Feb28 M3-Acute Abdominal Pain

Question 1

acute abdomen def

Answer 1

severe pain + abd tenderness bc of acute injury or disease

Question 2

pain in acute abdomen

Answer 2

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

Question 3

common end pathway of acute abdomen

Answer 3

parietal peritoneum is inflammed and pain now localized

Question 4

pain in pancreatitis

Answer 4

constant sharp radiating to the back

Question 5

pain in biliary colic

Answer 5

squeezing sensation

Question 6

pain in duod ulcer

Answer 6

gnawing achy pain

Question 7

intermittent pain ddx

Answer 7

gas pain, ureter stone, kidney stone (spasms)

Question 8

Murphy’s sign for what

Answer 8

acute cholecystitis (will irritate shoulder if severe enough)

Question 9

visceral pain def

Answer 9

vague choliky

Question 10

parietal pain def

Answer 10

felt on surface of abdomen and can be localized

Question 11

what causes visceral pain

Answer 11

DISTENSION of hollow organ

Question 12

visceral pain sensed how

Answer 12

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

Question 13

visceral pain location depending on what region affected

Answer 13

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

Question 14

pain in choledocholithiasis

Answer 14

initial: epigastric discomfort + N and V
after: RUQ

Question 15

appendicits pain

Answer 15

vague periumbilical

Question 16

parietal pain what nerves + signs of parietal pain

Answer 16

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

Question 17

frequent non surgical causes of acute abd pain

Answer 17

uremia, DKA, narcotic withdrawal, drug addiction

Question 18

5 most common surgical causes of acute abd pain

Answer 18

• acute appendicits
• rupture viscus
• acute pancreatitis
• acute cholecystitis
• acute diverticulitis

Question 19

pathophgy of appendicits

Answer 19

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

Question 20

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

Answer 20

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

Question 21

McBurney’s point and Rosvig sign

Answer 21

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

Question 22

considerations in women with acute abd pain

Answer 22

consider gyn causes

Question 23

acute appendicits gold treatment

Answer 23

usually surgical.

non operative in certain cases

Question 24

diverticular disease cause and charact

Answer 24

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

Question 25

diverticulosis vs itis

Answer 25

``` diverticulosis = ASYMPTOMATIC presence of diverticuli diverticulitis = perforation of diverticulum with resulting inflam ```

Question 26

diverticular disease pathophgy

Answer 26

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)

Question 27

symptoms of diverticular disease

Answer 27

- LEFT LQ cramp pain (bc of muscular spasm and hypertrophy) | - mild inflam if microperforation

Question 28

diverticular disease scoring

Answer 28

Hinchey classification. 4 = urgent surgery

Question 29

diverticular disease dx

Answer 29

LLQ pain, tenderness, maybe fever. | colonoscopy or CT with contrast

Question 30

complication of diverticular disease

Answer 30

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

Question 31

diverticulosis treatment

Answer 31

food bulking

Question 32

diverticulitis treatment

Answer 32

``` uncomplicated = hydration, IV Abx, refer to surgeon complicated = surgery consultation, IV Abx, hydration ```

Question 33

principle of pain treatment

Answer 33

treat the cause

Question 34

most popular pain drug

Answer 34

narcotis and opioids

Question 35

opioids analgesia: mech of action

Answer 35

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

Question 36

3 opioids consequences

Answer 36

- possible resp depression - miosis (pupils not responding) - reduced GI motility

Question 37

opioids more potent than morphine

Answer 37

carfentanyl (100 000x more. nanograms) | fentanyl (give micrograms)

Question 38

codeine effect + possible used

Answer 38

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

Question 39

general principle of pain management

Answer 39

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

Question 40

problem of narcotics

Answer 40

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

Question 41

(IMPORTANT)SIRS dx

Answer 41

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)

Question 42

causes of systemic inflam response syndrome

Answer 42

(many) - infections - inflam states - nutritional factors