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Flashcards in acute abdomen Deck (98):
1

time range of gangrene and bowel perforation that causes symptoms from interruption of intestinal blood supply secondary to strangulation or arterial embolus

2

time range of gangrene and bowel perforation that causes symptoms from interruption of intestinal blood supply secondary to strangulation or arterial embolus

3

visceral pain

from abd viscera innervated by autonomic nerve fibers; caused by distention, inflammation, or ischemia by stimulating the receptor neurons or by direct involvement (tumor infiltration) of sensory nerves

4

slow onset, vague, dull, nauseating, poorly localized

visceral pain

5

somatic (parietal) pain

from parietal peritoneum which is innervated by somatic nerves; caused by direct irritation of parietal peritoneum by pus, bile, urine, or gi secretions from infx, chemical or inflammatory process

6

more acute and sharp, well localized

somatic (parietal) pain

7

referred pain

pain perceived distant from its source; results from convergence of nerve fibers at the spinal cord

8

peritonitis

results from any abdominal condition that causes marked inflammation

9

cc of peritonitis

acute perf, appendicitis, diverticulitis, intestinal obstruction, pancreatitis, PID, acute mesenteric ischemia, ectopic pregnancy

10

causes of infectious peritonitis

ascitic fluid or indwelling shun, drain, or catheter in peritoneal cavity

11

effects of peritonitis

causes fluid to shift into peritoneal cavity causing severe dehydration and electrolyte imbalances; ARDS can develop rapidly; liver failure, kidney failures and DIC often follow, death can occur within days

12

BS for ileus vs obstruction

ileus has dec and obstruction being normal then inc to loud borborygmi

13

signs of shock

tachycardia, hypotension, diaphoresis, confusion

14

severe pain, silent abdomen, pt lying as still as possible

suggests peritonitis

15

ecchymosis of CVA (grey turner) or umbilicus (cullen)

suggests hemorrhagic pancreatitis

16

back pain w shock

suggests ruptured AAA; helpful if tender pulsatile abdominal mass

17

shock and vaginal bleeding

may suggest ruptured ectopic pregnancy

18

test of choice

ct

19

mesenteric ischemia

interruption of intestinal blood flow by embolism, thrombosis, or low flow state; leads to mediator release, inflammation, and ultimately infarction

20

abdominal pain out of proportion to PE

mesenteric ischemia

21

tx mesenteric ischemia

embolectomy, revascularization of viable segments or resection; sometimes vasodilators helpful; high mortality

22

acute perforation

any part of GI tract; can release gastric or intestinal contents into peritoneal space

23

symptoms are sudden w severe pain quickly followed by peritonitis and sings of shock

acute perforation

24

dx of acute perforation

imaging study showing free air in abdomen

25

tx acute perforation

fluid resuscitation, abx, surgical repair; mortality is high

26

abd pain, tenderness, and anorexia

appendicitis; acute inflammation of vermiform appendix

27

dx appendicitis

ct or us

28

tx appendicitis

surgical removal

29

hernias

protrusion of abd contents through acquired or congenital area of weakness or defect in abd wall

30

gradually inc pain, n/v, tender at site; guarding, rebound

incarcerated hernias that can't be reduced

31

tx incarcerated or strangulated hernia

urgent surgical repair

32

temporary arrest of intestinal peristalsis

ileus; mc after abd surgery; peritoneal inflammation, metabolic disturbances, drugs

33

n/v, vague abd discomfort, minimal peristalsis, nontender

ileus

34

dx ileus

xray; may need contrast ct to differentiate from obstruction

35

tx ileus

NGT and IVFs, NPO, replace electrolytes

36

what is someone dx w an ileum has it for >1wk

more likely to be mechanical obstruction and should undergo laparoscopy

37

intestinal obstruction

mechanical impairment or complete arrest of passage of intestinal contents

38

cramping pain, vomiting, obstipation and not passing flatus

intestinal obstruction

39

dx intestinal obstruction

abd xray

40

tx intestinal obstruction

ngt, ivfs, bowel rest

41

mc causes of intestinal obstruction

adhesions, hernias, tumors (sbo w/out prior abd surgery)

42

what causes volume depletion w intestinal obstruction

vomiting and 3rd spaced

43

intra abd abscess

suspect in pt w previous abd trauma or surgery or prev h/o of crowns ds, diverticulitis or pancreatitis

44

abd pain, fever, malaise

intra abd abscess

45

dx intra abd abscess

abd ct

46

tx intra abd abscess

percutaneous or surgical drainage and abx

47

ischemic colitis

transient reduction of blood flow to the colon; usually >60yo caused by small vessel atherosclerosis or can be complication of AAA repair

48

symp milder and slower than acute mesenteric ischemia; llq pain followed by rectal bleedign

ischemic colitis

49

dx ischemic colitis

ct or colonoscopy

50

tx ischemic colitis

supportive w ivfs, abx, bowel rest

51

visceral pain

from abd viscera innervated by autonomic nerve fibers; caused by distention, inflammation, or ischemia by stimulating the receptor neurons or by direct involvement (tumor infiltration) of sensory nerves

52

slow onset, vague, dull, nauseating, poorly localized

visceral pain

53

somatic (parietal) pain

from parietal peritoneum which is innervated by somatic nerves; caused by direct irritation of parietal peritoneum by pus, bile, urine, or gi secretions from infx, chemical or inflammatory process

54

more acute and sharp, well localized

somatic (parietal) pain

55

referred pain

pain perceived distant from its source; results from convergence of nerve fibers at the spinal cord

56

peritonitis

results from any abdominal condition that causes marked inflammation

57

cc of peritonitis

acute perf, appendicitis, diverticulitis, intestinal obstruction, pancreatitis, PID, acute mesenteric ischemia, ectopic pregnancy

58

causes of infectious peritonitis

ascitic fluid or indwelling shun, drain, or catheter in peritoneal cavity

59

effects of peritonitis

causes fluid to shift into peritoneal cavity causing severe dehydration and electrolyte imbalances; ARDS can develop rapidly; liver failure, kidney failures and DIC often follow, death can occur within days

60

BS for ileus vs obstruction

ileus has dec and obstruction being normal then inc to loud borborygmi

61

signs of shock

tachycardia, hypotension, diaphoresis, confusion

62

severe pain, silent abdomen, pt lying as still as possible

suggests peritonitis

63

ecchymosis of CVA (grey turner) or umbilicus (cullen)

suggests hemorrhagic pancreatitis

64

back pain w shock

suggests ruptured AAA; helpful if tender pulsatile abdominal mass

65

shock and vaginal bleeding

may suggest ruptured ectopic pregnancy

66

test of choice

ct

67

mesenteric ischemia

interruption of intestinal blood flow by embolism, thrombosis, or low flow state; leads to mediator release, inflammation, and ultimately infarction

68

abdominal pain out of proportion to PE

mesenteric ischemia

69

tx mesenteric ischemia

embolectomy, revascularization of viable segments or resection; sometimes vasodilators helpful; high mortality

70

acute perforation

any part of GI tract; can release gastric or intestinal contents into peritoneal space

71

symptoms are sudden w severe pain quickly followed by peritonitis and sings of shock

acute perforation

72

dx of acute perforation

imaging study showing free air in abdomen

73

tx acute perforation

fluid resuscitation, abx, surgical repair; mortality is high

74

abd pain, tenderness, and anorexia

appendicitis; acute inflammation of vermiform appendix

75

dx appendicitis

ct or us

76

tx appendicitis

surgical removal

77

hernias

protrusion of abd contents through acquired or congenital area of weakness or defect in abd wall

78

gradually inc pain, n/v, tender at site; guarding, rebound

incarcerated hernias that can't be reduced

79

tx incarcerated or strangulated hernia

urgent surgical repair

80

temporary arrest of intestinal peristalsis

ileus; mc after abd surgery; peritoneal inflammation, metabolic disturbances, drugs

81

n/v, vague abd discomfort, minimal peristalsis, nontender

ileus

82

dx ileus

xray; may need contrast ct to differentiate from obstruction

83

tx ileus

NGT and IVFs, NPO, replace electrolytes

84

what is someone dx w an ileum has it for >1wk

more likely to be mechanical obstruction and should undergo laparoscopy

85

intestinal obstruction

mechanical impairment or complete arrest of passage of intestinal contents

86

cramping pain, vomiting, obstipation and not passing flatus

intestinal obstruction

87

dx intestinal obstruction

abd xray

88

tx intestinal obstruction

ngt, ivfs, bowel rest

89

mc causes of intestinal obstruction

adhesions, hernias, tumors (sbo w/out prior abd surgery)

90

what causes volume depletion w intestinal obstruction

vomiting and 3rd spaced

91

intra abd abscess

suspect in pt w previous abd trauma or surgery or prev h/o of crowns ds, diverticulitis or pancreatitis

92

abd pain, fever, malaise

intra abd abscess

93

dx intra abd abscess

abd ct

94

tx intra abd abscess

percutaneous or surgical drainage and abx

95

ischemic colitis

transient reduction of blood flow to the colon; usually >60yo caused by small vessel atherosclerosis or can be complication of AAA repair

96

symp milder and slower than acute mesenteric ischemia; llq pain followed by rectal bleedign

ischemic colitis

97

dx ischemic colitis

ct or colonoscopy

98

tx ischemic colitis

supportive w ivfs, abx, bowel rest