Chapter 34: Acute Abdomen Flashcards
what is an acute abdomen?
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
what are peritoneal signs?
Signs of peritoneal irritation:
- extreme tenderness
- percussion tenderness
- rebound tenderness
- voluntary guarding
- Involuntary guarding/rigidity (late)
rebound tenderness
pain upon releasing the palpating hand pushing on the abdomen
motion pain
abdominal pain upon moving, pelvic rocking, moving of stretcher or heel strike
voluntary guarding
abdominal muscle contraction with palpation of abdomen
involuntary guarding
rigid abdomen as the muscles gaurd involuntarily
colic
intermittent severe pain ususally because of the intermittent contraction of a hollow viscus against an obstruction
what condisions can mask abdominal pain
- Steroids
- Diabetes
- Paraplegia
MC cause of acute abdominal surgery in US
Acute appendecitis
what should go first, auscultation or palpation
auscultation
best way for patient to localize the pain
point
classic position of pateint with peritonitis
motionless with knee flexed
classic position of patient with kidney stone
restless, writhing in pain
lab tests to evaluate a patient with acute abdomen
- CBC with differential
- Chem-10
- AMylase
- Type and screen
- Urinalysiss
- LFTs
what is a left shift on CBC differential
sign of inflammatory response ie. immature neutrophils (bands)
NOTE: Many call >80% of WBCs as neutrophils a “left shift”
women of childbearing age with an acute abdomen should recieve
BHCG to rule out ectopic/pregnancy
which xrays are used to evaluate patient with an acute abdomen
- uproght cxr
- upright abdomnial film
- supine abdominal
- if patient cannot stand: left lateral decubitus abdominal film
how is free air ruled out if the patient cannot stand
left lateral decubitus because free air collects over the liver ie NOT confused with gastric bubble
must consider this with every case of acute abdomen
appendicits
ddx of RUQ
- cholecystitis
- hepatitis
- pud
- perforated ulcer
- pancreatitis
- liveer tumor
- gastritis
- hepatic abscess
- choledocolithiasis
- cholangitis
- pyelonephritis
- nephrolithiasis
- appendecitis (esp during pregnancy)
- thoracic causes
- pleurisy
- pneumoia
- PE
- pericarditis
- MI (esp. inferior wall)
ddx of LUQ
- PUD
- perorated ulcer
- gastritis
- splenic injury
- splenic abscess
- reflux
- dissecting aortic aneurysm
- thoracic causes
- pyelonephritis
- nephrolithiasis
- hiatal hernia (strangulated paraesophageal hernia)
- boerhaave syndrome
- mw tear
- splenic artery aneurysm
- colon disease
ddx of LLQ
- diverticulitis
- sigmoid volvulus
- perforated colon
- colon cancer
- uti
- small bowel obstruction
- IBD
- nephrolithiasis
- pyelonephritis
- fluid accumulation from aneurysm or perforation
- referred hip pain
- gyne
- rarely appendicitis
ddx of RLQ
- Appendixitis
- LLQ
- mesenteric lymphadenitis
- cecel diverticulitis
- meckels diverticulum
- intussusception
ddx of epigastric
- PUD
- gastritis
- MI
- pancreatitis
- biliary colic
- gastric volvulus
- MW tear
nonsurgical causes of abdominal pain
- GE
- DKA
- sickle cell crisis
- rectus sheath hematoma
- acute porphyria
- kidney stone
- pyelonephritis
- hepatitis
- pancreatitis
- pneumonia
- MI
- C. dificile colitis
ddx of AIDs and abdominal pain
- all common causes
- CMV (MC)
- Kaposi sarcoma
- Lymphoma
- TB
- MAI
pain specific to dermatome
early zoster before vesicles erupt
cholecystitis pain usually refers to
right subscapular and epigastric
appendicitis pain usually refers to
early: periumbilical
rare: testicular
diaphragmatic irritation refers to
Shoulder pain and KEHR’S sign on the left
due to:
- spleen
- perforated ulcer
- abscess
pancreatitis/ca refers to
back
rectal disease refers to
small of the back
nephrolithiasis pain refers to
testicular pain/flank pain
rectal pain refers to
midline small of the back
small bowel pain refers to
periumbilical pan
uterine pain refers to
midline small of back
abdominal pain out of proportion to exam
mesenterich ischemia must be ruled out
hypotention and pulsatile abdominal mass
ruptured AAA
fever, LLQ pain, change in bowel habits
Diverticulitis
endocrine causes of abdominal pain
- DKA
- Addisonian crisis
chandelier sign associated with
PID
22 yr old f with acute onset of lower abdomial pain, hypotension, tachycardia, adenexal mass, free fluid on vaginal US
ectopic pregnancy
