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29 Cards in this Set
- Front
- Back
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Acute Abdomen
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A severe, often life threatening disease of abdominal organs, the primary symptom of which is pain
Traditionally connotes surgically treated diseases, but not all are surgically treated |
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Etiologies for the acute abdomen
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Inflammation (ie abscess, perforation)-spillage of gi contents etc
Ischemia/ Necrosis Obstruction / Distention-viscera is sensitive to stretch. Bleeding: Intraperitoneal-blood is irritant Intraluminal |
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Visceral Pain
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Visceral pain is deep, dull and crampy
Stretch of the viscera, obstruction leading to dilatation etc. Ischemia causes pain by cell death. Contraction against obstruction |
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Parietal Pain
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Trauma to peritoneum,
Infection / inflammation, Irritants Parietal pain is sharp, focal, intense, constant |
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Referred Pain
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Sensation of pain in a somatic distribution (dermatome or myotome) derived from the same spinal cord segments as the inflamed peritoneum (visceral or parietal)
Example: Small bowel pain perceived as diffuse discomfort in T10-12 dermatomes of back and anterior abdominal wall |
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Episodic pain can be indicative of
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obstruction
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Steadily progressive pain can be indicative of
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ischemia, peritoneal inflamm
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Colicky, changing to steady pain can be indicative of
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intestinal strangulation
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Sudden relief of pain can be indicative of
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relief of obstruction or perforation
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Instantaneous...
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perforation of hollow viscus or rupture of solid organ
ex:duodenal perf, cecal perf, splenic or hepatic rupture |
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Episodic pain can be indicative of
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obstruction
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Steadily progressive pain can be indicative of
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ischemia, peritoneal inflamm
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Colicky, changing to steady pain can be indicative of
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intestinal strangulation
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Sudden relief of pain can be indicative of
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relief of obstruction or perforation
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Instantaneous...
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perforation of hollow viscus or rupture of solid organ
ex:duodenal perf, cecal perf, splenic or hepatic rupture |
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Rapid onset pain (not instantaneous)
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Hollow organ obstruction
Inflammatory process Toxic or metabolic SBO, ureteral colic, sickle cell, porphyria, peritoneal blood, leaking perforation |
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Gradual onset of pain
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Chronic (non surgical) processes
Progressive inflammation Appendicitis, cholecystitis, PID |
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Iliopsoas sign
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lower quadrant inflamm processes- like appendicitis
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Obturator Sign
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same as iliopsoas
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Femal Pelvic Sources- operative
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ruptured ectopic pregnancy or ruptured cysts
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Female pelvic sources- non operative
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PID/Salpingitis, endometriosis, mittelmerz, tubovarian abcess
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Intra abdominal causes of pain
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Primary peritonitis
Porphyria, sickle cell crisis, polyserositis, uremia, DKA Neutropenic colitis Rectus hematoma Addison’s crisis |
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Extra abdominal causes of pain
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Pneumonia, pleural inflammation
PE, MI, pericarditis, esophagitis Toxins Herpes zoster |
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Gastrointestinal causes of pain
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Appendicitis, intestinal or colonic obstruction, strangulated hernia
Peptic ulcer disease (perforation) Diverticulitis Acute gastritis / gastroenteritis Intestinal perforation |
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When to use CT in evaluation of Abdominal pain
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For undifferentiated abdominal pain
For appendicitis VS ultrasound |
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Geriatric Pt common Dx
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Diverticulitis 18%
Bowel Obstruction 18% Nephrolithiasis 10% Gallbladder disease 10% |
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Causes of bowel obstruction
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Adhesions from prior surgery or peritonitis
Hernia* Anatomic Colonic obstruction Mass Volvulus* |
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Hernia
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Any defect in the abdominal wall that may allow peritoneal contents to protrude through the defect.
Inguinal Umbilical Incisional Many are chronic, minimally symptomatic Complications Incarceration: contents fixed or not reducible Strangulated: contents with vascular compromise |
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Volvulus
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Any twisting of the bowel on its own mesentery
Sigmoid, cecal Causes vascular compromise with pain and obstruction Requires reduction With endoscopic approach Recurs frequently Often requires surgical resection |
