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ECOS2 Exam 1 > Approach To Abdominal Pain 1 > Flashcards

Approach To Abdominal Pain 1 Flashcards

1
Q

Visceral Pain

A

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

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2
Q

Parietal Pain

A

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

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3
Q

Referred Pain

A

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

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4
Q

ROS for GI and GU and GYN

A

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

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5
Q

Complaint specific PMH

A

Hepatitis, Liver problems, GERD/PUD, IBD (Crohn’s), constipation, GB problems

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6
Q

What to ask in conjunction with PSH

A

ABD : cholecystectomy, Appendectomy, colonoscopy

GYN : Hysterectomy, C-section….

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7
Q

Pt taking a lot of aspirin

A

PUD and Gastritis can happen

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8
Q

Pt with ABD pain and takes narcotics

Or steroids

A

Can give chronic abd pain

Steroids can cause perforations in the ABD

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9
Q

Smoking weed and ABD pain

A

Can cause cyclic vomiting syndrome

Puking toes out

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10
Q

When do I use the bell of the stethoscope

A

Bruits sounds or listening to aorta or renal arteries

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11
Q

NO bowel movement upon auscultation

A

X in 2min, GI obstruction, perforation, mesenteric ischemia

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12
Q

Increased bowel movement upon auscultation

A

D, early bowel obstruction

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13
Q

High pitched raindrops on metal sound of bowel movement upon auscultation

A

Early GI obstruction

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14
Q

Bruits

A

Vascular sounds , sounds like heart murmur from turbulent flow in aorta or abd arteries (Renal A, femoral A, iliac A)
=vascular obstruction

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15
Q

Friction Rub sounds

A

Inflammation of peritoneal surface or spleen or liver

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16
Q

Venous Hum sounds

A

Soft humming noise

Increased circulation in portal ad systemic venous system over epigastric and umbilical regions

17
Q

Signs for Peritoneal Signs or peritoneal inflammation or acute abd

A
  1. Guarding - contraction to protect from pain when palpating (voluntary + involuntary)
  2. Rigidity - stiff contracted abd : peritonitis
  3. Rebound tenderness - more tender when letting go then pushing down
18
Q

Lloyd’s punch

A

Deep percussion on area of costovertebral angle(cva)
=pain
——> kidney inflammation, Pyelenephritis, ureterolithiasis(kidney stones)

19
Q

Murphy Sign

A

Biliary colic palpate deep under right costal margin
Deep breath and palpate deeper
+ GB, or biliary tree problem

20
Q

Fluid wave test

A

Patients hands show midline, you push on one side of abd

= you fell rebound or impulse on other flank ——> ASCITES

21
Q

McBurneys Point

A

BEST
Palpate in middle of ASIS (in front) and umbilicus (2in medial to ASIS)
= APPENDICITIS

22
Q

Rovsing’s sing

A

Palpate LLQ and pain in RLQ

= APPENDICITIS

23
Q

Psoas Sign

A

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

24
Q

Obturator sign

A

Flex hip and knee and internally rotate

= pain in right hypogastric region —> can at times show appendicitis

25
Q

Percussion

A

Assess fluid and solid spaces, and gas or feces
Tympanic - air
Dullness - solid organ or feces

26
Q

Where do you start palpating and what fingers

A

Digit pads of middle 3 fingers

First all 4 quadrants and start Away from the reported tenderness

27
Q

Where do you percuss the liver

A

Right midclavicular line from RLQ to dull
And from RUQ to dull
* normal = 6-12cm

28
Q

How to percuss the spleen

A

Laterally from the left ant axillary line

If dull = splenomegaly

29
Q

Reasons you can get enlarged spleen

A

Mono, portal HTN, blood malignancies, splenic hematoma, HIV

30
Q

Shifting Dullness Test

A

Percuss borders of tympani and dullness

Then pt lay on side and do again ,if borders change = + ASCITES

31
Q

ASCITES

A

Fluid is abd cavity and, causing swelling

Can be appendicitis

32
Q

what to order for ABD pain

A 
US
CBC (anemia and infection)
Chem profile(chem12) =also liver function test 
(chem 7= electrolytes, maybe)
Lipase - if yo want to check pancreas 
Preg test 
Urine test
33
Q

Epigastric pain DDX

A

PUD
Myocardial infarction
Cholecystitis
Pancreatitis

34
Q

Epigastric pain and smokes and drinks a lot of alcohol

Narrowed DX

A

PUD, Gastritis, and pancreatitis are some narrows DX

35
Q

Visceral pain moving to somatic pain

A

When you have had any acute -citis for a while

ECOS2 Exam 1 (15 decks)

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