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96 Cards in this Set
- Front
- Back
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Refers to any acute condition within the abdomen that requires immediate medical or surgical attention
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Acute Abdomen
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In acute abdominal pain to establish a complete and accurate diagnosis note the following:
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Age
Gender PMH Precipitating Factors Location of pain /radiating discomfort Associated Vomiting Altered bowel habits Chills/Fever Physical exam findings |
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Abdominal pain without other S/S is ?
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Rarely a serious problem
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Alarm signs that suggest a serious problem?
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Weight Loss
GI bleeding Anemia Fever Frequent Nocturnal symptoms Onset of symptoms in pt >50 |
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The most commom abdominal conditions requiring surgical intervention?
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Appendicitis
Cholecystitis Perforated paeptic ulcer |
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Other abdominal condiditons that require surgery?
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Acute intestinal obstruction
Torsion of Perforation of a viscus Ovarian torsion Tumors Ectopic Pregnancy Dissecting or ruptured aneurysms Mesenteric occlusion Bowel Embolization Bowel Infarction |
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Abdominal pain in the RUQ most frequently suggests.
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Cholecystitis
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If the abd pain is aggrevated by movement.
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Appendicitis
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The most common causes of abdominal pain
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Appendicitis
NSAP |
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The best test question used to differentiate NSAP and Appendicitis
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Is the pain aggrevated by coughing or movement
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Abdominal pain that is aggravated by coughing or movement is probabley caused by:
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Peritoneal inflammation
Appendicitis |
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Best Test signs in diff. diagnosis include:
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Palpable mass
Hyperatice Bowel Sounds Reduced Bowel Sounds Involuntary Guarding in RLQ |
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Palpable mass
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Diverticular disease
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Hyperactive Bowel Sounds
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Small Bowel Obstruction
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Reduced Bowel Sounds
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Perforation
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Involuntary Guarding in RLQ
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Appendicitis
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Most common causes of acute surgical abdomen in patients over 70:
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Strangulated Hernia
Intestianl obstruction |
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Common cause of NSAP in elderly patients > 50.
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Cancer
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Cancer should be strongly exspected if:
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1. > 50
2. PMH of unexplained abd pain 3. Present pain > 4 days 4. If constipation is present |
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Has a peak incidence in the second decade of life
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Appendicitis
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Incidence increases with age and is most frequesnt cause of acute abdominal pain in patients over 50
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Cholecystitis
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Cholecystitis is more common in whites or blacks? more prevelant in males or females?
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Whites
Females |
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Cholecystits is more common in what group of women:
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Females taking oral contraceptives or estrogens
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Drugs than increase cholesterol saturation also increase the incidence of ?
(Clofibrate, Atromid-s, Conjugated Estrogens, Estrogen porgesterone combinations) |
Cholecystitis
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Seems to be most common in young women with children
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Irritable colon
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Adb pain is
vague discomfort or pain in the left LLQ, RLQ, or midabdomen. May radiate to the back. May be releaved by defacation |
Irritable colon
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Abd pain may be associated with
1. mucus in the stool 2. constipation alternaing with diarrhea 3. small marble like stools |
Irritable colon
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This condition is most common b/w ages 30 and 50 but may occur in teenagers and rarely in young children
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Peptic Ulcer Pain
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Peptic ulcer pain is more common in men or women?
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Men
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This condition occurs in all age groups
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Acute Intestinal Obstruction
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In the elderly intestinal obstruction is usually caused by ?
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1. Strangulated hernias
2. cancer |
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In any patient with severe abd pain and a hx of abd surgery what is the most likely cause of intestinal obstruction?
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Adhesions
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Occures most frequently in alcoholics and those with gallstones
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Pancreatitis
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More common in males, mentally handicapped patients and pts with parkinsomism. Intes. obs. from twising.
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Sigmoid volvulus
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More common in females-intestinal obstruction from twisting or rotation of the cecum.
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Cecal volvulus
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Causes small bowel obstruction more often in elderly and in women.
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Gallstone Ileus
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Mesenteric adenitis is more common in what age group?
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Children
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Peptic esophagitis is more common in what patients?
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Obese
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The incidence of diverticulitis increases with age, this disorder is more common after what age?
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60
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Pain that develops in the evening and is usually a steady midepigastric or RUQ pain.
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Biliary Colic
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Colicy or crampy pain that begins in the midabdomen and progresses to a constant pain in the RLQ suggests:
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Appendicitis
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Colicy or crampy pain that progresses to a constant pain in the RUQ suggests:
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Cholelithiasis
Cholecystitis |
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Colicy or crampy pain which involves excruciating pain that frequently radiates to the groin, testes, or medial thigh.
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Intestinal obstruction
Ureterolithiasis |
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Constant buring or gnawing pain in the midepigatrium and occasionally associated with posterior radiation is seen with?
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Peptic Ulcer
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Pain induced by percussion in the epigastrium may be the only physical finding to suggest?
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Peptic Ulcer
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Severe exacerbation of Pain induced by percussion over the RUQ strongly suggests the presence of an?
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Inflamed Gallbladder
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Name the Rome II criteria.
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1. 12 wks of symptoms in preceding year
2. Change in freq. or form of stool 3. Bloating 4. Pain that is dull, crampy, and recurrent |
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Rome II criteria suggests what condition?
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Irritable bowel syndrome
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In elderly patients what condition may exist with similar symptoms as irritable bowel syndrome?
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Diverticulitis in elderly patients may have similar symptoms as irritable bowel.
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Most abd pain -even severe- usually develops over several hours.....when onset of severe abd pain is abrupt it suggests?
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1. perforation
2. strangulation 3. torsion 4. dissecting aneurysms 5. Ureterolithiasis |
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The most severe abdominal pain occurs with 2 conditions?
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1. dissecting aneurysms
2. ureterolithiasis |
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Tearing or ripping sensation that may radiate into the legs and through the torso to the back and pt may be in profound shock....
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Dissecting aneurysms
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Pain is sually unilateral in the flank, groin, or testicle and is often associated with nausea and occasional vomiting.
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Ureterolithiasis
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Writhing in agony but do not experience cardiovascular collapse.
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Ureterolithiasis
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Abd pain in the RUQ is most frequently seen in (3)?
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1. cholecystis
2. cholelithiasis 3. duodenal ulcer |
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Radiation of RUQ pain to the inferior angle of the right scapula?
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Gallbladder disease
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Hepatitis and congestive heart failure may have pain in?
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RUQ
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Myocardial infarction may present with pain in
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RUQ
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Less severe RUQ pain that is releaved with the passage of flatus?
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Hepatic flexure syndrome
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A gnawing, burning, midabdominal to upper abdominal pain sugests a condition with a ____etiology
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Peptic
-ulcer -gastritis -esophagitis |
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Buring epigastric pain that radiates to the jaw
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Peptic esophagitis
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Severe upper abdominal pain that radiates into the back and is associated with Nausea and vomiting. Worse when lying/improves when pt leans forward.
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Pancreatitis
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LUQ pain is most frequently seen in patients with?
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Gastroenteritis
Irritable colon |
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Pain may be in LUQ or in the chest. Pain tends to start when pt bends over, tight garment. Relieved by flatus.
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Splenic flexure syndrome
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RLQ pain is most often seen with (4)?
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1.muscle strain
2. appendicitis 3. salpingitis 4 diverticulitis (usually LLQ) |
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LLQ pain may be seen with (2)?
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Irritable colon
Diverticulitis |
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Common causes of central abdominal pain include(4).
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1 early appendicitis
2 small bowel obstruction 3 gastritis 4. colic |
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Pts with this condition experience less vomiting and greater distention.
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lower intestinal obstruction
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Vomiting soon after the onset of pain/vomitus light in color/ consists of digestive juices and bile/ =(3)
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Gastritis, Cholecystitis, or obstruction
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Jaundice, dark urine, and light to acholic stools(pale or clay colored) may be seen in patients iwth abdominal pain caused by
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Cholecystitis
Complete biliary obstruction should be expected |
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Hx of occasional silver colored stools alternating with normal or light colored stools
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Carcinoma of the ampulla of vater.
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location of intestinal obstruction---
undigested food in the vomitus |
obstruction is proximal to the stomach. May result from achalasia or peptic esophagitis
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Vomitus with undigested food and does not contain bile.
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Pyloric obstruction
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Brown vomitus with a fecal odor suggests:
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Mechanical or paralytic bowel obstruction.
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The more frequent the vomitting, the more ______ the obstruction.
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proximal
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The pain of ______ is worsened by ingestion of most food, exp alcoholic beverages.
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Gastritis
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____ _____ pain begins an hour or so after eating and is generally relieved by eating.
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Peptic ulcer
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If epigastric pain primarily occurs or is worsened in the recumbant position ...suspect.
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peptic esophagitis (GERD)
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Abdominal wall pain can be diagnosed by a positive
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Carnett test
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Rebound tenderness over McBurneys point & involuntary guarding
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Appendicitis
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Guarding in the RUQ and tenderness on palpation and percussion suggests?
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Cholecystitis
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No abnormal findings except pain on gentle percussion over the midepigastrium or duodenal sweep.
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Peptic Ulcer
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In pt with peptic ulcer, peritonitis develops secondary to perforation of the involved viscus. If viscus penetrates: anteriorly=
Posteriorly= |
Anteriorly= extreme rigidity fo the abd wall
Posteriorly=back pain is the major symptom |
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Most fregquently seen in post op patients and pt with severe hyperkalemis or diabetic ketoacidosis
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Atonic Gastric Dilation
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Classic Triad
-abdominal tenderness -palpable mass in LLQ -fever |
Acute Diverticulitis
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Costovertebral angel (CVA) and ileus tenderness
Dx usually confirmed by Hematuria |
Ureterolithiasis
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No significant physical findings
DX made by careful hx Palpable tender ascending or descending colon. |
Irritable colon
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If an acute surgical abdomen is suspected but dx is unknown...what should be ordered?
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1. electrocardiogram
2. chest and abdominal radiograph 3. BUN, 4.CBC with diff, 5.electrolytes, 6.serum amylase level (if pancreatitis is susp.) 7. urine and stool tests |
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In pt over 50 years of age with recurrent nonspecific acute abdominal pain what should be done?
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Stool examination for occult blood and colonoscopy to detect cancer
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What lab tests should be ordered with susp. dx of Appendicitis
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1.CBC with diff
2.helical computed tomography (CT) scans 3. Ultrasonography |
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What lab tests should be ordered with susp. dx of cholecystitis
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1. CBC with diff
2. isotopic and ultrasonographic scanning |
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What lab tests should be ordered with susp. dx peptic ulcer
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1. upper GI radiographs
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What lab tests should be ordered with susp. dx of perforated peptic ulcer
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1. radiographs to reveal free air
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What lab tests should be ordered with susp. dx of Acute obtestinal obstruction
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1. abdominal radiographs
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What lab tests should be ordered with susp. dx of uterolithiasis.
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1. intravenous pyelography
2. microscopic urinalysis |
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What lab tests should be ordered with susp. dx pancreatitis
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1. serum anylase level
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