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Surgery > The Acute Abdomen and Peritonitis > Flashcards

The Acute Abdomen and Peritonitis Flashcards

1
Q

How long should you hold analgesics for an acute abdomen?

A

Until after initial surgical evaluation is done

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2
Q

What is visceral pain?

A

Slow in onset, dull, poorly localized, protracted

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3
Q

What are the primary signals for visceral pain?

A

Distension and stretch

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4
Q

What types of nerves is visceral pain mediated by?

A

Autonomic (sympathetic and parasympathetic)

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5
Q

Where are receptors for visceral pain located?

A

Mucosa or muscularis on hollow viscera and the visceral peritoneum

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6
Q

What is parietal pain?

A

Intense, acute, sharp, better localized

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7
Q

What type of nerves is parietal pain mediated by?

A

Somatic

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8
Q

What causes precisely localized parietal pain?

A

Direct irritation of parietal peritoneum by pus, bile, urine, and GI secretions

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9
Q

What is referred pain?

A

Noxious sensations perceived at a site distant from that of a strong primary stimulus

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10
Q

What does referred pain feel like?

A

Arises from a deep structure. The pain is superficial, sharp, localized, and persistent

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11
Q

What times should be asked about when taking the history of the pain?

A

At onset and at presentation

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12
Q

What is explosive pain?

A

Pain that develops within seconds

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13
Q

What is Rapidly Progressive pain?

A

Pain that develops over 1-2 hours

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14
Q

What is gradual pain?

A

Pain that develops over several hours

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15
Q

What is important to ask about N/V and pain?

A

Which came first, the pain or vomiting

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16
Q

What organs should you specifically ask if the pt still has intact?

A

Gallbladder, appendix, uterus, ovaries

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17
Q

How much of the abdomen should you expose?

A

from the nipples to below inguinal region

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18
Q

What are the stages of the abdominal exam?

A

inspection
Auscultation
percussion
palpation

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19
Q

What should you ask the patient to do and then point to area of maximal pain?

A

cough

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20
Q

What does involuntary guarding on palpation indicate?

A

Peritoneal inflammation

21
Q

What does rebound tenderness indicate?

A

peritoneal inflammation

22
Q

What are some methods to elicit peritoneal pain?

A

Push with stethoscope
Bump bed
Shake pelvis

23
Q

What is rigidity a sign of?

A

Peritonitis

24
Q

What imaging should be ordered for an acute abdomen?

A

Abdominal xrays flat and upright with pa upright cxr
Abdominal us
Pelvic US
CT of abdomen and pelvis

25
Q

What is the ddx for right upper quadrant pain?

A 
Biliary
Colon
Hepatic
Pulmonary
Renal
26
Q

What is the ddx for epigastric pain?

A 
Biliary
Cardiac 
Gastric
Pancreatic
Esophagus
Vascular
27
Q

What is the ddx for left upper quadrant pain?

A 
Cardiac
Gastric
Colon
Pancreatic
Renal
Vascular 
Splenic
Pulmonary
28
Q

What is the ddx for RLQ pain?

A 
Colonic
GYN
renal
Rectus sheath
Hematoma
29
Q

What is the ddx for umbilical pain?

A

Colonic
Gastric
Vascular

30
Q

What is the ddx for LLQ pain?

A 
Colonic
GYN
Renal
Rectus sheath
Hematoma
31
Q

What is the ddx for suprapubic pain?

A

Colonic
GYN
Renal

32
Q

What is the ddx for pain whose onset is minutes?

A

Perforated viscera, testicular or ovarian torsion, ruptured AAA, ectopic pregnancy, pancreatitis, mesenteric ischemia

33
Q

What is the ddx for pain whose onset is hours?

A

Biliary, appendicitis, diverticulitis, SBO, PUD

34
Q

What is the ddx for pain whose onset is days?

A

IBD

35
Q

What are the PE findings that indicated a surgical consult?

A

Peritonitis
incarcerated hernia
Tender abdomen with a high fever or hypotension
Suspected ischemia

36
Q

What should be done after initial assessment ?

A 
Resuscitation
Pain meds
Abx
NGT
Foley
37
Q

What is peritonitis?

A

Inflammation or suppurative response of the peritoneal lining to direct irritant

38
Q

What are the local findings of peritonitis?

A 
Acute abdomen
Abdominal tenderness
Rebound tenderness
guarding
rigidity 
distention 
Diminished bowel sounds
Free air
39
Q

What are the systemic findings of peritonitis?

A 
Fever/chills/rigors
tachycardia 
Diaphoresis 
tachypnea
restlessness
dehydration/oliguria
disorientation
shock
40
Q

What is secondary peritonitis?

A

Occurs after perforation, inflammation, infection, or ischemic injuries

41
Q

What bacteria are responsible for peritonitis from PUD?

A

Usually no bacteria for first 12 hrs (peritonitis from chemical irritation)
>12 hrs then gram + and - w/ or w/o fungus

42
Q

Fecal spoilage can be associated with what bacteria?

A

Gram - and anaerobic bacteria

Most common= ecoli, strep proteus, enterobacter-klebsiella groups, anaerobes, bacteroides fragilis, cocci and clostridia

43
Q

What is the preop treatment for secondary peritonitis?

A 
IVF
Central venous catheter
Cardiovascular agents
Mechanical vent
A-line
ABX (broad spectrum)
44
Q

How long should abx be continued post op for peritonitis?

A

Until pt has remained afebrile with normal WBC

45
Q

What is primary peritonitis?

A

Occurs in absence of GI perforation

Hematogenous spread

46
Q

What diseases is primary peritonitis associated with?

A

Cirrhosis, liver disease, nephrotic syndrome, SLE

47
Q

How is primary peritonitis diagnosed?

A

peritoneal fluid analysis for c&s

48
Q

What does imaging show for primary peritonitis?

A

free fluid without free air

49
Q

What is the treatment for primary peritonitis?

A

Abx. No surgery

Surgery (10 decks)

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