Approach To Abdominal Pain 1 Flashcards
Visceral Pain
From:
1. Distention, stretching, contracting hollow organs
2. Stretching capsule of solid organs
3. Organ ischemia
*NOT LOCALIZED, felt in abd midline of organ level
EX: Periumbilical Pain = elderly appendicitis
Parietal Pain
By somatic pain fibers, from :
1. Inflammation of the parietal peritoneum
*more severe and constant, esp with moving or coughing
*LOCALIZED
EX: RLQ —> after a while of having acute appendicitis
LLQ —> after a while of having acute diverticulitis
Referred Pain
Originates within abd and felt at other places of the body at same spinal levels nerve
EX: heart gives left shoulder pain
Duodenum + Pancreas = back pain
Gallbladder = right shoulder pain
ROS for GI and GU and GYN
GI : N, V, D, weight loss, black stools, blood in stool/vomit
GU : dysuria, polyuria, hematuria, CVA pain
GYN : vaginal bleeding, vaginal discharge, last menstruation
Complaint specific PMH
Hepatitis, Liver problems, GERD/PUD, IBD (Crohn’s), constipation, GB problems
What to ask in conjunction with PSH
ABD : cholecystectomy, Appendectomy, colonoscopy
GYN : Hysterectomy, C-section….
Pt taking a lot of aspirin
PUD and Gastritis can happen
Pt with ABD pain and takes narcotics
Or steroids
Can give chronic abd pain
Steroids can cause perforations in the ABD
Smoking weed and ABD pain
Can cause cyclic vomiting syndrome
Puking toes out
When do I use the bell of the stethoscope
Bruits sounds or listening to aorta or renal arteries
NO bowel movement upon auscultation
X in 2min, GI obstruction, perforation, mesenteric ischemia
Increased bowel movement upon auscultation
D, early bowel obstruction
High pitched raindrops on metal sound of bowel movement upon auscultation
Early GI obstruction
Bruits
Vascular sounds , sounds like heart murmur from turbulent flow in aorta or abd arteries (Renal A, femoral A, iliac A)
=vascular obstruction
Friction Rub sounds
Inflammation of peritoneal surface or spleen or liver
Venous Hum sounds
Soft humming noise
Increased circulation in portal ad systemic venous system over epigastric and umbilical regions
Signs for Peritoneal Signs or peritoneal inflammation or acute abd
- Guarding - contraction to protect from pain when palpating (voluntary + involuntary)
- Rigidity - stiff contracted abd : peritonitis
- Rebound tenderness - more tender when letting go then pushing down
Lloyd’s punch
Deep percussion on area of costovertebral angle(cva)
=pain
——> kidney inflammation, Pyelenephritis, ureterolithiasis(kidney stones)
Murphy Sign
Biliary colic palpate deep under right costal margin
Deep breath and palpate deeper
+ GB, or biliary tree problem
Fluid wave test
Patients hands show midline, you push on one side of abd
= you fell rebound or impulse on other flank ——> ASCITES
McBurneys Point
BEST
Palpate in middle of ASIS (in front) and umbilicus (2in medial to ASIS)
= APPENDICITIS
Rovsing’s sing
Palpate LLQ and pain in RLQ
= APPENDICITIS
Psoas Sign
Pt lies on left side, extend right hip back
= abd pain , Psoas syndrome, can at times show appendicitis
OR
Pt sits and lifts right thigh up with resistance down
Obturator sign
Flex hip and knee and internally rotate
= pain in right hypogastric region —> can at times show appendicitis
