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NURS783 Exam 3 > Non-OB Abdominal Pain > Flashcards

Non-OB Abdominal Pain Flashcards

1
Q

How may appendicitis present in pregnancy?

A

RUQ pain may be higher d/t displaced GI system

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2
Q

What is the effect of progesterone?

A

smooth muscle relaxation –> decreased LES tone and peristalsis and increased intestinal transit time

appetite stimulant

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3
Q

What contributes to N/V?

A
  • hCG
  • estrogen
  • elevated T4
  • altered motility
  • reflux
  • emotions/psych
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4
Q

How do sodium and albumin levels change?

A

mildly decreased serum levels

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5
Q

How does hematocrit change?

A

moderately decreased blood levels –> physiologic anemia

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6
Q

How do serum bile acids, cholesterol, and triglyceride levels change?

A

mildly increased serum levels

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7
Q

ruptured ectopic

location, character, radiation, dx

A

location: lower abdomen, pelvis
character: localized, severe
radiation: none
dx: serum hCG, abdominal U/S

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8
Q

PID

location, character, radiation, dx

A

location: lower abdomen, pelvis
character: gradual onset, localized
radiation: flanks and thighs
dx: abd U/S

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9
Q

appendicitis

location, character, radiation, dx

A

location: periumbilical –> RLQ (RUQ in late pregnancy)
character: gradual onset –> focal
radiation: back, flank
dx: abd U/S, elevated WBCs

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10
Q

acute cholecystitis

location, character, radiation, dx

A

location: RUQ
character: focal
radiation: right scapula, shoulder, or back; middle of back
dx: abd U/S = thickened gallbladder wall, serum LFTs

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11
Q

pancreatitis

location, character, radiation, dx

A

location: epigastric
character: localized; deep, piercing, midline
radiation: middle of back
dx: (2 out of 3) clinical presentation, abd U/S = pancreatomegaly (CT better), serum lipase and amylase

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12
Q

perforated peptic ulcer

location, character, radiation, dx

A

location: epigastric or RUQ
character: burning, deep, piercing
radiation: right back
dx: abd U/S, laparotomy, H. pylori?

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13
Q

urolithiasis

location, character, radiation, dx

A

location: abdomen or flanks
character: intermittent, aching to severe, unremitting
radiation: groin
dx: abd U/S, urinalysis,, occasional fluoroscopy w/ contrast urography

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14
Q

What are abd pain red flags?

A

1) N/V after 20wks
2) hematemesis
3) blood in diarrhea, stool
4) jaundice

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15
Q

What labs should be ordered for abd pain?

A

1) CBC w/ diff
2) LFTs (alk phos normally elevated; ALT & AST same)
3) Cr > 1.1 = concerning
4) BMP (Na 129-143 = normal - low = concerning!)
5) amylase & lipase (lipase = better)
6) UA

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16
Q

What is the preferred dx test in pregnancy for abd pain?

A

abd U/S

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17
Q

What effect does pregnancy have on cholelithiasis?

A
  • increased cholesterol synthesis

- gallbladder hypomotility

18
Q

What is the most common cause of jaundice during pregnancy?

A

acute viral hepatitis

19
Q

What are 2nd and 3rd trimester differentials for jaundice?

A

2nd: drug hepatotoxicity and gallstone disease (e.g. acute cholecystitis, gallstone pancreatitis)
3rd: intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, HELLP syndrome

20
Q

What are differentials of RUQ abdominal pain?

A

pain characteristics important

pain + abnormal LFTs + new onset HTN = preeclampsia w/ hepatic involvement

21
Q

What are differentials of RLQ pain?

A

GI d/o: appendicitis, Crohn’s, intussusception, colon cancer, IBS

OB/GYN: ruptured ectopic, ovarian tumor/cyst rupture/torsion, endometriosis, uterine leiomyomas

renal: nephrolithiasis, cystitis

22
Q

What are differentials of N/V?

A

hyperemesis gravidarum

pancreatitis

cholelithiasis

peptic ulcer disease

acute fatty liver of pregnancy

HELLP

23
Q

Describe presentation of cholestasis

A
  • pruritus in third trimester
  • no hx chronic liver disease
  • absence of abdominal pain
  • affects hands and feet
  • mild to mod elevated serum transaminase and bili levels
24
Q

What is the most common non-obstetric surgical emergency in pregnancy?

A

appendicitis

25
Q

Why is biliary disease more common in pregnancy?

A

elevated estrogen –> gallstones, thicker bile sludge

progesterone –> muscle relaxation

26
Q

What are s/sx of biliary disease?

A
  • RUQ or epigastric pain POSTPRANDIAL
  • referred back pain
  • N/V
  • fever
  • Murphy’s sign
27
Q

What will labs for biliary disease show?

A
  • elevated WBCs

- elevated alk phos, bili

28
Q

What is tx for biliary disease?

A

conservative management w/ removal PP

*recurrent biliary colic/acute cholecystitis –> cholecystectomy

29
Q

When is the best time to perform cholecystectomy?

A

2nd trimester

1st tri –> fetal loss
3rd –> PTL

30
Q

What is the relationship b/w pregnancy and gallstones (cholesterol stones)?

A

increased cholesterol secretion into bile –> increased risk of cholesterol stones

31
Q

What are other s/sx of pancreatitis?

A 
N/V
pyrexia (fever)
mid-abdominal tenderness
abdominal guarding
hypotympany
32
Q

How is pancreatitis treated?

A

acute = mild –> IV fluids, gastric acid suppression, analgesia, NG suction, d/c PO intake

surgical = laparascopic cholecystectomy in 2nd tri

33
Q

What are other s/sx of peptic ulcer?

A
  • N/V
  • anorexia
  • early satiety
  • duodenal = eating does not improve pain
  • gastric = eating improves pain
34
Q

What is the fear w/ antacid use?

A

CAUTION

fluid overload
metabolic alkalosis

35
Q

What is tx for peptic ulcer?

A

PPIs for moderate disease

H2 receptors

avoid caffeine, alcohol, smoking, NSAIDs

36
Q

Celiac disease

A

chronic inflammation of small intestine, malabsorption issues

37
Q

Celiac disease s/sx

A

nausea, diarrhea, pale stools

*dermatitis herptiformis = rash on joints

38
Q

ulcerative colitis s/sx

A

bloody diarrhea
crampy abdominal pain
pyrexia

39
Q

Crohn’s disease s/sx

A 
diarrhea
abdominal pain
anorexia
pyrexia 
malnutrition
40
Q

What part of the GI tract is usually involved in Crohn’s?

A

terminal ileum or colon

41
Q

What are the most common causes of hematemesis?

A

1) GERD
2) gastritis
3) Mallory-Weiss tears 2/2 vomiting
4) ulcers

42
Q

What is the most common cause of rectal bleeding?

A

hemorrhoids

but also: Crohn’s, colitis, rectal fissures

NURS783 Exam 3 (8 decks)

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