powerpoints CA Flashcards
More adult patients visit the ED for _________ than for any other CC
“stomach and abdominal pain, cramps, or spasms”
influence both incidence and clinical expression of abdominal disease
Demographics (age, gender, ethnicity, family history, sexual orientation, cultural practices, geography)
__________ is often required to make a specific diagnosis
imaging
Best way to practice a GI exam
Thorough approach
Logical approach
LOCATION of the pain drives the evaluation
Begin the evaluation by ruling out serious disease and/or surgical conditions
what drives the evaluation
LOCATION
STEPS of Triage and Transfer
Step 1: Is the patient critically ill?
Check ABCs, resuscitate if needed
Step 2: Acute abdominal pain may need transfer to acute care facility if…
- -> Suspected surgical abdomen
- -> Requiring resuscitation or IV analgesia
Step 3: Less acute illness, often detailed history and initial assessment
what is life threatening in the album?
- -> ruptured appendix
- -> malignancy: not usually acute though
- ->AAA: will radiate to back
- -> mesenteric ischemia: block blood flow to abdomen
- -> hypo profusion: acute blood loss… abdomen gets left out from blood flow
what is a sterile spot
stuff in the abdomen…
Cognitive impairment secondary to dementia Intoxication Psychosis Intellectual disability Autism Patients w/ aphasia or language barriers Older adults (physical or laboratory findings may be minimal) Spinal cord injury patients Asplenic patients Neutropenic patients Transplant patients Immunosuppressed patients (eg, HIV) Immune-suppressive or immune-modulating medications (eg, steroids, chemotherapy agents)
HIGH risk groups
this is an LO:
8. Identify and recognize high-risk patients in which critical illness may be “camouflaged” by their medical/physical/mental condition
Critical illness in high risk pt may be
camouflaged
Requires understanding of possible mechanisms responsible for pain
Broad differential of common causes (abdominal and extra-abdominal causes)
Recognition of typical patterns and clinical presentations
Consider unusual causes, especially in older adults and immunocompromised patients
Differential Diagnosis
Pain receptors in the abdomen respond to (2)
- Mechanical stimuli (eg, stretch, distention, contraction, traction, compression, torsion)
- Chemical stimuli due to inflammation or ischemia
TRUE or FALSE: multiple stimuli may be occurring at once
TRUE
what about not understood pain?
Perception of pain not completely understood:
Psychologic factors likely important factor
3 types of pain
visceral
parietal
referred
dull, aching, can be colicky, poorly localized; arises from distension of hollow organ (eg, bowel obstruction)
when pushing deep
visceral
sharp, very well localized; arises from peritoneal irritation (eg, appendicitis)
inflammation of peritoneum
parietal
aching, perceived to be near surface of body (eg, cholecystitis referred to right scapula)
referred
aka gallbladder and scapula
ADD PICTURE FROM SLIDE 10!
…..
What is included in the Pain Hx.?
Location, Location, Location!
Key to formulating DDx list!
Where does the patient POINT to?
Do they point with one finger or use their whole hand (specific vs vague)
what are the locations pain can be (8)
RUQ LUQ RLQ LLQ Epigastric Periumbilical Suprapubic Diffuse
add picture from slide 14
….
what organs are in the RIGHT UPPER QUADRANT
Liver, gallbladder Pylorus, duodenum Head of pancreas Ascending/transverse colon Right kidney/adrenal
what organs are in the LEFT UPPER QUADRANT
Liver (left lobe) Spleen Stomach Body of pancreas Descending/transverse colon Left kidney/adrenal