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GI Topics > Acute Abdominal Pain > Flashcards

Acute Abdominal Pain Flashcards

1
Q
  • vague, dull

- localized to midline

A

Visceral (Soft organ) Pain

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2
Q
  • Stimulation of parietal peritoneum
  • More intense and localized
  • Worsened by movement/coughing
A

Somatoparietal Pain

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3
Q
  • In area remote from diseased organ
  • Visceral afferents and somatic afferents converge at the same level of the spinal cord

Typical sites:

  • Gallbladder (RUQ to shoulder)
  • Esophagus (shoulder)
  • Pancreas: straight back
  • RUQ: liver, gallbladder, stomach, esophagus; lungs and heart
  • LUQ: stomach, spleen
A

Referred Pain

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4
Q
  • Waxing and waning pain

- Commonly due to Biliary Colic

A

Colicky Pain

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5
Q
  • Waxing and waning RUQ pain
  • due to the gallbladder contracting against a stone lodged in the cystic duct
  • Typically precipitated by a fatty meal, can recur
  • symptoms relieved if the stone passes
A

Biliary Colic

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6
Q
  • Classic heartburn
  • Precipitating Factors: Fatty or greasy foods, caffeine, chocolate, alcohol, tobacco
  • Diagnosis: Clinical, endoscopy, upper GI series
  • Treatment: PPI
A

GERD

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7
Q
  • Episodic cramping pain
  • Precipitated by: Hot or cold liquids, GERD
  • Diagnosis: Clinical, manometry
  • Treatment: PPI, nitrates, calcium channel blockers
A

Diffuse Esophageal Spasm

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8
Q
  • Dull gnawing pain in upper abdomen
  • May change with food intake
  • Perforation: sudden, sharp, severe
  • Causes: H pylori, NSAIDS, Zollinger Ellison
  • Diagnosis: Clinical, endoscopy, upper GI series
  • Treatment: PPI, antibiotic for H pylori, endoscopy/surgery if complications
A

Peptic Ulcer Disease

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9
Q
  • RUQ pain – capsule distension
  • Associated jaundice, fever
  • Causes: Viral, drugs, ischemia
  • Diagnosis: Laboratory
  • Treatment: Supportive care, rarely transplant
A

Hepatitis

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10
Q
  • Constant and severe RUQ pain, radiation to shoulder
  • Associated fever, nausea, vomiting
  • Obstruction of cystic duct by gallstone
  • Diagnosis: Murphy’s sign, Ultrasound, CT scan
  • Treatment: Cholecystectomy or cholecystotomy
A

Acute Cholecystitis

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11
Q
  • Charcots Triad: Fever, RUQ pain, jaundice
  • Reynolds Pentad: sepsis, mental status change
  • Obstruction of common bile duct: Stone, cancer, stricture
  • Diagnosis: Clinical, ultrasound, CT, endoscopy (ERCP)
  • Treatment: ERCP with stone removal/stent, surgery
A

Ascending Cholangitis

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12
Q
  • Constant epigastric pain radiating to back
  • Causes: Alcohol and gallstones
  • Diagnosis: Clinical, amylase, lipase, CT scan
A

Acute Pancreatitis

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13
Q
  • Obstruction: complete or partial
  • Spasm
  • Inflammation: infection, Crohn’s disease
A

Small Intestine

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14
Q
  • Constant LLQ pain
  • Associated fever
  • Obstruction, microperforation of diverticuli
  • Diagnosis: Clinical, CT scan
  • Treatment: Antibiotics, drainage or surgery for abscess
A

Diverticulitis

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15
Q
  • Diffuse or segmental abdominal pain
  • Associated diarrhea +/- blood
  • Causes: Ulcerative Colitis; Ischemic; Infectious
  • Diagnosis: Endoscopy, CT scan
  • Treatment: Dependant on cause
A

Colitis

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16
Q
  • Altered mental status
  • Unstable vitals: Tachycardia, Hypotension
  • Peritoneal signs: acute abdominal pain, abdominal tenderness, and abdominal guarding, which are exacerbated by moving the peritoneum, e.g., coughing, flexing one’s hips, or eliciting the Blumberg sign (a.k.a. rebound tenderness)
A

Indications for Surgical Consult

17
Q
  • Classically pain beginning in umbilical area (midline) then localizing to RLQ
  • McBurney’s point: 2/3 way down btw umbilicus and iliac crest
  • Hamburger sign: these Pts usually not hungry at all
  • May have associated nausea, vomiting, fever
  • Psoas sign: lift leg straight up against resistance
A

Appendicitis

18
Q
  • Sudden crampy periumbilical pain
  • Associated distension, nausea, vomiting(bilious/feculent)
  • Causes: adhesions, incarcerated hernia, Crohn’s, malignant
  • Exam: decreased bowel sounds, tympanic
  • Diagnosis: Abdominal x ray, CT scan
  • Treatment: Decompression, surgery
A

Small Bowel Obstruction

19
Q
  • Similar symptoms as SBO, less vomiting
  • Causes: Cancer; Volvulus – sigmoid most common
  • Diagnosis: Abdominal x-ray, CT
    Treatment: Surgery, colonoscopy
A

Colonic Obstruction

20
Q
  • Diffuse abdominal pain out of proportion to exam
  • Causes: Thromboembolism: arterial/venous; Arteriosclerosis; Hypotension, low flow states
  • High pitched bowel sounds
  • Diagnosis: Abdominal x-ray, CT scan , angiography
  • Treatment: Mostly supportive; Intervention if massive – surgery, interventional radiology
A

Ischemia to Small Bowel or Colon

21
Q
  • Evaluation difficult due to altered anatomy from enlarge uterus – atypical symptoms
  • Most important factor to health of fetus is a healthy mother

Diagnosis:

  • Avoid CT scans and unnecessary x –rays
  • Ultrasound preferred

Treatment:
Surgery only if necessary – 2nd trimester (safest time to perform Sx)

A

Abdominal Pain in Pregnancy

GI Topics (17 decks)

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