Onset hours to days causing periumbilical pain that is crampy and does not radiate

Question 13

Mesenteric ischemia/infarct common features

Answer 13

Onset minutes in the periumbilical area described as agonizing pain that does not radiate

Question 14

Ruptured abdominal aortic aneurysm common features

Answer 14

Onset in minutes in abdomen, back, flank, causing tearing pain that radiates to back and flank

Question 15

Gastroenteritis common features

Answer 15

Onset hours to days, causes periumbilical spasmodic pain

Question 16

PID common features

Answer 16

Onset hours to days with either lower quadrant or pelvis pain described as an ache perhaps radiating to upper thigh

Question 17

Ruptured ectopic pregnancy common features

Answer 17

Onset minutes causing either lower quadrant or pelvis pain, severe pain that doesn’t radiate