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Adult/Ped Medicine 4 > Acute Surgical Abdomen - Sasek > Flashcards

Acute Surgical Abdomen - Sasek Flashcards

1
Q

Causes of Pain by Location:

Suprapubic

A
  • UTI
  • Bladder Cancer
  • Uterine Fibroids
  • Bacterial Vaginosis
  • Cervicitis
  • Advanced Pregnancy
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1
Q

Peritonitis

A

inflammation of the peritoneum

signs:

  • distended or rigid abdomen
  • fever and chills
  • fluid in abdomen
  • passing few or no stools or gas
  • excessive fatigue
  • low urine output
  • nausea and vomiting
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2
Q

Character: Colicky or Crampy

A

distension or stretching

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3
Q

Diarrhea

A

watery: gastroenteritis - medical conditions
blood: inflammatory bowel (Chron’s; UC)

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4
Q

Mesenteric Intestinal Ischemia

  • Cause
  • Signs
  • Risk Factors
  • Diagnosis
  • Treatment
A

abrupt onset of pain out of proportion to examination

CAUSE

  • emboli/thrombi

SIGNS

  • nuaea and vomiting common
  • acidosis common

RISK FACTORS:

  • > 50
  • A FIB
  • Atherosclerotic Disease
  • Hypercoagulability

DIAGNOSIS:

  • CT - CTA or MRA
  • Angiography ** Gold Standard **
  • Elevated Serum lactate
  • Heme positive stool
  • Early surgical consult

TREATMENT:

  • IV fluids
  • surgical removal
  • IV ABX
  • Pain control
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4
Q

Pancreatitis

A
  • acute upper abdominal pain
  • band-like radiation to the back
  • alcohol, gallstones
  • nausea, vomiting
  • toxic apearing - febrile
  • patient is restless
  • elevated: serum lipase and amylase
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4
Q

Appendicitis

A
  • pain begins at umbilicus, shifts to right lower quadrant
  • anorexia
  • may have vomiting
  • tenderness at McBurney’s point
  • rebound tenderness
    • obturator
    • iliospsoas

diagnostics

  • CT with contrast
  • Ultrasound can rule in or rule out
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5
Q

Causes of pain by location:

Left Lower Quadrant

A
  • Diverticulitis
  • Ovarian Cyst
  • Ectopic Pregnancy
  • PID
  • Renal Stones (L flank)
  • Ovarian Torsion
  • Inguinal Hernia
  • Referred Hip Pain
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6
Q

Immediately Life Threatening Abdomen Conditions

A
  • AAA
  • Mesenteric Ischemia
  • Perforation GI tract
  • Acute bowel obstruction
  • Volvulus
  • Ectopic Pregnancy
  • Placental Abruption
  • MI
  • Splenic Rupture
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7
Q

Character: Burning

A

ulcer

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8
Q

define: Acute Abdomen

A

sudden, spontanoues non-traumatic disorder whose chief manifestation is in the abdominal area and for which urgent operation may be necessary

delay in tx will adversly affect outcomes

25% discharged vs. 35-40% admitted

elderly - higher mortality rates

kids - 2/3 surgical appendectomy

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9
Q

Obstipation

A

absence of both stool AND flatus

indicative of mechanical bowel obstruction

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10
Q

Abdomen Imaging

A

Plain Film - low yield

Ultrasound - AAA, gallbladder, female GU

CT - acute abdomen

Angiography - mesenteric ischemia, AAA

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11
Q

Ruptured Ectopic Pregnancy

A

TRIAD

  1. Amenorrhea
  2. Crampy, unilateral abdominal pain
  3. Vaginal bleeding

Need transvaginal US or serial HCG - pelvic exam is non-diagnostic

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12
Q

Diagnostic Clues for Abdominal Disorders

A
  • CXR - free air = perforation
  • ABD XR - multiple air-fluid levels = obstruction
  • CT scan - determine cause and site of obstruction more accurately
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12
Q

Bowel Obstruction

  • Signs
  • Risks
A

most often the small bowel

SIGNS:

  • crampy/peristaltic pain
  • distension
  • vomiting
  • absence of flatus

RISKS:

  • pervious surgery
  • elderly
  • Chron’s
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12
Q

Acute Paralytic Ileus

A

Neurogenic failure or loss of peristalsis

common in hospitalizated patients

DX: CT & ABD films - gas filled loops

TX - treat primary cause

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13
Q

Acute Cholecysitis

A

5F predisposition

RUQ pain with nausea and vomiting

RUQ tenderness; guadring; + Murphy’s sign

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14
Q

Abdominal Pain by Location:

Diffuse

A
  • Ulcerative Colitis/Crohn’s Disease
  • Endometriosis
  • Gastroenteritis
  • Peritonitis
  • Constipation
  • Mesenteric Ischemia
  • Diabetic Ketoacidosis
  • Porphyria
  • Malaria
16
Q

Abdomen Physical Exam: Inspection

A
  1. Insepction
  • essentially well or globally ill
  • writhing or motionless
  • distension
  • scars
17
Q

Volvulus

A

anatomic obstruction; malrotation is common in pediatrics

SIGNS:

  • gradual lower abdominal cramping pain
  • chronic pain in kids
  • distension

DIAGNOSIS:

  • barium enema
  • plain film
  • sigmoidoscopy
  • US
19
Q

severe uncontrollable retching

A

pancreatitis

20
Q

Abdomen Physical Exam: Percussion

A

3. Perucssion

  • tenderess on percussion
  • rebound tenderness
  • tympany midline: distended bowel loops
  • shifting dullness = free peritoneal fluid
20
Q

GI Perforation

A

causes: peptic ulcer, NSAIDS

signs & symptoms:

  • abrupt onset of severe, diffuse abdominal pain
  • board rigid abdomen
  • free air under the diaphrgam
  • quiet bowel sounds
21
Abdomen Physical Exam: Auscultation
**2. Auscultation** * hyperactive - gastroenteritis, dysentery, cholera * hypoactive - constipation * high pitched - bowel obstruction * absent - peritonitis, end stage obstruction, mesenteric ischemia
23
bilious vomit
lesion in proximal small bowel
24
Causes of pain by location: Periumbilical
* Early appendicitis * Small bowel obstruction * Colitis * Umbilical Hernia
25
Toxic Appearing Child
* pale or cyanotic * lethargic or inconsolably irritable * tachypnea * tachycardia * poor capillary refill
26
Diverticulitis
* pain for several days * change in bowel habits common * tenderness, mass may be felt * more common \> 50 * fever and malaise * may be constipated * low grade leukocytosis
27
Abdomen Physical Exam other locations to check out
Digital Rectal Exam * frank blood or occult blood * lesions, masses, level of bleeding * hemorrhoids * prostate enlargment Female Pelvic Exam * PID vs. ovarian cyst, abscess or appendicitis Male GU * testicular/ scrotal/ hernia exam EXTRA-ABDOMINAL * Heart & Lungs * CVA tenderness * Eyes - Icterus * Skin * Musculoskeletal (hip pain)
29
Causes of Pain by Location Left Upper Quadrant
* Splenic infarct/rupture * Myocardial infarction * Pericarditis * Pneumonia * Diverticulitis (occassionally) * Pyelonephritis (L flank) * Renal stones (L flank)
30
Testicular Torsion
* sudden onset of severe, unilateral scrotal pain * typically follows vigorous activity * school age and adolescents * exam * high-riding, transversley oreinted testis, loss of cremasteric reflex * SURGICAL EMERGENCY
32
Abdomen Physical Exam: Palpation
**4. Palpation** * "board rigid" patient is dying * start light and away from pain * check for masses and organomegaly
33
Causes of Pain by Location: Right Upper Quadrant
* cholecystitis * cholelithiasis * liver abscess * hepatitis * cancer of liver or gallbladder * pnemonia * pyelonephritis * renal stones
35
Causes of Pain by Location: Epigastrium
* GERD * Myocardial Infarction * Gastritis * Gastric Ulcer or Peptic Ulcer * Pancreatitis * Pancreatic Cancer * Abdominal or Thoracic Aortic Aneurysm/Dissection
36
Abdomen Diagnostic Studies
* CBC * Pregnancy Test * Liver Panel * Amylase & Lipase * Glucose * UA
37
Shock | (Toxic Adults)
* Anxiety or agitation * Hypotension * Cool, clammy skin * Confusion * Decreased or no urine output * General weakness * Pale skin color (pallor) * Tachypnea * Unconsciousness
38
Intussception
**telescoping of bowel segments -** segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction common: ILIEOCECAL Valve TRIAD of Symptoms 1. Vomiting 2. Abdominal Pain 3. Blood in Stool Pain - colicky every 15-20 minutes
39
Abdominal Aortic Aneurysm * Risk Factors * Evaluation
focal dilation of at least 50% compared to normal or \> 3 cm abdominal, back or flank pain rupture = unstable hypotension RISK FACTORS * Males * \> 60 * COPD * PVD * HTN * smoking * family hx EVALUATION * Abdominal Ultrasound * CT when planning repair * surgery if \> 5.5 cm * routine for follow up depends on size/growth
40
HepatoBiliary Disease
* localized RUQ pain - radiation to right shoulder/back * nausea, vomiting and anorexia
41
Right Lower Quadrant
* Appendicitis (usually later) * Ovarian Cyst * Ectopic Pregnancy * PID * Renal Stones (R flank) * Ovarian Torsion * Inguinal Hernia * Referred Hip Pain
42
Pain 1st \>\> Vomit 2nd vs. Vomit 1st \>\> Pain 2nd
Pain 1st \>\> Vomit 2nd (surgical) vs. Vomit 1st \>\> Pain 2nd (medical) lesion indicated by vomiting character
43
Spleen
* LUQ pain * consider signs and symptoms of infectious mononucleosis
44
Evaluation of Acute Abdomen
History * pain: type, location, onset, progression * associated symptoms * other: GYN, social, travel, surgical, family Exam * inspect * auscultation * percussion * palpation Diagnostic Test Management
45
Differential Diagnosis Pediatrics Acute Abdomen
Most Common * Appendicitis * Infectious Gastroenteritis * Colic Less Common * Pancreatitis * Gallbladder Disease * Lymphoma

Adult/Ped Medicine 4 (17 decks)

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