Acute Abdominal Pain

Question 1

Differential for Shockey Abdo

Answer 1

Sepsis

Aortic Aneurysm

Question 2

Shockey Abdo pain

Answer 2

Abdominal Aneursym

Acute appendicitis

Question 3

Physical exam

Answer 3

McBurney’s point - 1/3 between ASIS and pubis symphysis
Psoas sign - passively extend the hip - inflamed appendix
Obturator sign - internal rotation - inflamed appendix
Rovsing sign - pain provoking structure

Question 4

Tests to order

Answer 4

B-HCG
CBC, lytes, urea, creatinine
type, screen, crossmatch
Imaging:
- U/S FAST - looking for free fluid in the abdomen
- CT scan - looking for alternate diagnosis, perforated viscous and AAA
- CXR - free air, gastric air

Question 5

Appendicitis

Answer 5

periumbilical pain localizes to the RLQ
associated with anorexia, nausea, vomiting, fever
caution with:
- elderly, kids < 5 years, pregnant (displaced laterally), immunosuppressed (less inflammatory response), late presentation (perforated, and walled off), atypical

Question 6

Ectopic pregnancy

Answer 6

Presentation - syncope and low BP
abd, missed menses, PV bleeding
risk factors - previous ectopic, fertility,
tests - doubling BHCG

Question 7

Perforated viscous

Answer 7

ulcers, small bowel, colon and rectum

Question 8

Ruptured AAA

Answer 8

Triad of abdominal pain, hypotension, pulsatile mass

Presentation - presyncope/syncope, or assymptomatic, associated back pain

Question 9

Mesenteric ischemia

Answer 9

acute onset of generalized abdominal pain +/- N, V, diarrhoea
pain is out of proportion
arrhythmia, atherosclerotic risk factors, cardiogenic shock

Question 10

Peritoneal signs

Answer 10

Fever
Abdominal pain
Tenderness to palpation
Preferential flexion of hips/knees