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test > Acute Abdomen & Referred Pain > Flashcards

Acute Abdomen & Referred Pain Flashcards

1
Q

What is an acute abdomen?

A

Acute abdominal pain so severe that the patient seeks medical attention

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2
Q

What are peritoneal signs?

A

Signs of peritoneal irritation (extreme tenderness, percussion tenderness, rebound tenderness, voluntary guarding, motion pain, involuntary guarding (late))

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3
Q

What is rebound tenderness?

A

Pain upon releasing the palpating hand pushing on the abdomen

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4
Q

What is motion pain?

A

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

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5
Q

What is voluntary guarding?

A

Abdominal muscle contraction with palpation of the abdomen

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6
Q

What is involuntary guarding?

A

Rigid abdomen as the muscles guard involuntarily

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7
Q

What is colic?

A

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

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8
Q

What conditions can mask abdominal pain?

A

Steroids, diabetes, paraplegia

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9
Q

What is the most common cause of acute abdominal surgery in the US?

A

Acute appendicitis

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10
Q

What should the acute abdomen physical exam include?

A

Inspection (surgical scars, distention).
Auscultation (bowel sounds, bruits).
Palpation (tenderness, R/O hernia, CVAT, rectal, pelvic exam, rebound, voluntary guard, motion tenderness).
Percussion (liver size, spleen size).

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11
Q

What is the best way to have a patient localize abdominal pain?

A

Point with one finger to where the pain is worse

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12
Q

What is the classic position of a patient with peritonitis?

A

Motionless (often with knees flexed)

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13
Q

What is the classic position of a patient with a kidney stone?

A

Cannot stay still, restless, writhing in pain

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14
Q

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

A

Use stethoscope to palpate abdomen

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15
Q

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

A

CBC with differential, Chem-10, amylase, T&S, U/A, LFTs

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16
Q

What is a left shift on CBC differential?

A

Immature neutrophils; sign of inflammatory response

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17
Q

What lab test should every woman of childbearing age with an acute abdomen receive?

A

B-HCG

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18
Q

Which XRs are used to evaluate the patient with an acute abdomen?

A

Upright CXR, upright AXR, supine AXR.

If patient cannot stand, left lateral decubitus AXR.

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19
Q

How is free air ruled out if the patient cannot stand?

A

Left lateral decubitus (free air collects over the liver and does not get confused with the gastric bubble)

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20
Q

What is the differential diagnosis for RUQ pain?

A

Cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumors, gastritis, hepatic abscess, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis, pleurisy, pneumonia, PE, pericarditis, MI

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21
Q

What is the differential diagnosis for LUQ pain?

A

PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurysm, pyelonephritis, nephrolithiasis, hiatal hernia, Boerhaave’s syndrome, Mallory-Weiss tear, splenic artery aneurysm, colon disease, pleurisy, pneumonia, PE, pericarditis, MI

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22
Q

What is the differential diagnosis for LLQ pain?

A

Diverticulitis, sigmoid volvulus, perforated colon, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic cause

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23
Q

What is the differential diagnosis for RLQ pain?

A

Appendicitis, mesenteric LAD, cecal diverticulitis, Meckel’s diverticulum, intussusception, sigmoid volvulus, perforated colon, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic cause

24
Q

What is the differential diagnosis for epigastric pain?

A

PUD, gastritis, MI, pancreatitis, biliary colic, gastric volvulus, Mallory-Weiss tear

25
Q

What is the differential diagnosis for gynecologic pain?

A

Ovarian cyst, ovarian torsion, PID, mittelschmerz, TOA, uterine fibroid, necrotic fibroid, pregnancy, ectopic pregnancy, endometriosis, cancer (cervix, uterus, ovary), endometrioma

26
Q

What is the differential diagnosis for thoracic causes of abdominal pain?

A

MI, pneumonia, dissecting aorta, aortic aneurysm, empyema, esophageal rupture or tear, PTX, esophageal foreign body

27
Q

What is the differential diagnosis for scrotal causes of lower abdominal pain?

A

Testicular torsion, epididymitis, orchitis, inguinal hernia, referred pain from nephrolithiasis or appendicitis

28
Q

What are nonsurgical causes of abdominal pain?

A

Gastroenteritis, DKA, sickle-cell crisis, rectus sheath hematoma, acute porphyria, PID, kidney stone, pyelonephritis, hepatitis, pancreatitis, pneumonia, MI, C. difficile colitis

29
Q

What is the unique differential diagnosis for the patient with AIDS and abdominal pain?

A

CMV, Kaposi’s sarcoma, lymphoma, TB, MAC

30
Q

What are the possible causes of suprapubic pain?

A

Cystitis, colonic pain, gynecologic causes, appendicitis

31
Q

What causes pain limited to specific dermatomes?

A

Zoster

32
Q

What is referred pain?

A

Pain felt at a site distant from a disease process.

Caused by the convergence of multiple pain afferents in the posterior horn of the spinal cord.

33
Q

What is gastroenteritis?

A

Viral or bacterial infection of the GI tract, usually with vomiting and diarrhea, pain (usually after vomiting)

34
Q

What is classically stated to be the great imitator?

A

Constipation

35
Q

What are the classic locations of referred pain with cholecystitis?

A

Right subscapular pain

36
Q

What are the classic locations of referred pain with appendicitis?

A

Early: periumbilical pain
Late: testicular pain

37
Q

What are the classic locations of referred pain with diaphragmatic irritation (from spleen, perforated ulcer or abscess)?

A

Shoulder pain

38
Q

What are the classic locations of referred pain with pancreatitis or pancreatic cancer?

A

Back pain

39
Q

What are the classic locations of referred pain with rectal disease?

A

Pain in the small of the back

40
Q

What are the classic locations of referred pain with nephrolithiasis?

A

Testicular or flank pain

41
Q

What are the classic locations of referred pain with small bowel disease?

A

Periumbilical pain

42
Q

What are the classic locations of referred pain with uterine disease?

A

Midline small of back pain

43
Q

What disease classically presents as hypotension and pulsatile abdominal mass?

A

Ruptured AAA

44
Q

What disease classically presents as fever, LLQ pain, and change in bowel habits?

A

Diverticulitis

45
Q

What is the test of choice for cholelithiasis?

A

U/S

46
Q

What is the test of choice for bile duct obstruction?

A

U/S

47
Q

What is the test of choice for mesenteric ischemia?

A

Mesenteric A-gram

48
Q

What is the test of choice for ruptured abdominal aortic aneurysm?

A

None - operate

49
Q

What is the test of choice for AAA?

A

Abdominal CT or U/S

50
Q

What is the test of choice for abdominal abscess?

A

Abdominal CT

51
Q

What is the test of choice for severe diverticulitis?

A

Abdominal CT

52
Q

What is the most common cause of RUQ pain?

A

Cholelithiasis

53
Q

What is the most common cause of surgical RLQ pain?

A

Acute appendicitis

54
Q

What is the most common cause of LLQ pain?

A

Diverticulitis

55
Q

What endocrine problems can cause abdominal pain?

A

Addisonian crisis, DKA

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