Lecture 7: Abdominal Pain I Flashcards
What are the types of abdominal pain?
Visceral Pain
Parietal Pain
Referred Pain
Describe visceral pain.
Stimulation of visceral pain fibers
- distension or stretching of hollow organs
- not localized, usually midline
Describe parietal pain.
Stimulation of somatic pain fibers
- inflammation in parietal peritoneum
- localized, sharp, usually worse with movement of coughing
Describe referred pain.
Pain that originates within abdomen but felt other places
-example: duodenal and pancreatic pain felt in back
What are the more important OLDCAAARTS to focus on for patients presenting with abdominal pain?
Location: what quadrant
Aggravating/Alleviating Factors: food
What GI ROS questions should you ask a patient with abdominal pain?
Nausea Vomiting Diarrhea Black stools Blood in stools Blood in vomit
What GU ROS questions should you ask a patient with abdominal pain?
Dysuria
Polyuria
Hematuria
Flank or CVA pain
What GYN ROS questions should you ask a patient with abdominal pain?
Vaginal Bleeding
Vaginal Discharge
Last Menstrual Period
Possibility of pregnancy
What are some specific GI cases to pay attention to in a patient’s history?
Hepatitis GERD IBD Chronic abdominal pain Constipation Liver issues
What are some specific GI surgical cases to pay attention to in a patient’s history?
Abdominal: cholecystectomy, appendectomy
GYN: hysterectomy, tubal ligation, c-section, ovarian cyst
In what order should the physical exam be performed?
Inspection
Auscultation
Percussion
Palpation
What are some important landmarks to inspect for?
Xiphoid process
Costal margins
Umbilicus
ASIS
What main organs are found in the RUQ?
Liver
Gallbladder
What main organs are found in the RLQ?
Appendix
Ovary
What main organs are found in the LUQ?
Stomach
Spleen
What main organs are found in the LLQ?
Colon
Ovary
What main organs are found in the epigastric area?
Pancreas
What are some things to inspect for on the abdominal surface?
Surface and contour of abdomen
Skin color Surgical scars Striae (stretch marks) Dilated veins Rash Ecchymoses Hernias
To listen for bruits, what do you use?
Bell of stethoscope
What can absent bowel sounds indicate?
Long-lasting intestinal obstruction
Intestinal perforation
Mesenteric ischemia
What can decreased bowel sounds indicate?
Post-surgical ileus
Peritonitis
What can increased bowel sounds indicate?
Diarrhea
Early Bowel Obstruction
What can high pitched bowel sounds indicate?
Early intestinal obstruction
What can bruits indicate?
Vascular obstruction
What can friction rub indicate?
Inflammation of peritoneal surface of an organ, heard best at liver and spleen
What can venus hum indicate?
Increased collateral circulation b/t portal and systemic venous systems, heard best at epigastric and umbilical regions
When percussing the abdomen, what type of sound predominates?
Tympany: high-pitched and air filled
If the spleen is enlarged, what does it do?
Expands anteriorly, downward, and medially
If the vertical span of the liver is increased, what can that indicate?
Cirrhosis Lymphoma Hepatitis Right-sided heart failure Amyloidosis Hemochromatosis RIght pleural effusion
If the vertical span of the liver is decreased, what can that indicate?
Cirrhosis
If irregular edges or nodules are palpated on the liver, what can that indicate?
Hepatocellular carcinoma
If firmness or hardness are palpated on the liver, what can that indicate?
Cirrhosis
Hemochromatosis
Amyloidosis
Lymphoma
If dullness is percussed at the midaxillary line, what can that indicate?
Splenomegaly
What is a systematic approach to developing a broad differential diagnosis for GI issues?
VINDICATE
- Vascular
- Infection/Inflammatory
- Neoplasm
- Drugs/Degenerative
- Iatrogenic/Idiopathic
- Congenital
- Autoimmune/allergic/anatomic
- Trauma
- Endocrine/environment
What are some symptoms of bilary colic secondary to choelithiasis?
RUQ Pain
- Pain can feel sharp, crampy, or like a constant dull ache. –Colic after eating a heavy meal
- Bilious vomiting
- Positive Murphy’s sign
What are some symptoms of pancreatitis?
Epigastric abdominal pain
- bilious vomiting
- abdominal pain that radiates to your back.
- abdominal pain that feels worse after eating.
- tenderness when touching the abdomen.
What are some symptoms of ureterolithiasis?
Severe pain in the side and back, below the ribs.
- pain that radiates to the lower abdomen and groin.
- pain that comes in waves and fluctuates in intensity.
- pain on urination.
- pink, red or brown urine.
- Cloudy or foul-smelling urine.
- nausea and vomiting
- persistent need to urinate.
What are some symptoms of appendicitis?
RLQ Abdominal Pain
- pain starts in belly button move to RLQ
- low grade fever and chills
- nausea and vomiting
- loss of appetite.
- constipation or diarrhea
- inability to pass gas
- stomach swelling
