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Surgical Recall > Chapter 34: Acute Abdomen > Flashcards

Chapter 34: Acute Abdomen Flashcards

1
Q

what is an acute abdomen?

A

Undiagnosed sudden pain that lasts less than seven days and forces patient to seek medical attention

NOTE: NOT surgical abdomen because most acute abdomen do not need surgery

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2
Q

what are peritoneal signs?

A

Signs of peritoneal irritation:

  1. extreme tenderness
  2. percussion tenderness
  3. rebound tenderness
  4. voluntary guarding
  5. Involuntary guarding/rigidity (late)
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3
Q

rebound tenderness

A

pain upon releasing the palpating hand pushing on the abdomen

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4
Q

motion pain

A

abdominal pain upon moving, pelvic rocking, moving of stretcher or heel strike

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5
Q

voluntary guarding

A

abdominal muscle contraction with palpation of abdomen

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6
Q

involuntary guarding

A

rigid abdomen as the muscles gaurd involuntarily

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7
Q

colic

A

intermittent severe pain ususally because of the intermittent contraction of a hollow viscus against an obstruction

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8
Q

what condisions can mask abdominal pain

A
  1. Steroids
  2. Diabetes
  3. Paraplegia
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9
Q

MC cause of acute abdominal surgery in US

A

Acute appendecitis

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10
Q

what should go first, auscultation or palpation

A

auscultation

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11
Q

best way for patient to localize the pain

A

point

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12
Q

classic position of pateint with peritonitis

A

motionless with knee flexed

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13
Q

classic position of patient with kidney stone

A

restless, writhing in pain

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14
Q

lab tests to evaluate a patient with acute abdomen

A
  1. CBC with differential
  2. Chem-10
  3. AMylase
  4. Type and screen
  5. Urinalysiss
  6. LFTs
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15
Q

what is a left shift on CBC differential

A

sign of inflammatory response ie. immature neutrophils (bands)

NOTE: Many call >80% of WBCs as neutrophils a “left shift”

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16
Q

women of childbearing age with an acute abdomen should recieve

A

BHCG to rule out ectopic/pregnancy

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17
Q

which xrays are used to evaluate patient with an acute abdomen

A
  1. uproght cxr
  2. upright abdomnial film
  3. supine abdominal
  4. if patient cannot stand: left lateral decubitus abdominal film
18
Q

how is free air ruled out if the patient cannot stand

A

left lateral decubitus because free air collects over the liver ie NOT confused with gastric bubble

19
Q

must consider this with every case of acute abdomen

A

appendicits

20
Q

ddx of RUQ

A
  1. cholecystitis
  2. hepatitis
  3. pud
  4. perforated ulcer
  5. pancreatitis
  6. liveer tumor
  7. gastritis
  8. hepatic abscess
  9. choledocolithiasis
  10. cholangitis
  11. pyelonephritis
  12. nephrolithiasis
  13. appendecitis (esp during pregnancy)
  14. thoracic causes
    1. pleurisy
    2. pneumoia
    3. PE
    4. pericarditis
    5. MI (esp. inferior wall)
21
Q

ddx of LUQ

A
  1. PUD
  2. perorated ulcer
  3. gastritis
  4. splenic injury
  5. splenic abscess
  6. reflux
  7. dissecting aortic aneurysm
  8. thoracic causes
  9. pyelonephritis
  10. nephrolithiasis
  11. hiatal hernia (strangulated paraesophageal hernia)
  12. boerhaave syndrome
  13. mw tear
  14. splenic artery aneurysm
  15. colon disease
22
Q

ddx of LLQ

A
  1. diverticulitis
  2. sigmoid volvulus
  3. perforated colon
  4. colon cancer
  5. uti
  6. small bowel obstruction
  7. IBD
  8. nephrolithiasis
  9. pyelonephritis
  10. fluid accumulation from aneurysm or perforation
  11. referred hip pain
  12. gyne
  13. rarely appendicitis
23
Q

ddx of RLQ

A
  1. Appendixitis
  2. LLQ
  3. mesenteric lymphadenitis
  4. cecel diverticulitis
  5. meckels diverticulum
  6. intussusception
24
Q

ddx of epigastric

A
  1. PUD
  2. gastritis
  3. MI
  4. pancreatitis
  5. biliary colic
  6. gastric volvulus
  7. MW tear
25
nonsurgical causes of abdominal pain
1. GE 2. DKA 3. sickle cell crisis 4. rectus sheath hematoma 5. acute porphyria 6. kidney stone 7. pyelonephritis 8. hepatitis 9. pancreatitis 10. pneumonia 11. MI 12. C. dificile colitis
26
ddx of AIDs and abdominal pain
1. all common causes 2. CMV (MC) 3. Kaposi sarcoma 4. Lymphoma 5. TB 6. MAI
27
pain specific to dermatome
early zoster before vesicles erupt
28
cholecystitis pain usually refers to
right subscapular and epigastric
29
appendicitis pain usually refers to
early: periumbilical rare: testicular
30
diaphragmatic irritation refers to
Shoulder pain and KEHR'S sign on the left due to: 1. spleen 2. perforated ulcer 3. abscess
31
pancreatitis/ca refers to
back
32
rectal disease refers to
small of the back
33
nephrolithiasis pain refers to
testicular pain/flank pain
34
rectal pain refers to
midline small of the back
35
small bowel pain refers to
periumbilical pan
36
uterine pain refers to
midline small of back
37
abdominal pain out of proportion to exam
mesenterich ischemia must be ruled out
38
hypotention and pulsatile abdominal mass
ruptured AAA
39
fever, LLQ pain, change in bowel habits
Diverticulitis
40
endocrine causes of abdominal pain
1. DKA 2. Addisonian crisis
41
chandelier sign associated with
PID
42
22 yr old f with acute onset of lower abdomial pain, hypotension, tachycardia, adenexal mass, free fluid on vaginal US
ectopic pregnancy

Surgical Recall (168 decks)

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