Acute Abdominal Lecture Flashcards
Prevalence of abdominal pain
Diverse geographic regions and age groups
What drives the evaluation of acute abdominal pain?
LOCATION of pain
What are the steps triaging a patient with acute abdominal pain?
Step 1: Is the patient clinically ill? Check ABCs, resuscitate if needed
Step 2: May need transfer to acute care facility if suspected surgical abdomen or if requiring resuscitation or IV analgesia
Step 3: Less acute illness: detailed history and initial assessment
What are mechanical stimuli
Stretch, distention, contraction, traction, compression, torsion
What are chemical stimuli
Due to inflammation or ischemia
Can the stimuli be occuring at the same time?
YES!
Dull, aching that can be colicky, poorly localized; arises from distention of hollow organ
e.g. bowel obstruction
Visceral pain
sharp, very well localized; arises from peritoneal irritation
e.g. appendictis
Parietal pain
aching, perceived to be near surface of body
e.g. cholecysitis referred to right scapula
Referred pain
Cardiac causes of acute abdominal pain
- MI
- Myocarditis
- Endocarditis
- HF
Thoracic casues of acute AP
- Pnuemonia
- PE
- Pnuemothorax
- Empyema
- Esophagitis
- Esophageal spasm
- Esophageal rupture
Neurologic causes of acute AP
- Tabes dorsalis
- Radiculitis
- Abdominal epilepsy
Metabolic causes of acute AP
- uremia
- DM
- porphyria
- acute adrenal insufficiency
- hyperlipidemia
- hyperparathyroidism
Hematologic causes of acute AP
- Sickle cell
- Hemolytic anemia
- acute leukemia
- Henoch-Schonlein purpura
What is important about pain history?
LOCATION, LOCATION, LOCATION!
