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SF3- EXAM 3 (Camelita) > Clinical Applications: Acute Abdomen > Flashcards

Clinical Applications: Acute Abdomen Flashcards

1
Q

Characteristics of Acute abdomen

A
  • Rapid onset
  • Severe pain
  • Requires urgent decision/diagnosis
  • Treatment often surgical
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2
Q

Statistics of acute abdomen

A
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3
Q

Why are older patients difficult diagnosis?

A
  • Difficult to examine
  • Patient doesn’t respond
  • Low rate of fever

NOTE: This can also apply to the very young

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4
Q

What is the pathophysiology of abdominal pain?

A
  • Referred pain
    • ​Pain occuring a considerable distance from the source
  • Somatic pain
    • ​Segmental spinal nerves
  • Visceral pain
    • ​Sympathetic, parasympathetic, or somatic pathways
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5
Q

What should be covered in a history when examining a patient with acute abdomen?

A
  • Description of pain
  • Associated symptoms
  • Gynecologic/ genitourinary (GU) history
  • Past medical history
  • Family, social history
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6
Q

What are some symptoms associated with acute abdomen?

A
  • Nausea, vomiting
  • Fever, chills
  • Anorexia, weight loss
  • Food intolerance
  • Pulmonary symptoms
  • Cange in bowel habits
  • Genitourinary complaints
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7
Q

What should be considered regarding gynecologic or genitourinary history when screening for acute abdomen?

A
  • Last menses
  • Contraception
  • Sexual history
  • Obstetric history
  • Vaginal discharge, bleeding
  • Previous STDs
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8
Q

What components of past medical history are important when screening for acute abdomen?

A
  • Cardiac or pulmoanry disorders
  • GI, vascular diseases
  • Diabetes, HIV
  • Medications
    • Specifically, all over the counter meds
  • Recent invasive procedures
  • Trauma
  • Recent URI or strep throat
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9
Q

Which components of family and social history should be gather when questioning for acute abdomen?

A
  • Inflammatory bowel disease
  • Connective tissue disorders
  • Bleeding conditions/problems
  • Cancer
  • Recent travel
  • Environmental hazards
  • Drugs, alcohol
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10
Q

What are the components of a physical examination for acute abdomen?

A
  • General appearance
  • Chest
  • Abdomen
  • Rectal
  • pelvic
  • GU
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11
Q

What are the components of a general examination for acute abdomen?

A
  • Distress
  • Acutely or chronically ill
  • Body position
  • Color
  • Vital signs
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12
Q

What the components of a chest exam for acute abdomen?

A
  • Cardiac arrhythmias
  • Murmurs
  • Mechanical heart valves
  • Signs of pneumonia

NOTE: Mechanical valves can get clots and throw emboli into systemic circulation, which can cause problems in the GI tract

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13
Q

What are the three components to an abdominal exam?

A
  • Look
    • Distention
    • Breathing pattern
    • Discolaroration
    • Scars and hernia
  • Listen
    • Auscultation
    • Percussion
      • Fluid
      • Air
  • Feel
    • Areas of maximal tenderness
    • Costoverterbal angle or flank tenderness
    • Masses
    • Hernia
    • Peritoneal signs

NOTE: The components should take place in this order

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14
Q

What abdomen conditions can result in shortness of breath?

A

Inflammation of gall bladder. Patients will have shortness of breath to prevent the gall bladder from hitting up against the periteneum.

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15
Q

What are the physical characteristics of a person with hemorrhagic pancreatitis?

A

Light skin

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16
Q

When listening to a patient during an abdominal exam, where should you begin?

A

With quadrant opposite to location of pain

NOTE: You should listen to all 4 quadrants

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17
Q

If a person has inflammation of kidney you can thumb or percuss in the ___________.

A

Costovertebral angle

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18
Q

Rovsing’s sign

A
  • If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant

Appendix is main culprit

19
Q

Psoas sign

A

Indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal).

RARE

20
Q

Obturator sign

A
  • performed when acute appendicitis is suspected.
  • indicates the presence of an inflamed pelvic appendix.

RARE

21
Q

Murphy’s sign

A
  • positive in cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.
    *
22
Q

Mechanism for testing for Murphy’s sign

A
  1. Ask patient to take a deep breath
  2. Palpate right upper quadrant
  3. Ask patient to release breath
  4. You will see a cessation of breathing in a positive Murphy sign, becuase diaphragm pushes down and gallbladder hits peritoneum
23
Q

What should be accessed in a pelvic/rectal/ genitofemoral exam?

A
  • Tenderness
  • Masses
  • Hernias
  • Discharge, bleeding
  • Blood-occult or gross

NOTE: A complete acute abdomen assessement includes a pelvic/rectal exam

24
Q

What is a basic work-up of acute abdomen?

A
  • Urinalysis
  • CBC
    • Includes a WBC and a hemoglobin/hemocrit
  • Amylase, lipase
  • Pregnancy test
  • Liver test
  • EKG
  • Chest x-ray
  • Abdominal x-ray
25
Q

What’s included in a complex work-up of acute abdomen?

A
  • Computed tomography
  • ultrasound
  • Angiography
  • Barium Enema
    • Contrast in rectum to see colon
  • Endoscopy
  • Laparoscopy, especially in women
    • Done when we are not sure what is going on but we know it’s something serious
26
Q

Appendicitis

A
  • History: Periumbilical pain migrating to RLQ; anorexia
  • Exam: tenderness in RLQ and on rectal or pelvic
      • Rovsing’s sign, Psoas sign, obturator sign
  • Ultrasound useful in women
  • CT in equivocal cases
  • Laparoscopy
    • Appendix comes off where the 3 tenia colace
27
Q

Small Bowel Obstruction

A
  • History of previous abdominal operation
  • Triad of diagnostic symptoms
    • Cramping abdominal pain
    • Vomiting
    • Obstipation
  • ​Usually abdomen is symmetrically distended
    • If colon, is obstructed, it will be lopsided because it is located on the side
  • Quartet of physical findings
    • Distention
    • Early: no tenderness
    • Late: Tenderness and guarding
    • Borborygmi (growling bowel sounds)
28
Q

What are the radiographic findings of a small bowel obstruction?

A
  • Air-fluid levels in dilated loops of small bowel
  • Paucity/absence of air in colon/ rectum
29
Q

What are the most common causes of a small bowel obstruction?

A

Post-surgical adhesions

  • Most common in a person who has had a hysterectomy
30
Q

Large Bowel Obstruction

A
  • Better tolerated than small bowel obstuction
    • Less fluid and electrolyte disturbance
  • Abdomen asymmetrically distended
  • Sudden onset of abdominal distention
31
Q

Causes of large bowel obstruction

A
  • Extrinsic: Volvulus (#2), hernia
  • Intrinsic: Cancer (#1)
    • Inflammatory: Ulcreative colitis, diverticulitis, radiation, ischemic structure
  • Congenital: Imperforate anus
  • Intraluminal: Meconium ileus, intussusception, impaction
  • Adynamic: Ogilvie’s-electrolyte abnormal, post-op, opoids, intra-abdominal infection, anticholinergics Hirchsprung’s

NOTE: Adhesions almost never cause obstruction of the colon, because the colon is too powerful to give time for adhesions to obstruct

32
Q

Volvulus

A
  • Twisting of a loop of bowel

NOTE: A sigmoid volvulus is the most common because the sigmoid is redundant and floppy and has a long mesentery

33
Q

Perforated Peptic Ulcer

A
  • History: Peptic ulcer disease, NSAIDS, steroids, critically ill
    • @ stomach and 1st part of duodenum
  • Exam: Generalized peritonitis
  • Free air seen on plain radiographs or CT
34
Q

How is a perforated duodenal ulcer treated?

A
  • Antibiotics
  • Tie greater omentum over perforation, suture like a patch
    • Do not close hole

NOTE: Patient will be extremely sick ICU afterwards

35
Q

Acute diverticulitis

A
  • History: LLQ pain, fever, constipation, diarrhea
  • Exam: LLQ tenderness, mass
  • Labortatory tests
    • Pyuria, WBC elevated
    • CT- up to 93% sensitivity
36
Q

What is the gold standard used to diagnose acute diverticulitis?

A

CT scan of the abdomen and pelvis

  • If a diverticulitis is associated with an abscess you will see puss in the pelvis
37
Q

Tx for acute diverticulitis

A
  • Antibiotics
  • Surgery is not a great situation. Nothing looks normal due to inflammation
38
Q

Pancreatitis

A
  • History: alcohol, gallstones, epigastric pain radiating to the back
  • Exam: Generalized upper abdominal tenderness, most marked in epigastrium
  • Increased amylase and lipase levels
39
Q

How is acute pancreatitis diagnosed?

A
  • With murphy’s sign at RUQ
  • Use ultrasound for confirming acute pancreatitis
  • In CT, pancreas will appear light
40
Q

Cholecystitis

A
  • History: Crampt epigastric and RUQ pain, fatty food intolerance
  • Exam: RUQ tenderness, +Murphy’s sign, jaundice
  • US- thickened GB wall, pericholecystic fluid

NOTE: If jaundice is present, there is a stone in the common bile duct

41
Q

What is the diagnostic procedure of choice for acute cholecystitis?

A

Ultrasound

  • Fluid around gallbladder
  • Acoustic shadow from gall stones
42
Q

Cholecystectomy

A
  • Laparoscopic
  • Does NOT require emergency operation
  • Urgent operation is what is done- 24-48 hrs
    • Make sure they are hydrated
43
Q

Common Causes of Acute Abdomen

A

—Appendicitis

—Diverticulitis

—Cholecystitis

—Pancreatitis

—Bowel obstruction

  • Small Bowel Obstruction
  • Large Bowel Obstruction
    • Colorectal cancer
    • Colonic Volvulus

—Perforated viscus

—IBD

—Ectopic pregnancy

—PID/TOA

—Gastroenteritis

—Mesenteric ischemia

—Nephrolithiasis

44
Q

Additional Causes of Acute Abdomen

A

—Cholangitis

—Pneumonia

—Acute MI

—Ovarian torsion/cyst

—Hepatitis

—Sickle cell disease

—Ureterolithiasis

—IBD: Crohn Disease

—Gastroenteritis

—Diabetic ketoacidosis

—Uremia

—Porphyria

—Intussusception

—Lupus

—HIV intestinal disease

—Mesenteric ischemia/ Infarction

SF3- EXAM 3 (Camelita) (23 decks)

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