Module 4 EB #1 Flashcards
Murphy sign
RUQ pain on deep inspiration or palpating the RUQ as they take a deep breath –> inflamed gallbladder
rovsing sign
palpation of the LLQ –> pain in the RLQ –> appendicitis
what imaging test is used to dx renal stones?
renal CT
appendicitis
-where is pain? where does it radiate to?
-periumbilical pain that later migrates to RLQ
what signs indicate appendicitis?
-pain at McBurney’s point (RLQ)
-rebound tenderness
-Obturator, Rovsing and Iliopsoas signs
-involuntary abd guarding (rigidity)
-low-grade fever
appendicitis
-symptoms
anorexia, periumbilical pain that later migrates to RLQ, N/V usually after onset of pain, prefers to remain still
appendicitis
-signs
pain at McBurney’s point (RLQ), rebound tenderness, + obturator, Rovsing, and Iliopsoas signs, involuntary abdominal guarding (rigidity), low-grade fever
appendicitis
-labs
WBC may be normal or slightly elevated
appendicitis
-diagnostic imaging
ultrasound very specific but not as sensitive as CT, useful in females to rule out gyn causes; CT more sensitive
appendicitis
-treatment
if high suspicion of appendicitis, some surgeons forego imaging prior to surgery
cholelithiasis/cholecystitis
-cause
can develop from mechanical obstruction, local inflammation, or combination of these factors
cholelithiasis/cholecystitis
-symptoms
pain is colicky, located in epigastrium or RUQ with radiation to the flanks and occasionally the R shoulder. Classic pain occurs within 1 hour after eating a large meal, lasts for several hours, and is followed by residual aching that can last for days
cholelithiasis/cholecystitis
-associated sx
anorexia, N/V, fever
cholelithiasis/cholecystitis
-signs
may have + murphy’s sign, guarding and rebound
cholelithiasis/cholecystitis
-labs
Inc WBC, total bili, ALT, Alk Phosphatase, and amylase
cholelithiasis/cholecystitis
-diagnostic imaging
RUQ ultrasound has a sensitivity >95% in detecting stones in the gallbladder. HIDA scan may show obstructed cystic duct
cholelithiasis/cholecystitis
-treatment
bowel rest (NPO), pain management, IV antibiotics
-Laparoscopic cholecystectomy, usually within 24 hours after infection is controlled
pancreatitis
-risks
history of gallstones, heavy alcohol use, HLD, some meds, abd trauma
-may be a hx of recent heavy drinking or large meal prior to attack
pancreatitis
-sx
abrupt onset of severe epigastric pain that may radiate to the back; pain is increased with movement or lying supine and patient prefers to sit up and lean forward
pancreatitis
-associated sx
N/V, sweating, and anxiety
pancreatitis
-signs
abd tenderness w/o guarding, rigidity, or rebound; distension
, absent bowel sounds; fever, tachycardia, pallor and hypotension may be present
pancreatitis
-labs
inc amylase and lipase. Inc WBC, inc ALT
pancreatitis
-diagnostic imagining
KUB, CT of abd
pancreatitis
-treatment
REFER for hospitalization