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PCM2 > Acute Abdominal Pain - SP Exam > Flashcards

Acute Abdominal Pain - SP Exam Flashcards

1
Q

DDx - diffuse abdominal pain (15)

A
  1. Bowel obstruction
  2. GI tract perforation
  3. Acute mesenteric ischemia
  4. IBD (UC/CD)
  5. Viral gastroenteritis
  6. Peritonitis
  7. Colorectal cancer
  8. Celiac disease
  9. Ketoacidosis
  10. Adrenal insufficiency
  11. Foodborne illness
  12. IBS
  13. Constipation
  14. Diverticulosis
  15. Lactose intolerance
  16. Colitis
  17. Diverticulitis
  18. Nephrolithiasis
  19. Pyelonephritis
  20. Muscle strain
  21. Herpes zoster
  22. Hernia
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2
Q

DDx - lower abdominal pain

A
  1. Appendicitis
  2. Diverticulitis
  3. Nephrolithiasis
  4. Pyelonephritis
  5. Acute urinary retention
  6. Cystitis
  7. Infectious colitis
  8. Gynecologic - ectopic pregnancy, fibroids, ovarian mass, ovarian torsion, PID, endometriosis
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3
Q

Which causes of lower abdominal pain localize to the RLQ generally?

A

Appendicitis

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4
Q

Which causes of lower abdominal pain localize to the LLQ generally?

A

Diverticulitis

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5
Q

Which causes of lower abdominal pain localize to the suprapubic area generally?

A

Acute urinary retention

Cystitis

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6
Q

Which causes of lower abdominal pain can be found in either quadrant?

A

Nephrolithiasis
Pyelonephritis
Infectious colitis

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7
Q

DDx - LUQ abdominal pain

A

Splenic problem (splenomegaly, splenic infarct, abscess, rupture)

Could also be cardiac (angina, MI, pericarditis), gastric (esophagitis, gastritis, PUD), pancreatic (mass, pancreatitis), vascular (aortic dissection)

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8
Q

DDx - epigastric abdominal pain

A 
Acute MI
Acute pancreatitis
PUD
GERD
Gastritis/gastropathy
Functional dyspepsia
Gastroparesis
Aortic dissection
Pericarditis
Esophagitis
Biliary
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9
Q

DDx - RUQ abdominal pain

A

Biliary - colic (cholelithiasis), acute cholecystitis, acute cholangitis, Sphincter of Oddi dysfunction

Hepatic - acute hepatitis, perihepatitis, liver abscess, Budd-Chiari, portal vein thrombosis, mass

Less likely - pneumonia, PE

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10
Q

Pertinent positives and negatives - acute cholecystitis

A

Positives - prolonged (>4-6 hours) RUQ or epigastric pain, fever, Murphy’s sign, abdominal guarding, jaundice, may radiate to shoulder or back, N/V, anorexia, ingestion of fatty food 1+ hours before onset

Labs - leukocytosis, increased bands (left shift)

Diagnosis - imaging

Rx - admit (supportive care, determine surgical risk, cholecystectomy)

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11
Q

Pertinent positives and negatives - acute hepatitis

A

Positives - RUQ pain, jaundice, changes in urine/stool, fatigue, malaise, N/V, anorexia, pruritis, ascites/abdominal distention

PE - neuro (asterixis), skin (jaundice), ascites

Labs - prolonged PT-INR, markedly elevated ALT/AST, elevated bilirubin, low platelets

Diagnosis - elevated aminotransferase + hepatic encephalopathy + prolonged PT INR

Rx - supportive, work-up for cause (chemistries, liver, CBC, acteaminophen level, viral serologies, tox screen, AI markers, etc.)

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12
Q

Pertinent positives and negatives - PUD

A

Positives - concurrent, episodic gnawing or burning epigastric pain, pain relieved by food, nighttime awakening with pain, recent use of NSAIDs, nausea, hematemesis, melena

Labs - CBC (iron deficiency?)

Dx - upper endoscopy to visualize ulcer

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13
Q

Pertinent positives and negatives - pancreatitis

A

Positives - epigastric pain, pain relieved by sitting up and leaning forward, radiates to the back

Negatives - elevated lipase with normal amylase

Labs - elevated amylase, lipase, markers of immune activation (CRP, etc.), leukocytosis, elevated hematocrit

Diagnosis - 2/3 - acute onset of persistent, severe, epigastric pain often radiating to the back + elevation in serum lipase or amylase 3x or greater than upper limit of normal, + findings on CT/MRI/ultrasound

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14
Q

Pertinent positives and negatives - mesenteric ischemia

A

Positives - starts within one hour of eating, family history of DVT/PE, unintentional weight loss, abdominal pain out of proportion to the physical exam

Labs - non-specific

Dx - if unstable, resuscitate, plain abdominal films, surgery
if stable, CT

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15
Q

Pertinent positives and negatives - appendicitis

A

Positives: pain moves from periumbilical area to the RLQ, fever, psoas sign, rebound tenderness, rigidity, anorexia

Note - normal WBC count does not rule out appendicitis

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16
Q

Pertinent positives and negatives - bowel obstruction

A

Positives: constipation, abdominal distention, pain decreases after vomiting, colic, previous abdominal surgery

17
Q

Pertinent positives and negatives - peritonitis

A

Positives: patient lies motionless on their back, rebound tenderness, abdominal rigidity

18
Q

Pertinent positives and negatives - PID

A

Positives - new or multiple sexual partners

19
Q

Pertinent positives and negatives - acute cholangitis

A

Positives - fever, jaundice, RUQ pain

20
Q

When should patients be referred to the ED with acute abdominal pain?

A
  1. Unstable vital signs
  2. Signs of peritonitis on abdominal exam
  3. Concern for a life-threatening condition (acute bowel obstruction, acute mesenteric ischemia, perforation, acute MI, ectopic pregnancy)
21
Q

Pertinent positives and negatives - PID

A

Positives - new or multiple sexual partners, cervical motion tenderness

22
Q

Which imaging studies should be ordered and why?

A
  1. Abdominal ultrasound (hepatobiliary etiologies, splenic - LUQ)
  2. Endoscopy (PUD)
  3. CT (splenic - LUQ)
  4. Pregnancy test - women of childbearing age
23
Q

When should patients be referred to the ED with acute abdominal pain?

A
  1. Unstable vital signs
  2. Signs of peritonitis on abdominal exam
  3. Concern for a life-threatening condition (acute bowel obstruction, acute mesenteric ischemia, perforation, acute MI, ectopic pregnancy)
  4. Concern for a surgical condition (appendicitis, cholecystitis)
24
Q

Which lab tests should be ordered and why?

A
  1. CBC w/differential - RUQ, Epigastric, lower abdominal pain)
  2. Kidney chemistries
    - electrolytes, BUN, creatinine, glucose - RUQ, Epigastric
  3. Liver chemistries - aminotransferases, alkaline phosphatase, bilirubin - RUQ, Epigastric
  4. Lipase/amylase - RUQ, Epigastric
  5. Pregnancy test - women of childbearing age
  6. Urinalysis and culture (cystitis, pyelonephritis)
25
Q

Which imaging studies should be ordered and why?

A
  1. Abdominal ultrasound (hepatobiliary etiologies, splenic - LUQ, suprapubic)
  2. Endoscopy (PUD)
  3. CT (splenic - LUQ)
  4. CT with IV contrast media (RLQ)
  5. CT with oral and IV contrast media (LLQ)
26
Q

Which lab tests should be ordered and why?

A
  1. CBC w/differential - RUQ, Epigastric, lower abdominal pain, infection or blood loss, prep for surgery)
  2. Kidney chemistries
    - electrolytes, BUN, creatinine, glucose - RUQ, Epigastric
  3. Liver chemistries - aminotransferases, alkaline phosphatase, bilirubin - RUQ, Epigastric
  4. Lipase/amylase - RUQ, Epigastric
  5. Pregnancy test - women of childbearing age
  6. Urinalysis and culture (hematuria, dysuria, flank pain - cystitis, pyelonephritis)
  7. Troponin (MI)
27
Q

Which imaging studies should be ordered and why?

A
  1. Abdominal ultrasound (hepatobiliary etiologies, splenic - LUQ, suprapubic)
  2. Endoscopy (PUD)
  3. CT (splenic - LUQ)
  4. CT with IV contrast media (RLQ)
  5. CT with oral and IV contrast media (LLQ)
  6. Transvaginal ultrasound (ectopic pregnancy, other gyne causes)
28
Q

Evaluation of LLQ abdominal pain (algorithm)

A

If patient has a history of fever or diverticular disease - CT or empiric treatment of diverticulitis

If not, assess for abdominal distention, tenderness, and rectal bleeding; if positive - CT or empiric treatment of diverticultitis
if negative - urinary or gyne evaluation

29
Q

Evaluation of LLQ abdominal pain (algorithm)

A

If patient has a history of fever or diverticular disease - CT or empiric treatment of diverticulitis

If not, assess for abdominal distention, tenderness, and rectal bleeding; if positive - CT or empiric treatment of diverticultitis
if negative - urinary or gyne evaluation

30
Q

Evaluation of LLQ abdominal pain (algorithm)

A

If patient has a history of fever or diverticular disease - CT or empiric treatment of diverticulitis

If not, assess for abdominal distention, tenderness, and rectal bleeding; if positive - CT or empiric treatment of diverticultitis
if negative - urinary or gyne evaluation

31
Q

Admitting Orders (ADC)

A

Admit (admit to)
Diagnosis (main diagnosis and any others pertinent to care)
Condition (serious, guarded, critical, etc.)

32
Q

Admitting Orders (VAAN)

A

Vitals (how frequently to check the vitals)
Activity (limitations on activity - bed rest, bed rest w/bathroom privileges, crib, no restrictions)
Allergies
Nursing (what you want the nurses to routinely do - daily weight, pulse ox, input/output, etc.)

33
Q

Admitting Orders (DISML)

A

Diet (what you want the patient to eat)
IVF
Special
Medications (what meds the patient will be receiving, includes oxygen)
Labs (what should be done now, what should be done routinely)

PCM2 (16 decks)

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