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Bloc E - GI & Metabolism > Feb28 M3-Acute Abdominal Pain > Flashcards

Feb28 M3-Acute Abdominal Pain Flashcards

1
Q

acute abdomen def

A

severe pain + abd tenderness bc of acute injury or disease

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2
Q

pain in acute abdomen

A

vague, colicky. can’t find comfortable position. not localized

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3
Q

common end pathway of acute abdomen

A

parietal peritoneum is inflammed and pain now localized

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4
Q

pain in pancreatitis

A

constant sharp radiating to the back

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5
Q

pain in biliary colic

A

squeezing sensation

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6
Q

pain in duod ulcer

A

gnawing achy pain

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7
Q

intermittent pain ddx

A

gas pain, ureter stone, kidney stone (spasms)

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8
Q

Murphy’s sign for what

A

acute cholecystitis (will irritate shoulder if severe enough)

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9
Q

visceral pain def

A

vague choliky

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10
Q

parietal pain def

A

felt on surface of abdomen and can be localized

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11
Q

what causes visceral pain

A

DISTENSION of hollow organ

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12
Q

visceral pain sensed how

A

autonomic splanchnic nerves afferents
SS: thoraco-lumbar
PSS: cranio-caudal(Sacral)

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13
Q

visceral pain location depending on what region affected

A

always refers to midline
foregut = epigastrium
midgut = periumb
hindgut = hypogastrium, supra-pubic

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14
Q

pain in choledocholithiasis

A

initial: epigastric discomfort + N and V
after: RUQ

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15
Q

appendicits pain

A

vague periumbilical

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16
Q

parietal pain what nerves + signs of parietal pain

A

somatic nerves
guarding voluntary or not = PERITONITIS
+ tenderness to percussion (pt reacts)

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17
Q

frequent non surgical causes of acute abd pain

A

uremia, DKA, narcotic withdrawal, drug addiction

18
Q

5 most common surgical causes of acute abd pain

A
  • acute appendicits
  • rupture viscus
  • acute pancreatitis
  • acute cholecystitis
  • acute diverticulitis
19
Q

pathophgy of appendicits

A

fecalith blocks, swelling (vague pain), venous blood pools, more swelling, arterial supply is cut, ischemia, necrosis, inflammation, appendix irritated

20
Q

true vs false diverticulum and appendix and Meckel’s is what

A

true = all layers
false = no tunica muscularis
appendix and Meckel’s = TRUE

21
Q

McBurney’s point and Rosvig sign

A

rebound tenderness showing perit irritation at 2 thirds of way from umb to ASIS
Rosvig’s = that but on opposite side

22
Q

considerations in women with acute abd pain

A

consider gyn causes

23
Q

acute appendicits gold treatment

A

usually surgical.

non operative in certain cases

24
Q

diverticular disease cause and charact

A

changes in colonic wall. FALSE diverticula. weak pts in bowel. maybe bc of diet

25
Q

diverticulosis vs itis

A 
diverticulosis = ASYMPTOMATIC presence of diverticuli
diverticulitis = perforation of diverticulum with resulting inflam
26
Q

diverticular disease pathophgy

A

tension in wall (T = PR: higher P and R), sigmoid colon pushing hard and hypertrophied and distended with time
MUCOSA HERNIATES TO VASA RECTA (vessels in mesentery)

27
Q

symptoms of diverticular disease

A
  • LEFT LQ cramp pain (bc of muscular spasm and hypertrophy)

- mild inflam if microperforation

28
Q

diverticular disease scoring

A

Hinchey classification. 4 = urgent surgery

29
Q

diverticular disease dx

A

LLQ pain, tenderness, maybe fever.

colonoscopy or CT with contrast

30
Q

complication of diverticular disease

A

diverticulitis (abcess, pus, inflam), stricture with repeated inflam and scaring. colovesical fistulas

31
Q

diverticulosis treatment

A

food bulking

32
Q

diverticulitis treatment

A 
uncomplicated = hydration, IV Abx, refer to surgeon
complicated = surgery consultation, IV Abx, hydration
33
Q

principle of pain treatment

A

treat the cause

34
Q

most popular pain drug

A

narcotis and opioids

35
Q

opioids analgesia: mech of action

A

(morphine for ex). act at 3 Rs (mu**, delta, kappa.). GPCR

36
Q

3 opioids consequences

A
  • possible resp depression
  • miosis (pupils not responding)
  • reduced GI motility
37
Q

opioids more potent than morphine

A

carfentanyl (100 000x more. nanograms)

fentanyl (give micrograms)

38
Q

codeine effect + possible used

A

constipator. can be used as antidiarrheal. metabolite generated by cyp450 is cough suppressant

39
Q

general principle of pain management

A

tylenol + NSAID (baseline control). add narcotic like morphine on top if needed

40
Q

problem of narcotics

A

can dev tolerance and start using more dose (and won’t report resp depression or constipation)

41
Q

(IMPORTANT)SIRS dx

A

2 of these 4

  • temp less 36 or over 38
  • pulse over 90
  • WBC less 4000 or over 12000 (or more 10%)
  • resp rate over 20 (or PaCO2 less 32)
42
Q

causes of systemic inflam response syndrome

A

(many)

  • infections
  • inflam states
  • nutritional factors

Bloc E - GI & Metabolism (58 decks)

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