Term
| how can acute abdominal pain be approached? |
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Definition
| the likelihood of disease (age); complaints and other associated symptoms; physical examination; laboratory tests and imaging studies |
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Term
| pain receptors in the abdomen |
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Definition
| visceral and mucosal receptors |
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Term
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Definition
on serosal surfaces within the mesentery
respond to mechanical and chemical stimuli |
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Term
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Definition
| respond to chemical stimuli |
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Term
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Definition
| visceral, referred and localized pain |
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Term
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Definition
| poorly localized in the midline |
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Term
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Definition
| in the viscera originating from a site distant from the affected organ |
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Term
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Definition
| parietal peritoneum becomes inflamed |
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Term
| what are the associated symptoms of abdominal pain? |
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Definition
constipation - bowel obstruction
fever, anorexia - appedicitis
surgical emergency - fever, protracted vomiting, syncope, or presyncope, and GI bleed |
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Term
| physical examination for abdominal pain |
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Definition
inspection (jaundice, distention, evidence of bleeding or bruising)
auscultation (bowel sounds, bruits)
palation (masses or organomegaly, hernias, guarding, rebound tenderness)
percussion
special testing
general appearance |
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Term
| physical examination cont'd |
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Definition
murphy's sign -chlesystitis
mcburney's point - appendicitis
psoas sign - appendiciis
obturators sign - appendicitis |
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Term
| common signs of appendicitis |
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Definition
RLQ pain on palpation
low grade fever
localized tenderness to percussion
guarding
psoas sign (extension of right thigh)
obturator sign (nternal rotation of right thigh)
rovsing's sign - pain in RLQ with palpation of LLQ
Dunphy's sign - pain with coughing
McBurney's point |
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Term
| Lab tests: CBC, Amylase and lipase, UA |
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Definition
CBC - infeciton or blood loss
Amylase and lipase - suspect pancreatitis
UA - hematuria, dysuria or back pain |
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Term
| Imaging studies based on quadrants |
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Definition
RUQ - ultrasound
LUQ - CT
RLQ - CT with IV contrast
LLQ - CT with oral and IV contrast
suprapubic - ultrasound
plain films to detect free air, bowel obstruction |
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Term
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Definition
pulmonary symptoms - PE or pneumonia
Urinary symptoms - UA positive -UTI or pyelonephritis
Colic - hepatobiliary or nephrolithiasis |
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Term
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Definition
fever or pain that moves from periumbilical to RLQ - peritonitis or appendicitis - CT with IV contrast
no fever or movement of pain -assess psoas sign, rigidity, rebound, guarding or pain on right side of rectum |
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Term
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Definition
fever or diverticular disease; assess for abdominal distention, tenderness and rectal bleeding
CT with oral and IV contrast |
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Term
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Definition
variety of clinical conditions
if history suggests esophageal or gastric pathology - endoscopy or upper GI series
older patinets - CT to image pancreas, spleen, kidneys, intestines, and vasculature |
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Term
| plain films of the abdomen |
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Definition
more readily available and less expensive
free air - perforated viscus
abnormal calcifications - gallstones kidney stones, appendicholiths |
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Term
| women with abdominal pain |
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Definition
| ectopic pregnancy, ovarian cysts, uterine fibroids, pelvic inflammatory disease, tubo-ovarian abcesses, endometriosis |
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Term
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Definition
| fever, leukocytosis, localize pain to the RLQ |
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Term
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Definition
| RUQ pain associated with fever and leukocytosis; older patients are more likely to prsent with generalized pain, decreased bowel sounds, a mass, rigidity, longer duration of pain |
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Term
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Definition
| midepigastric pain, decreased bowel sounds, nausea, emesis, pain radiating to back; advanced age has 20-30% mortality rate; general population has 8-10% |
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Term
| peptic ulcer disease and perforation |
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Definition
| midepigastric pain, nausea, emesis, fever, pain worse with eating or anorexia; 16% of older patinets complain of abdominal pain |
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Term
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Definition
| fever, leukocytosis, LLQ pain, incidence increases with age; 10-30% with diverticular disease will have diverticulitis or painful disease |
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Term
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Definition
generalized abdominal pain, decreased bowel sounds, distended abdomen, fever, leukocytosis
most commonly caused by adhesions from previous surgeries (50-70%)
gallstone ileus - rare cause; more common in women |
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Term
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Definition
| malignancy is most common cause |
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Term
| abdominal aortic aneurysm |
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Definition
infrarenal and extend to iliac
highest risk older men who use tobacco, have hypertension, or peripheral vascular disease and family history of abdominal aortic aneurysm |
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Term
| acute mesenteric ischemia |
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Definition
uncommon but fatal in older patients
superior mesenteric artery - more commonly affected
severe, poorly localized pain out of proportion to physical findings |
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Term
| abdominal pain in children you should look at |
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Definition
| age, pain history, recent trauma, precipitating or relieving factors, associated symptoms, gynecologic history, past health, family history (cystic fibrosis) |
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Term
| children with acute abdominal pain |
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Definition
| nausea, vomiting, fever, anorexia, change in activity level, abdominal distention, rash, diarrhea, constipation |
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Term
| common causes of pediatric acute abdominal pain |
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Definition
| colic, constipation, gasteroenteritis, streptococcal pharyngitis, UTI, pneumonia, viral illness |
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Term
| indications for surgical consult in children with acute abdominal pain |
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Definition
severe or increased abdominal pain with signs of deterioration
bile stained or feculent vomit
involuntary abdominal distention
signs of acute fluids or blood loss
significant abdominal trauma
suspected surgical cause
abdominal pain without obvious etiology |
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Term
| life threatening causes of abdominal pain in children and adolescents |
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Definition
| trauma, appendicitis, intussusception, malrotation of midgut volvulus, incarcerated inguinal hernia, adhesions, necrotizing enterocolitis, peptic ulcer disease, ruptured ovarian cyst or ovarian torsion, ectopic pregnancy, PID, foreign body ingestion, hemolytic uremia syndrome, diabetic ketoacidosis, primary bacterial peritonitis |
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