EM Abdominal Pain
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| Differential Dx can be formed using ___ in presentation of abdominal pain | patient age
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| Pediatrics | Appendicitis,intussusception, gastroenteritis
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| Adults | Biliary tract dz, SBO, PUD, diverticulitis, Pancreatitis, Holiday abdomen
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| Elderly | Bowel obstruction, AAA, Neoplastic Process
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| History of pain | Location, radiation, quality, severity, Palliative or exacerbating, onset/timing
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| RUQ | Biliary colic, Perforated Duodenal Ulcer
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| Pain radiating to the groin | kidney stones
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| Pain radiating to the Back | AAA, Pancreatitis
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| Pain radiating to the Left Arm | Acute coronary syndrome
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| Neck pain | Pain from phrenic irritation
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| Sudden and Sharp pain | Acute vascular lesion, ischemia or infarction, rupture of a hollow viscous
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| Dull or Vague pain | inflammation of viscera
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| Colicky (intermittent) pain | Cholecystitis, Nephrolithiasis, SBO
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| Slow onset pain | think about inflammatory process
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| Causes of Vomiting | Severe irritation of peritoneal or mesenteric nerves, obstruction of an involuntary muscular tube (biliary duct, ureter, intestine, appendix)
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| Specific Diseases to gather hx about with abdominal pain | PUD, IBS, diverticular Dz, Hx of AA or repair of AAA, GB dz, Renal Dz, CAD
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| PE | Irregular heart beat: Afib, emobolus to mesenteric vasculature. Decreased breath sounds: lower lobe pneumonia mimicking abdominal pain. Legs flexed, staying still: peritonitis
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| Involuntary contractions of abdominal muscles indicates that it is | time for a surgery consult
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| High Hct/Hgb may indicate | dehydration, COPD
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| Low Hct/Hgb may indicate | bleeding, anemia
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| Elevated amylase | in pancreatitis, small bowel obstruction, salivary gland infection
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| Elevated LFTs | ALT/AST elevated in hepatitis, biliary/Alk Phos- common bile duct
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| Urinalysis | renal stones, hematuria. No blood does not r/o stones.
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| Imaging of Abdomen | Plain films (CXR, KUB), US, CT, Angiography, Barium Swallows, MR
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| CXR shows | Pneumonia and free air, kidney stones, GB stones (if radiopaque)
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| US is useful in | gallbladder and ovarian dz, hydronephrosis on kidney, pancreas may show dilated duct
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| ___is very sensitive to free air, and may be used for therapeutic procedures (drainage of abscess) | CT
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| Evaluation of Mesenteric Ischemia | Angiography
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| ____ is a dangerous study in perforation | Barium Studies, never place barium above obstruction.
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| Indication for Barium Studies | Volvulus, Colon Cancer, Mucosal detail
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| Common Five F's | Female, Fertile, Forty, Fat, Flatulent
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| Acute Cholecystitis | RUQ pain, hx of biliary colic, N/V, Febrile, Murphy's sign
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| Acute Appendicitis | Hx: Periumbilical pain that migrates to RLQ, Anorexia. PE: Low grade fever, RLQ (McBurney's pt), Obturator sign/psoas sign. Lab: Usually mild leukocytosis, Morbidity related to perforation with >95% perf. rate after 48 hours of sx
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| Mecke's Diverticulitis | Rules of 2: 2% of pop, 2 ft proximal to ileocecal valve, 2 types of mucosa, 2 years of age (50% cases>age 2), 2:1 M:F ratio. Tx is resection
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| Severe egigastric pain radiating to the back, often associated with ETOH, usually elevated amylase, tx is medical | Acute pancreatitis.
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| Ulcer Dz | Gastric or duodenal ulcer, epigastric pain, may present w/ bleeding obstruction or perforation, Free air on CXR, bleeding or ulcer present during endoscopy
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| Small bowel obstruction | Physiology: food or fb stuck in bowel lumen, Peristalsis causes contractions against obstruction, N/V, bilious vomiting, constipation, severely dehydrated,electrolyte abnormalities
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| PE of small bowel obstruction | distended abdomen, surgical scars (previous surgeries), high pitched bowel sounds, tympanic to percussion
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| TX of SBO | Non-operative: NPO, NGT - decompression, IV fluids
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| Large Bowel Obstruction | same physiology as SBO, presents with diffuse pain, constipation, abdomen markedly distendd, most common causes: diverticulitis, cancer, volvulus
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| Diverticulitis commonly seen where? | LLQ. Left colon. Fever. Diagnosis confirmed with CT. Tx: IVF, ABX
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| Mesenteric Ischemia | Sudden onset of abd. pain, N/V, diarrhea, GI bleeding, may have hx of postprandial angina, atherosclerosis, smoking. Pain out of proportion. Dx confirmed by angiograpy
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| Ruptured AAA | tearing sensation to back. Often present in schock. Exam reveals pulsatile abdominal mass, Rapid diagnosis with US. Surgical Emergency. >5cm - high risk. Higher assciation with COPD, diastolic hypertension
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| The most life-threatening gynecologic cause of acute abdomen | ectopic pregnancy. Get a pregnancy test: serum B-HCG
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| PID | ages 15-35, sexually active, prior hx of PID or STD, during or before menstruation, lower diffuse abdominal pain, vaginal discharge
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| PID PE | Fever, Diffuse lower abdominal pain, hyperemic cervix, "Chandelier Sign". Labs: leukocytosis, abnormal wet prep
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Created by:
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