What characterizes surgical abdominal pain?
awakens pt from sleep
causes pt to pass out
pain presents prior to n/v
steady pain for >6hrs
what are the quality of pain designators and what do they mean?
Colic - intermittent
cholelithiasis, urolithiasis, gastroenteritis
what do absent bowel signs indicate?
over 2mins is an ileus due to:
what does Kehr's sign indicate?
left shoulder means lower lobar pneumonia or spleen
right pain means lower lobe pneumonia
what does Rovsing's sign indicate?
deep palpationin LLQ causes pain in RRQ may indicate appendicitis
what does a heel tap sign indicate?
heel percussion pain in the abdomen indicates possible appendicitis
what does murohy's sign indicate?
hooking the liver places pain on the aggrivated gall bladder, cholecystitis
which pathologies refer pain to the back?
splenic - shoulder point
pancreatic inflammation - mid spine
diaphragm or lower lobar pneumonia - trap
billary colic - scapula point
renal colic - renal area
uterine enlargement - sacrum
which rays should be taken for an abdominal pain pt, and when?
abdominal - flat and upright
ultrasound for blunt trauma
get the following labs:
electrolytes, bilirubin, amylase, and liver enzymes
always cbc with differential, stool guiac, urinalysis, O and P
who is at the greatest risk from diarrhea?
peds and geri's
what are the four major host defense systems in the GI tract?
gastric acidity - most effective
small bowel motility
local antibody production
what is the difference between small and large bowel diarrhea?
small - large volume, infrequent events, watery, no fever/low fever, short term
large - frequent events, small volume, mucosy poo, fever, long term
what are the two main groups of viruses that lead to gastroenteritis?
in us, gastroenteritis is generally caused by viruses. small bowel pattern
what is the major pathogen in infantile gastroentiritis?
rota virus, common in fall season
lasts five to eight days
what are the types of invasive gastroenteritis? (large bowel pattern)
what bacteria causes typhoid fever?
salmonella typhi (-)
sewage, flies, shellfish
lines intestinal wall in peyers patches
threes stages of about a week a piece
how does shigellosis present?
tenesmus (gotta-go-meow syndrome)
gripping abdominal pain
vomiting is unusual
starts as watery stool, progresses to multiple bloody stools per day
can create a toxic megacolon (>4cm)
what group of medications are contraindicated by gross bloody stool?
antiperistaltics, can create toxic megacolon
what is the leading cause of acute diarrhea worldwide?
commonly from undercooked poultry
Abrupt high fever
severe abdominal pain in RLQ
large bowel pattern
may cause febrile seizures, reactive arthritis, Guillan-Barre syndrome
what is the most common carrier of staph food poisoning?
vomiting overshadows diarrhea
small bowel pattern
what is the most fatal form of food poisoning?
found in improperly canned foods (most common in Alaska)
neurological disorders, approaching paralysis
wtf is clostridium perfingens?
exotoxin creates GI upset
sewage contaminated water ingestion
sudden onset of effortless, painless diarrhea
rice water stool
treat with doxy and rehydration
50-100ml/kg every four hours
improper temperature control
treat with antihistamines and epi
ciguatera fish poisoning
found between 35n and 35s lat
pain, NVD, parasthesia
paradoxical temperature reversal
ataxia, vertigo, paralysis
activated charcoal w/I four hours
most common etiology:
three or more unformed stools in under 24hrs
usually large bowel pattern
make best guess and treat appropriately
what are the two types of inflammatory bowel disease?
presents with chronic diarrhea
always starts in rectum
presents with abdominal pain,fever, weight loss
can lead to toxicmegadolon, could mean cancer
insidious onset, affects small intestine
abdominal pain, perianal disease
usually RLQ tenderness
occasional RLQ mass
frequent bloody stools
imbalance of mucosa lining with generally inflammatory response
epigastric discomfort relives with food and antacid
alcohol, gall stones, elevated triglycerides, high intake of refined carbs
boring and intense epigastric pain goin through to mid back
pain relieved by sitting up and leaning forward
npo/ ng suction
1L fluid/hr, then titrate to 50ml of urine/hr
Opioid analgesia, no morphine!!
etiology: gallstone formed by mostly cholesterol, some by calcium
risk factors: fat, female, preggers, estrogen use
presents with: RUQ colicky pain (fixed with cystitis) referred to back or right subscapula, Murphy's sign
stones visible on ultrasound
treat with: antispasmodic agents, analgesics (no morohine), antiemetics, referral
cystitis: npo/ng suction, IV fluids, antiemetic, analgesia but no morphine, if febrile ampicillin REFER
small bowel: adhesion from previous surgery, hernias
large bowel: cancer (most common), diverticulitis, volvulus, intussusception
presents with: obstapation, abdominal pain/distention, lack of/irregular bowel noises, bloody stools
feculant or billious vomit=small bowel obstructin
npo/ng suction, analgesic, evac/referral
etiology: most common surgical condition
fecolith, lymphatic hyperplasia, parasites, foreign body
presents with: periumbical pain, low grade moving to high fever, n/v, anorexia, RLQ pain and tenderness
Mcburney's pt, psoas sign, obturator sign, flank pain
treat with: surgery
what are the specific tests for appendicitis?
Heel percussion test
ddx for appendicitis
mesenteric adentis - pain shifts with positioning, no elevated wbc, fever, or peritoneal signs
gastroenteritis - n/v precedes pain, diarrhea, peritoneal signs rare
diverticulitis- hx of recurring symptoms, might need surgical consult to dx
UTI- cells and bacteria in urine, no peritoneal signs
Urolithiasis- migratory pain, visible on ultrasound
etiology: pancretitis, ectopic pregnancy, perforated ulcer, bacterial infection of internal organ
presents with: intense abdominal pain, tachycardia, tachypnea, fever
rebound tenderness, guarding, sepsis, and death
treat with: analgesia, broad spectrum abx (carbapenum, flagyl), npo/ng suction, Foley, referral