Exam 3 Abdominal Pain Flashcards
Characteristics of Visceral pain? (3)
Dull, ache, colic
Poorly localized, periumbilical
Distention or spams of hollow organ
Characteristics of Parietal (Somatic) pain? (3)
Sharp
Well demarcated
Peritoneal irritation/Somatic innervation
Characteristics of Referred pain? (2)
Distant site, somatic, similar nn level
Aching, perceived near body surface
Sharp/localized pain a/w? (3)
ischemia, inflamm, stretch of peritoneum
Dull/diffuse pain a/w?
Visera: wall of hollow organs, capsules of solid organs
Obstruction presents as? (8)
Pain Anorexia Bloating N/V Obstipation High-pitched or no BS Tympany percussion Dilated proximal bowel loops
Emergencies? (7)
Perforation Ruptured AAA or Ectopic Obstruction Toxic mega colon Appendicitis Ovarian torsion Acute mesenteric ischemia
Urgent? (5)
Cholecystitis/Cholangitis Pancreatitis Hepatitis Diverticulitis PUD/Gastritis
Abd pain labs? (6)
CBC w/ diff CMP LFT: AST/ALT, Alk Phos, Total Bili Amyl, Lipase UA! Preggo
Abd pain imagining? (3)
XRay
CT (better for obstruction)
US
Abd pain exam should include? (8)
Vitals Appearance/level of discomfort Position while in pain Movement or lack of Eyes Lungs Heart Abd
Abd pain ABDOMINAL exam should include?
Inspection BS Percussion Palp noting guarding/rigidity RECTAL PELVIC
Abd pain ABX?
Cefazolin
Cefotin
Cefotetan
Ampicillin-Sulbactam (UNASYN)
Abd pain DDX: RUQ? (9)
Cholecyctitis Cholangitis Biliary colic Pancreatitis Hepatitis PNA Abscess Hepatic congestion Budd-Chiari
Abd pain DDX: LUQ? (6)
Spleen abscess or inflamm Gastritis Gastric ulcer Pancreatitis PNA MI
Abd pain DDX: RLQ? (8)
Appendicitis Salpingitis Ectopic preg Inguinal hernia Nephrolithiasis IBD Mesenteric adenitis Tiflitis/Cecitis
And pain DDX: LLQ? (8)
Diveriticulitis Salpingitis Overian cyst rupture Ectopic preg Inguinal hernia Nephrolithiasis IBS IBD
Epigastric pain DDX? (9)
PUD GE reflux Esophagitis Hiatal hernia Gastritis Pancreatitis MI Pericarditis AAA
Periumbilical pain DDX? (4)
Early appendicitis
Gastroenteritis
Bowel obstr
AAA
Low Mid Abd pain DDX? (2)
Bladder distention
Cystitis
Diffuse abd pain DDX? (8)
Gastroenteritis Mesenteric Ischemia Metabolic Malaria FMF Peritonitis IBD Obstruction
Appendicitis primary imaging?
CT
Mesenteric Adenitis is?
Presents?
Tx?
Inflamm of mesenteric lymph nodes
Mimics appendicitis
No surgery needed
Typhlitis is?
Presents?
Tx?
Inflammation of the cecum from necrotizing enterocolitis
Mimics appendicitis
Abx
Surgery only if complicated
SBO Extraluminal causes? (6)
Adhesions CA Hernia Bands Malrotation Abscess
SBO Intrinsic causes? (4)
Intussception
CA
Crohn’s
Inflamm/Ischemic strictures
SBO initial management?
NG tube
IV fluids w/ e-
Serial exams: physical, imaging
Surgery if sxs worsen, peritoneal signs, unresolved w/ NG tube
Acute Abd Pain management? (6)
NPO IV NS Pain meds No NSAIDS PPI Phenergan/Zofran
Pain meds for acute abd pain?
Dilaudid
Morphine Sulfate
Demerol
Toradol (renal stones)
Pain before vomiting U a/w?
Pain after vomiting U a/w?
surgical abd
non-surgical illness
Pain lasting > 6 hrs should be considered what?
acute abd until proven otherwise
