Term
Acute apendicitis
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
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Definition
RLQ pain, anorexia, nausea, vomiting
Pain migration to RLQ, low-grade fever
+ Mcburney's, Rovsing's, psoas, obturator signs
Elevated WBC
CT scan of abdomen & pelvis, ultrasound
Appendectomy req'd |
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Term
Acute cholecystitis
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
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Definition
RUQ or epigastric pain, possible radiation to right shoulder or back
Nausea, vomiting, anorexia
Fatty food ingestion before initial pain onset
Prolonged pain with fever |
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Term
Ruptured ectopic pregnancy
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
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Definition
Hx of PID, STDs, infertility treatment, IUD, previous ectopic pregnancy
Possible amenorrhea, vaginal bleeding
Severe, sharp constant pain localized to the affected side; more diffuse abdominal pain with intraperitoneal hemorrhage
Signs of shock, peritonitis
Beta hCG testing, transvaginal ultrasound
Urgent surgical intervention |
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Term
Ruptured AAA
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
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Definition
More frequent: older, male
Risk factors: HTN, diabetes, smoking, atherosclerosis
Acute epigastric & back pain
Syncope, shock
Possible radiation to back, groin, testes
Normal-hypotensive vital signs; bruits/unequal pulses
CT preferred, FAST imaging
Urgent surgical intervention |
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Term
Acute mesenteric ischemia
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
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Definition
More frequent: elderly, CV disease, CHF, dysrhythmias
Severe ab pain that's colicky, periumbilical
Vomiting, diarrhea, abdominal angina (pain after eating)
Benign abdominal exam, + bowel sounds
Rectal exam
Leukocytosis, elevated amylase, creatine kinase, *metabolic acidosis with infarction*
CT, MRI, angiography have variable accuracy
High mortality; req's resection of ischemic bowel |
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Term
Diverticulitis
Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
|
Definition
risk factors: aging, too little fiber, not enough exercise, obesity
Pain is sudden, severe, LLQ
tenderness, fever, N&V, diarrhea, constipation
elevated WBC
CT scan
liquid diet, antibiotics, if severe primary bowel resection or bowel resection with colostomy |
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Term
Small bowel obstruction
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
|
Definition
Previous abdominal surgery, infancy/old age
Vomiting, third spacing of fluid, strangulation & necrosis of bowel, diffuse abdominal pain, distention, obstipation
Usually normal vital signs, high pitched tinkling bowel sounds
Elevated WBC, abnormal electrolytes (vomiting)
Abdominal radiographs, CT scan
Many require surgery |
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Term
Peritonitis/perforated viscus
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
|
Definition
Hx: older, PUD, diverticular disease, duodenal ulcer eroding through serosa
Caused by spillage of bowel contents
Acute onset epigastric pain, pain may localize
Shock, fever, tachycardia, diminished/- bowel sounds, board like abdomen (later stages)
Leukocytosis, elevated amylase
Imaging - Free air |
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Term
Acute pancreatitis
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
|
Definition
Alcohol abuse, biliary tract disease,
Acute boring epigastric pain radiating to back
Nausea, vomiting, relatively normal physical findings, fever, hypotension/tachypnea, usually no guarding/rebound
Flank or periumbilical ecchymosis possible
Lipase test, electrolytes, glucose O2 sat
Ultrasound - edema, pseudo cyst, biliary tract disease
CT - necrosis, abscess, hemorrhage
Volume repletion, pancreatic enzymes |
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Term
Acute nephrolithiasis
- Hx/presentation
- PMx/Sx
- Physical exam
- Confirm diagnosis? (lab studies, imaging studies) |
|
Definition
(a.k.a. ureteral colic, kidney stones)
Flank pain radiating to the groin, hematuria; paroxysms of severe pain 20-60 min duration
Pt is uncomfortable, restless; vomiting
CT
Possible urological intervention |
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Term
Generalized abdominal pain
"PAP" |
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Definition
Perforation
AAA
Acute pancreatitis |
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Term
|
Definition
early appendicitis
small bowel obstruction
acute pancreatitis
ruptured AAA
mesenteric ischemia |
|
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Term
|
Definition
duodenal ulcer/gastric ulcer
acute pancreatitis
AAA |
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Term
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Definition
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Term
|
Definition
ectopic pregnancy
diverticulitis |
|
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Term
|
Definition
acute appendicitis
diverticulitis
ureteric colic
ectopic pregnancy |
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Term
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Definition
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Term
|
Definition
diverticulitis
ectopic pregnancy |
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Term
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Definition
Perceived MIDLINE - bilateral innervation (except GB, asc & desc colon)
dull, aching, poorly localized |
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Term
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Definition
can be localized to dermatome directly above site of stimulus
sharp, well localized |
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Term
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Definition
skin hyperalgesia, increased muscle tone
visceral afferent nerve fibers enter the spinal cord close to the inputs from somatic receptors; both types of inputs activate the same spinothalamic pathway |
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Term
A 75 year old man presents to the emergency room with sever abdominal pain.
The pain is severe, periumbilical and started two hours ago. He has been having pain
that is less severe after meals for the past two weeks. He has vomited once. He has
a history of hypertension, diabetes, COPD, and peripheral vascular disease. He has had
bilateral femoral popliteal bypasses. He continues to smoke one pack of cigarettes
per day.
On physical examination, he appears acutely ill and frail. His heart rate is 110,
BP 100/60. he is afebrile. His lungs are clear. His heart exam reveals a 2/6 systolic
ejection murmur heard at left sternal border. His abdominal exam reveals
mild distention but active bowel sounds.
Laboratory studies WBC 26,000, Sodium 140 , Potassium 6, Chloride 100, and
Bicarbonate 10.
What is the most likely diagnosis? |
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Definition
| Acute mesenteric ischemia |
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