Term
where is the pain located in pt with
lower esophageal pain
gastric and duodenal dz
small bowel pain. |
|
Definition
lower esophageal pain: subxyphoid and substernal butmay refer to back
gastric and duodenal dz: epigastric which radiates to back
small bowel pain: periumbilical. when TI is involved RLQ pain |
|
|
Term
where is the pain located in pt with
transverse colon problem
rectosigmoid porblem
colonic pain |
|
Definition
transverse colon problem: upper abdomen and periumbilical disconfort
rectosigmoid porblem: sacrum region
colonic pain: lower abdomen-LLQ |
|
|
Term
what could it be in pt with
diffuse pain in abdomen? |
|
Definition
Gen. peritonitis
metabolic disturbances
psychogenic illness |
|
|
Term
| pain receptors in the bowel, biliary tree and ureters respond to 2 things--- |
|
Definition
| dilation and inc wall tension |
|
|
Term
| severity of pain in abdomen depends on 2 things-- |
|
Definition
| speed of onset and degree of distention |
|
|
Term
| describe the pain in acute obstruction? (abdomen) |
|
Definition
| pain is severe and colicky or wave like in nature - pt appears restless |
|
|
Term
| in which small bowel obstruction is the greatest pain felt? (name the S. intestine area) |
|
Definition
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|
Term
| vomiting is More common if obstruction is ---proximal or distal...for actue small bowel obstrction |
|
Definition
|
|
Term
| what is the mechanism of obstruction when steady pain is felt in acute small bowel obst? |
|
Definition
, complete strangulation is assoc w/STEADY pain from 2° vascular
insufficiency or Peritoneal irritation. |
|
|
Term
| describe PE for pt presenting with A. Small Bowel obst. |
|
Definition
Restless
Temp may be elevated or normal
abdomen distended
hight pitch hyperactive bowel sound
tenderness to palpation (if ischemia)
stool (-) for occult blood |
|
|
Term
| which one is less painful? small bowel or large bowel |
|
Definition
|
|
Term
| which has has less or no vomitting? small or large bowel obstruction |
|
Definition
|
|
Term
| explain diarrhea, abdomen distention and constipation issues in large bowel obst. |
|
Definition
if partially obst. then diarrhea may be noticed
full obst. - constipation or change in bowel habits.
distention is greater than small bowel obstruction |
|
|
Term
| what result would you get for large bowel obst- occult blood test? explain your ans |
|
Definition
+ for blood
malignancy and diverticular disease
in cases of BO, WBC count may be normal |
|
|
Term
| describe plain Xray for SBO. |
|
Definition
no gass in large bowel distal to obstruction.
SB will be dilated with airfluid lvl sign. if ileocecal valve is compitent less SB dilation ensues |
|
|
Term
| this pt comes in with 1 hr steady acute pain in RUQ. what could be the problem? |
|
Definition
Cystic Duct Obstruction by a stone produces ACUTE pain (biliary colic).
-Gradual obstruction-PAINLESS.
-Acute obstruction is STEADY lasting >lhr p onset. |
|
|
Term
| what are 6 sx of acute cholecystitis? name the special test |
|
Definition
Fever
NV
Jaundice
RUQ pain
Scapula pain
--inspiratory arrest in response to RUQ palpation
murphy's test |
|
|
Term
| 3 lab value elevated in Acute cholecystitis. |
|
Definition
leukocytosis
elev. alkaline phosphate
slight hyperbilirubinemia |
|
|
Term
| if the bladder is palpable what does it suggest. |
|
Definition
| ductal obstruction secondary to malignancy |
|
|
Term
pt present with
cramping pain -
onset sudden
beginning in the back and flank and
radiating to the lower abd and
groin
also has abdominal pain.
what could it be? |
|
Definition
Urinary Tract Obstruction-may present as abdominal pain. Acute ureteral blockade is
uncomfortable. Onset is Sudden. Pain is cramping, beginning in the back and flank and
radiating to the lower abdomen and groin. |
|
|
Term
pt present with fever and chills + all this
cramping pain -
onset sudden
beginning in the back and flank and
radiating to the lower abd and
groin
also has abdominal pain.
what could it be? |
|
Definition
|
|
Term
pt present with
abdominal pain
lower abd distention
suprapubic pain
what could it be? |
|
Definition
| Acute bladder outflow obstruction |
|
|
Term
| 5 sx of peritoneal irritation |
|
Definition
- pain:::: sharp, aching, burning
-involuntary guarding of abd muscle
-rebound tenderness
- pt lie still because pain is accentuated by pressure changes in the peritoneum. (vs colicky pt-restless)
- BS: reduced or absent
-r/o appendicitis |
|
|
Term
| why is pain more severe in peritoneal irritation? |
|
Definition
| rich nerve innervation of parietal peritoneum |
|
|
Term
| this D/O is Autosomal recessive that causes what ? |
|
Definition
Familial Mediterranean Fever (FMF)-Autosomal recessive disorder that causes
recurrent, severe attacks of peritoneal irritation. |
|
|
Term
FMF happens in two races?
sx -- 6 of them? |
|
Definition
armenians and jews
1. fever
2. severe pain
3. synovitis
4. abdominal swelling
5. peritoneal irritation
6. pruritis |
|
|
Term
| what drug relives pain and prevent amyloid deposition and renal impairment |
|
Definition
|
|
Term
pt states that
MILD constant pain started 6 days ago
now it is severe in abdomen.
pt has no tenderness or rigidity.
pt has surgical hx of GB and appen* removal. |
|
Definition
Acute Arterial insufficiency
must check peritonitis and shock from peritoenal soilage |
|
|
Term
| what is a typical sx of chronic arterial insufficiency for abdomen? |
|
Definition
Chronic Arterial Insufficiency-May precede an acute episode of infarction
-Pt c/o:Cramping or dull Midabdominal Pain that come on 15 to 30 min AFTER a meal
and can last up to 2 or 3 hours. Abdominal Angina-occurs at max. demand for bid supply
to the bowel (p.o) Some pts LOSE WT b/c of fear of pain. Sickle Cell is also a cause. |
|
|
Term
| mesenteric infarction could have one specific sign ...what is it? |
|
Definition
| pain is constant --but no tenderness or inc pain upon palpation... |
|
|
Term
| pain radiation to the back in pt with duodenal ulcers suggests what? |
|
Definition
|
|
Term
| with gastoenteritis what type of sx are seen? |
|
Definition
| NV, Fever, hyperactive bowel sounds, occasionally focal and simulates appendicitis |
|
|
Term
| give 7 sx of irritable bowel syndrome. |
|
Definition
1.constipation alternating with diarrhea
2. pain relieved by defecation
3. more freq loose stools with onset of pain
4. feeling of incomplete evacuation
5. sx may arise from esophagus, stomach, SI, B.tree, Colon
6. psyc distrubances -anxiety, mood d/o
7. broad spectrum of presentation that results in nv, dyspepsia, flatulence, cramping abd pain, altered motility, diverticular disease |
|
|
Term
| what are causes of hepatic capsular distention? sx? |
|
Definition
from hepatic swelling 2° to hepatitis, CHF, Fatty
infiltration, or subcapsular hematoma. May result in Upper Quadrant Pain. |
|
|
Term
if pt has subdiaphragmatic peritoneal irritation.
pain radiates to ipsi! shoulder.
what should you find out? |
|
Definition
any hx of trauma in LUQ...splenic capsular distention.
Splenic trauma-deceptive period of time bfr peritoneal signs develop due to migration of blood to the peritoneum |
|
|
Term
| 2 d/o that could stimulate B.O. |
|
Definition
| porphyria and lead poisoning |
|
|
Term
this pt has
abd pain.
poorly localized and colicky
rigid abdomen
+ sign of encephalopahty |
|
Definition
| lead poisoning - peripheral neuropathy and anemia common. |
|
|
Term
lancinating pain
rectus mm spasm but normal bowel function
palpation alleviate the spasms
what would check for and what is it that you are looking for. |
|
Definition
Herpes Zoster-may be mistaken for an intraabdominal process bfr the rash appears.
-Symptoms: Pt c/o Severe lancinating pain, Rectus mm spasm simulating peritonitis but
w/o effect on bowel function. Palpation may alleviate the spasms. Pain often precedes the
rash by several days and persists after the skin clears (mainly in elderly) |
|
|
Term
a CONSTANT, ACHING, and EXACERBATED
BY MVMT or PRESSURE of the abdomen --what do you thing is underlining cause? |
|
Definition
| Abdominal wall pathology- may be trauma |
|
|
Term
| out of all the causes which causes is most dangerous in abdominal pain. |
|
Definition
vascular insufficiency
obstruction
peritoneal irritation |
|
|
Term
90% of LBO happens due to? 2 of them
75% of SBO is due to ? 2 of them |
|
Definition
LBO:diverticular dz and carcinoma
SBO: Adhesions or external hernias |
|
|
Term
| in metabolic imbalance which disease could be fatal? |
|
Definition
| ketoacidosis -- 8% present with abd pain |
|
|
Term
| 2 imp sign of nerve involvement are |
|
Definition
*2 impfsigns of nerve involvement are pain in a dermatomal distribution and
hyperesthesia; both occur w/ herpes zoster or nerve root impingement; hyperesthesia also
seen w/ focal peritoneal irritation |
|
|
Term
| what should on done on PE in pt with psycogenic pain? |
|
Definition
| deep palpation while pt is distracted |
|
|
Term
In elderly pt w/ no hx of somatizing, the presence of significant abd pain out of
proportion to tenderness suggests vascular compromise -- just a note |
|
Definition
|
|
Term
| what two type of film would you order for bowel obstruction? |
|
Definition
|
|
Term
| would sign are present for adynamic ileus on xray? |
|
Definition
| colonic obstruction with a competent ileocecal valve only the Ig bowel appears distended but if valve is not competent both the Ig and sm bowel demonstrate distention and gas, mimicking the findings of adynamic ileus; |
|
|
Term
| if xray shows large bowel obstruction what would you do next? |
|
Definition
Berium enema study.
*****contraindication: must not performe upper GI series |
|
|
Term
| how do you diff between small bowel obstruction and ileus? |
|
Definition
|
|
Term
| what is the sign for retroperitoneal bleeding? |
|
Definition
absent psoas shadow
it could be present in abscess or mass pathology |
|
|
Term
| amylase could be elevated in --4 things |
|
Definition
pancreatitis
intestinal obst
perforated ulcer
biliary tract dz |
|
|
Term
| if urine coproporhyrin test is + what do you suspect? |
|
Definition
| lead poisoning. urine coproporhyrin test is more sensitive than serum lead level |
|
|
Term
| what is watson schwartz test used for? |
|
Definition
| detects urinary porphobilinogen for acute intermittent porphyria |
|
|
Term
| RUQ + (+) alk phos -- what imaging study would u order? |
|
Definition
|
|
Term
| with lower abd pain and evidence of bleeding what must be done? |
|
Definition
|
|
Term
| if pt has flank pain and hematuria and pyuria what test should be done? (radiologic) |
|
Definition
|
|
Term
| for renal stone what test? |
|
Definition
|
|
Term
| what 3 evidence suggest that pt should be immediately hospitalized or/and call for surgical consult. |
|
Definition
peritoneal irritation
obstruction
acute vascular compromise |
|
|
Term
| to tx IBS empirically what do tell pt to do? |
|
Definition
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