Upper Abdominal Pain Flashcards
What are the classifications of abdominal pain based on location?
Right upper quadrant, epigastric, left upper quadrant, periumbilical, right lower quadrant, and left lower quadrant.
What is the first step in evaluating a patient with abdominal pain?
Assess ABCDE to determine if the patient is stable or unstable.
What immediate management should be done for an unstable patient with abdominal pain?
Stabilize the airway, provide supplemental oxygen, establish IV access, and continuously monitor hemodynamics.
What is the first step in evaluating a stable patient with abdominal pain?
Obtain a focused history and physical exam (H&P).
What are the key aspects of history-taking in a patient with abdominal pain?
Location, severity, chronicity, aggravating and alleviating factors, associated symptoms, and recent abdominal or GI procedures (EDG, colonoscopy, recent surgeries, or aortic abdominal aneurysm).
What are the physical exam findings of an acute abdomen?
Diffuse tenderness, rebound pain, rigidity, and guarding.
What imaging should be obtained to rule out a perforated viscus?
Upright chest x-ray or abdominal x-ray series to check for free air under the diaphragm.
What are the common causes of acute abdomen requiring emergency surgery?
Perforated viscus, abdominal sepsis, ruptured abdominal aortic aneurysm.
What is the role of exploratory laparotomy in acute abdomen?
It is both diagnostic and therapeutic.
Right upper quadrant pain is associated with what major conditions?
RIGHT UPPER QUADRANT PAIN:
* Biliary colic
* Cholelithiasis
* Acute cholecystitis
* Acute cholangitis
* Acute hepatitis
* Liver abscess
* Budd-Chiari syndrome
* Portal vein thrombosis
* Pancreatitis
* Duodenal ulcer
* Nephrolithiasis
Which labs become critical for diagnosing RUQ pain?
CBC, CMP (LFTs), LIPASE, AMYLASE
What is the classic presentation of biliary disease?
Acute onset of pain after eating a fatty meal, nausea, vomiting, and sometimes fever.
What are key risk factors for biliary disease?
Female sex, obesity, age over 40.
What physical exam finding is associated with acute cholecystitis?
RUQ tenderness with a positive Murphy sign.
What are common lab findings in biliary disease?
Leukocytosis with a left shift, elevated LFTs, and normal lipase/amylase.
What imaging modality is first-line for suspected biliary disease?
Right upper quadrant ultrasound.
What imaging findings suggest biliary disease?
Gallbladder sludge, stones, pericholecystic fluid, thickened gallbladder wall.
Gallbladder sludge or stones with no other findings is diagnostic for …?
Biliary colic.
Fever, positive Murphy’s sign with pericholecystic fluid or a thickened gallbladder wall, without jaundice is diagnostic for … ?
Cholecystitis.
A dilated common bile duct is diagnostic for … ?
Choledocholithiasis.
Fever with pericholecystic fluid or a thickened gallbladder wall, with jaundice or hyperbilirubinemia is diagnostic for … ?
Cholangitis.
What symptoms are associated with liver disease?
Nausea, vomiting, fever, RUQ tenderness, hepatomegaly, jaundice, altered mental status in extreme cases. Patients may also have substantial risk factors.
RISK FACTORS:
~ SUBSTANCE USE DISORDER
~ IMMUNOSUPPRESSION
~ CANCER
~ HYPERCOAGULABLE STATE
What CT finding is diagnostic of a liver abscess?
Peripheral rim-enhancing liver lesion in a patient with fever.
What CT finding is diagnostic of Budd-Chiari syndrome?
Hepatomegaly and thrombosed hepatic veins.
What CT finding is diagnostic of portal vein thrombosis?
Thrombus in the portal vein.
What are classic symptoms of pancreatitis?
Sudden severe epigastric pain radiating to the back, nausea, vomiting, chills, malaise.
What imaging is done for suspected pancreatitis?
RUQ ultrasound or CT scan.
What are classic symptoms of gastric conditions (e.g., GERD, gastritis, PUD)?
Burning sensation after eating, bloating, nausea, vomiting, hematemesis.
What is the Carnett sign and how is this used to help diagnose abdominal pathology?
While supine, ask the patient to tense their abdomen while lifting their head or legs. If the pain increases the source of pain is likely in their abdominal wall. A negative sign would indicate that pain is in their abdominal cavity.
Upper EGD will help to diagnose … ?
PUD, Gastritis, Duodenitis, GERD.
What hematologic conditions cause left upper quadrant pain?
Splenic conditions (splenic abscess, infarction, splenic artery aneurysm) and hematologic disorders (sickle cell anemia, lymphoma).
What is the diagnostic workup for suspected hematologic conditions?
Blood smear!
What are classic symptoms of splenic pathology?
Abdominal fullness, early satiety, fatigue, referred shoulder pain.
What imaging should be ordered for suspected splenic pathology?
Abdominal ultrasound followed by CT if needed.
What CT finding suggests splenic infarction?
Wedge-shaped hypodense lesion.
What is characteristic of a splenic abscess?
Riim enhancements and septations.
What CT finding suggests a splenic artery aneurysm?
Well-defined, round, hyperdense lesion (surgical emergency).
What is the importance of the hepatic and splenic flexures in abdominal pain?
Colon diseases can ALSO present with upper quadrant pain.
