Feb28 M3-Acute Abdominal Pain Flashcards
acute abdomen def
severe pain + abd tenderness bc of acute injury or disease
pain in acute abdomen
vague, colicky. can’t find comfortable position. not localized
common end pathway of acute abdomen
parietal peritoneum is inflammed and pain now localized
pain in pancreatitis
constant sharp radiating to the back
pain in biliary colic
squeezing sensation
pain in duod ulcer
gnawing achy pain
intermittent pain ddx
gas pain, ureter stone, kidney stone (spasms)
Murphy’s sign for what
acute cholecystitis (will irritate shoulder if severe enough)
visceral pain def
vague choliky
parietal pain def
felt on surface of abdomen and can be localized
what causes visceral pain
DISTENSION of hollow organ
visceral pain sensed how
autonomic splanchnic nerves afferents
SS: thoraco-lumbar
PSS: cranio-caudal(Sacral)
visceral pain location depending on what region affected
always refers to midline
foregut = epigastrium
midgut = periumb
hindgut = hypogastrium, supra-pubic
pain in choledocholithiasis
initial: epigastric discomfort + N and V
after: RUQ
appendicits pain
vague periumbilical
parietal pain what nerves + signs of parietal pain
somatic nerves
guarding voluntary or not = PERITONITIS
+ tenderness to percussion (pt reacts)
frequent non surgical causes of acute abd pain
uremia, DKA, narcotic withdrawal, drug addiction
5 most common surgical causes of acute abd pain
- acute appendicits
- rupture viscus
- acute pancreatitis
- acute cholecystitis
- acute diverticulitis
pathophgy of appendicits
fecalith blocks, swelling (vague pain), venous blood pools, more swelling, arterial supply is cut, ischemia, necrosis, inflammation, appendix irritated
true vs false diverticulum and appendix and Meckel’s is what
true = all layers
false = no tunica muscularis
appendix and Meckel’s = TRUE
McBurney’s point and Rosvig sign
rebound tenderness showing perit irritation at 2 thirds of way from umb to ASIS
Rosvig’s = that but on opposite side
considerations in women with acute abd pain
consider gyn causes
acute appendicits gold treatment
usually surgical.
non operative in certain cases
diverticular disease cause and charact
changes in colonic wall. FALSE diverticula. weak pts in bowel. maybe bc of diet
diverticulosis vs itis
diverticulosis = ASYMPTOMATIC presence of diverticuli diverticulitis = perforation of diverticulum with resulting inflam
diverticular disease pathophgy
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)
symptoms of diverticular disease
- LEFT LQ cramp pain (bc of muscular spasm and hypertrophy)
- mild inflam if microperforation
diverticular disease scoring
Hinchey classification. 4 = urgent surgery
diverticular disease dx
LLQ pain, tenderness, maybe fever.
colonoscopy or CT with contrast
complication of diverticular disease
diverticulitis (abcess, pus, inflam), stricture with repeated inflam and scaring. colovesical fistulas
diverticulosis treatment
food bulking
diverticulitis treatment
uncomplicated = hydration, IV Abx, refer to surgeon complicated = surgery consultation, IV Abx, hydration
principle of pain treatment
treat the cause
most popular pain drug
narcotis and opioids
opioids analgesia: mech of action
(morphine for ex). act at 3 Rs (mu**, delta, kappa.). GPCR
3 opioids consequences
- possible resp depression
- miosis (pupils not responding)
- reduced GI motility
opioids more potent than morphine
carfentanyl (100 000x more. nanograms)
fentanyl (give micrograms)
codeine effect + possible used
constipator. can be used as antidiarrheal. metabolite generated by cyp450 is cough suppressant
general principle of pain management
tylenol + NSAID (baseline control). add narcotic like morphine on top if needed
problem of narcotics
can dev tolerance and start using more dose (and won’t report resp depression or constipation)
(IMPORTANT)SIRS dx
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)
causes of systemic inflam response syndrome
(many)
- infections
- inflam states
- nutritional factors
