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Abdominal Pain Questions And Answers Latest Update 2024/2025
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Abdominal Pain Questions And Answers Latest Update 2024/2025
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Abdominal Pain Questions And AnswersLatest Update 2024/2025
What is an "acute abdomen"?
Acute abdominal pain so severe that the patient seeks medical attention (Note: not the same as a
"surgical abdomen," because most cases of acute abdominal pain do not require surgical treatment).
What is visceral pain?
Originating from interior organs
Aching, Poorly localized, Often accompanied by autonomic responses (vomiting, nausea, pallor,
diaphoresis)
What is parietal pain?
Parietal pain arises from the parietal peritoneum. This pain is more localized and intense than visceral
pain. Nerve fibers from the parietal peritoneum travel with peripheral nerves to the spinal cord, and the
sensation of pain corresponds to skin dermatomes T6 and L1.
What are peritoneal signs?
Signs of peritoneal irritaion: extreme tenderness, percussion tenderness, rebound tenderness, voluntary
guarding, motion pain, involuntary guarding/rigidity (late).
What are the types of peritonitis?
Primary / Spontaneous Peritonitis
-Source outside abdomen (ex. Cirrhosis)
Secondary Peritonitis
-Intra-abdominal pathology (ex. Perforation of the appendix)
Tertiary Peritonitis
-Persistent infx d/t inadequate tx of secondary peritonitis
What is rebound tenderness?
Pain upon releasing the palpating hand pushing on the abdomen.
What is motion pain?
,Abdominal pain upon moving, pelvic rocking, moving of a stretcher, or heel strike.
What is voluntary guarding?
Abdominal muscle contraction with palpation of the abdomen.
What is involuntary guarding?
Rigid abdomen as the muscles "guard" involuntarily.
What is colic?
Intermittent severe pain (usually because of intermittent contraction of a hollow viscus against an
obstruction).
What conditions can mask abdominal pain?
Steroids, diabetes, paraplegia
What is the most common cause of acute abdominal surgery in the US?
Acute appendicitis (7% of the population will develop it sometime during their lives)
What should the acute abdomen physical exam include?
Inspection (e.g. surgical scars, distention)
Auscultation (e.g. bowel sounds, bruits)
Palpation (e.g. tenderness, R/O hernia, CVAT, rectal, pelvic exam, rebound, voluntary guard, motion
tenderness)
Percussion (e.g. liver size, spleen size)
What is the classic position of a patient with peritonitis?
Motionless (often with knees flexed).
What lab tests are used to evaluate the patient with an acute abdomen?
CBC with differential
Chem-10
Amylase
Type and screen
, Urinalysis
LFT's
What is a "left shift" on CBC differential?
Sign of inflammatory response: immature neutrophils (bands)
Many call >80% of WBCs as neutrophils a "left shift"
What lab test should every women of childbearing age with an acute abdomen receive?
Human chorionic gonadotropin (beta-hCG) to rule out pregnancy/ectopic pregnancy
Which x-rays are used to evaluate the patient with an acute abdomen?
Upright chest x-ray, upright abdominal film, supine abdominal x-ray (if patient cannot stand, left lateral
decubitus abdominal film).
How is free air ruled out if the patient cannot stand?
Left lateral decubitus--free air collects over the liver and does not get confused with the gastric bubble.
What diagnosis must be considered in every patient with an acute abdomen?
Appendicitis
What differential diagnoses should you suspect for RUQ pain?
Cholecystitis
Hepatitis
PUD
Perforated ulcer
Pancreatitis
Liver tumors
Gastritis
Hepatic abscess
Choledocholithiasis
Cholangitis
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