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Surgical Recall > SR 35 - Acute Abdomen and Referred Pain > Flashcards

SR 35 - Acute Abdomen and Referred Pain Flashcards

1
Q

What are peritoneal signs?

A

Signs of peritoneal irritation:

  • Extreme tenderness
  • Percussion tenderness
  • Rebound tenderness
  • Voluntary gaurding
  • Motion pain
  • Involuntary gaurding/rigidity
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2
Q

Define colic

A

Intermittent severe pain

Due to intermittent contraction of a hollow viscus against an obstruction

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3
Q

What conditions can mask abdominal pain?

A

Steroids
Diabetes
Paraplegia

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4
Q

What is the classic position of a patient with peritonitis?

A

Motionless, with knees flexed

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5
Q

What is the classic positino of a patient with a kidney stone?

A

Cannot stay still, restless, writhing in pain

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6
Q

Appropriate lab tests in acute abdomen?

A 
CBC with differential
Chem-10
Amylase
Type and screen
Urinalysis
LFTs
Pregnancy test
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7
Q

What is a left shift on CBC differential?

A

Sign of inflammatory response
Immature neutrophils (bands)
(sometimes >80% neutrophils)

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8
Q

Which x-rays are used in an acute abdomen?

A

Upright CXR
Upright AXR
Supine AXR
If patient cannot stand - left lateral decubitus AXR (need to see free air)

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9
Q

What are DDx of acute abdomen - RUQ?

A 
Cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumor, gastritis, hepatic abscess, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis
Thoracic causes (i.e. pleurisy, pneumonia), PE, pericarditis, MI (espeically inferior wall)
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10
Q

What are DDx of acute abdomen - LUQ?

A

PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurysm, thoracic causes, pyelonephritis, nephrolithiasis, hiatal hernia (strangulated paraesophageal hernia), Boerhaave’s syndrome, Mallory-Weiss tear, splenic artery aneurysm, colon disease

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11
Q

What are DDx of acute abdomen - LLQ?

A

Diverticulitis
Sigmoid volvulus, perforated colon, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic causes, appendicitis (rare)

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12
Q

What are DDx of acute abdomen - RLQ?

A

Appendicitis!!
And same as LLQ - Diverticulitis, sigmoid volvulus, perforated colon, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic causes

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13
Q

What are DDx of epigastric pain?

A

PUD, gastritis, MI, pancreatitis, biliary colic, gastric volvulus, Mallory-Weiss

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14
Q

What are the DDx of gynecologic pain?

A

Ovarian cyst, ovarian torsion, PID, mittelschmerz, tubo-ovarian abscess, uterine fibroid, necrotic fibroid, pregnancy, ectopic pregnancy, endometriosis, cancer, endometrioma, torsion of cyst or fallopian tube

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15
Q

What are the DDx of thoracic causes of abdominal pain?

A

MI (especially inferior), pneumonia, dissecting aorta, aortic aneurysm, empyema, esophageal rupture/tear, PTX, esophageal foreign body

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16
Q

What are the DDx of scrotal cause of lower abdominal pain?

A

Testicular torsion, epididymitis, orchitis, inguinal hernia, referred pain from nephrolithiasis or appendicitis

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17
Q

Non-surgical causes of abdominal pain?

A

Gastroeneteritis, DKA, Sickle cell crisis, rectus sheath hematoma, acute porphyria, PID, kidney stone, pyelonephritis, hepatitis, pancreatitis, pneumonia, MI, C. difficile colitis

18
Q

What is the DDx for a patient with AIDS and abdominal pain?

A 
All common causes +
CMV (most common)
Kaposi's sarcoma
Lymphoma
TB
MAI (Mycobacterium Avium Intracellulare)
19
Q

What is the DDx of suprapubic pain?

A

Cystitis, colonic pain, gynecologic causes (and appendicitis)

20
Q

What is gastroenteritis?

A

Viral or bacterial infection of the GIT
Associated with vomiting (after pain) and diarrhea
Non-surgical

21
Q

Classic location of referred pain - Cholecystitis?

A

Right subscapular pain (also epigastric)

22
Q

Classic location of referred pain - Appendicitis?

A

Early - periumbilical

Rare - testicular pain

23
Q

Classic location of referred pain - Diaphragmatic irritation?

A

Shoulder pain (+ Kehr’s sign on the left)

24
Q

Classic location of referred pain - Pancreatitis/cancer?

A

Back pain

25
Q

Classic location of referred pain - Rectal disease?

A

Pain in the small of the back

26
Q

Classic location of referred pain - Nephrolithiasis?

A

Testicular pain or flank pain

27
Q

Classic location of referred pain - Rectal pain?

A

Midline small of back pain

28
Q

Classic location of referred pain - Small bowel?

A

Periumbilical pain

29
Q

Classic location of referred pain - Uterine pain?

A

Midline small of back pain

30
Q

Classic diagnosis?

Abdominal pain out of proportion to exam

A

Rule out mesenteric ischemia

31
Q

Classic diagnosis?

Hypotension and pulsatile abdominal mass

A

Ruptured AAA

Go to the OR

32
Q

Classic diagnosis?

Fever, LLQ pain, and change in bowel habits

A

Diverticulitis

33
Q

Test of choice?

Cholelithiasis

A

US

34
Q

Test of choice?

Bile duct obstruction

A

US

35
Q

Test of choice?

Ruptured AAA

A

NONE - emergent laparotomy

36
Q

Test of choice?

AAA

A

Abdominal CT or US

37
Q

Test of choice?

Abdominal abscess

A

Abdominal CT

38
Q

Test of choice?

Severe diverticulitis

A

Abdominal CT

39
Q

What is the most common cause of RUQ pain?

A

Cholithiasis

40
Q

What is the most common surgical cause of RLQ pain?

A

Acute appendicitis

41
Q

What is the most common GIT LLQ pain?

A

Diverticulitis

42
Q

What endocrine problems can cause abdominal pain?

A

Addisonian crisis

DKA

Surgical Recall (32 decks)

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