Chapter 71: Acute Abdominal Pain Flashcards
Obstruction, ischemia, or inflammation can cause stretching of unmyelinated fibers that innervate the walls or capsules of organs
Visceral pain
Why visceral pain is initially felt midline?
Because intraperitoneal organs are bilaterally innervated, stimuli are sent to both sides of the spinal cord, causing intraperitoneal visceral pain to be felt in the midline
Usually perceived on the same side as the involved organ, because it is not mediated by fibers that provide bilateral innervation to the cord. It is felt in the midline only if the pathologic process is also located in the midline
Referred pain
Shock that develops rapidly after the onset of acute abdominal pain is usually the consequence of?
Intra-abdominal hemorrhage
A useful parameter for the assessment of volume depletion, but its absence does not exclude blood/fluid loss
Tachycardia
What are the visceral pain features?
Foregut - stomach to second part of duodenum
Midgut - 3rd part of duodenum to proximal 2/3 of transverse colon
Hindgut - distal 1/3 of transverse colon to rectum and GU orgasn
Patients with CD4 counts over ____ are much less likely to have opportunistic infections
Patients with CD4 counts over 200/mm3 are much less likely to have opportunistic infections
Hyperactive bowel sound may be noted in? A. ileus B. mesenteric infarction C. peritonitis D. small bowel obstruction
D. small bowel obstruction
Regarded as the sine qua non for peritonitis
Rebound tenderness
Evaluate the abdominal aorta, particularly in patients ____ years of age with acute abdominal, flank, or low back pain
Evaluate the abdominal aorta, particularly in patients >50 years of age with acute abdominal, flank, or low back pain
Pain medications that can be given to abdominal pain that does not obscure abdominal findings?
Opioid analgesia
IV dose of Ondansetron?
4 or 8 mg (0.45mg/kg/day) to maximum of 32mg
If patient was given metoclopromide and develop extrapyramidal side effects. What drug can be given?
Dipenhydramine IV 25-50mg prophylaxis for dystonia
The use of plain abdominal radiographs should be limited to screening for
- Severe constipation
- Obstruction
- Sigmoid volvulus
- Perforation
If patient has cholecystitis has normal ultrasound what is recommended?
Cholescintigraphy
Noncontrast abdominopelvic CT has about 97% specificity for the diagnosis of acute appendicitis, with the possible exception of what?
Noncontrast abdominopelvic CT has about 97% specificity for the diagnosis of acute appendicitis, with the possible exception of patients with a low body mass index (<25 kg/m2)
The preferrred imaging modality for the diagnosis of kidney and ureteral stones
Noncontrast CT
Imaging modality of choice in many institutions for suspected GI abscess, perforation and fistula
PO contrast CT
It is the initial test of choice for suspected abdominal aortic aneurysm rupture or mesenteric ischemia
IV contrast CT
What level of creatinine should you not order CT with contrast?
Serum creatinine is >1.5 milligrams/dL or the glomerular filtration rate is <60 mL/min/1.733 m2
Patients with an unclear diagnosis at discharge, even if the CT scan is “negative” (or for whom response to treatment is a concern), should be asked to return to the ED or their primary care physician for re- evaluation within how many hours?
Patients with an unclear diagnosis at discharge, even if the CT scan is “negative” (or for whom response to treatment is a concern), should be asked to return to the ED or their primary care physician for re- evaluation within 12 hours
Leading cause of pregnancy-related maternal death in the first trimester
Ectopic pregnancy
The most common surgical entity in elderly patients with abdominal pai
Cholecystitis
The most common early complications of bariatric surgery?
leakage, stenosis and bleeding
