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Flashcards in Abdominal Pain Deck (13)
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1
Q

Visceral peritoneum

A

Predominately medaited by unmyelinated C-fibers

Pain is dull, cramp or aching

Pain receptors on serosal surfaces of the abdemon, mesentery

Visceral pain perceived along the spiunal segments where visceral affarent nerves enter the spinal cord

Most GI is perceived at midline

Pain from one structure will be able to be lateralized bc only one side

Referred pain becasue visceral and somatic synapse on same dorsal horn nuclei and impulses transmitted via the spinothalamic pathway to the brain

2
Q

Right shoulder
Left should
Left lower chest and midline mid back

A

Diaphrag irriation from ulcer, liver, cholecystitis

Diaphrag irritation from ulcer or splenic rupture

Stomach/duodenum

3
Q

Right scap
Midline to left mid-back
Perumbilical pain

A

Gallbladder/biliary tree
Pancreas
Small intestine

4
Q
Unilateral flank to groin
Hypogastric/lower back
Uni hypogastric
Midline hypogastric
Midline presacral
A
Kidney/ureter
Colon
Overaises/tests
Uterus
Rectum
5
Q

Pareital peritonuem

A

Somatic nerve innervation

Innervate overlying abdominal wall as well

May experience curaneous pain with pressure over the skin

Pain is accentuated by pressure changes like moving or sneezing

Lie motionless in bed and resist movement

Rebound tenderness

6
Q

Abdominal wall pain

Obstruction of gollow viscera

A

Occurs bc of muscle spasm of pressure….tends to be constant and aching and worse with movement or prolonged standing

Central mech of viscerally mediated…small bowel is intermittent and poorly localized periumb pain….gallbladder with sudden distension is RUQ

7
Q

Vasc disturbances

Parietal peritoneal inflamm

A

Variable presentation but due to ischemia…pain out of porpotiotn to exam…mesenteric thrombosis produces constant or IM and poorly localized generalized ab pain

Steady and sharp locally over inflamed area…tonic spam…pressure changes worse

8
Q

Eval of abdominal pain

A

If acute, consider surgical abdomen - intestinal obstruction and peritonotis

Intestinal obstruction - pain, anorexia, bloating, N/V…emesis can consist of undigested food but may progress…hugh pitched or absent bowel sounds…get CT

Peritonitis - usually with signs of sepsis…lie very still and motion make worse…will have muscle spasms

9
Q
Gastroenteritis
Acute mesenteric ishcemia
Chronic mesenteric ischemia
Small bowel obstruction
Intussusception
A

acute to subacute and mild to mod…N/V and diarrhea

Acute, severe and persistent pain with hx of afib

Intestinal angina (self-limited pain after eating)…ass with weight loss and eating of smaller meals

Aucte, severe and peristent pain…associate wit hnasuea and emesis

Acute and intermittent at 15-30 minute intervals
Associated with anoreixa, N/V

10
Q
Spontaneous bact peritonitis
DKA
Ruptured aortic anuerysm
IDS 
Constipation
A

Acute to subacute mode to severe pain…hx of cirrhosis

Pain asnd tenderness that shift…hx of diabetes

Ab or back pain and associated with hypotension or pulsatile ab mass

Chronic and mild to mod paine worse with eating and stres but relieved by defacation…acute onset of diarrhea or coinstipation

Chronic, intermittent mild to mod paid
Fecal impacted if acute,sever,e and anorexia

11
Q

PUD
GERD
Gastritis
Gastroparesis

A

Subacute to chronic mild to mod relieved or worsened by eating…perforation with acute exacerbation and guarding

Chronic midl to mod worse with eating and lying down…regurg and heartburn

Acute to chornic mild to mod pain worse with eating…aspirin, NSAIDs and alcool

Chonirc, insidois post prandial fullness improved ith eating smlaller meals and ass with vomiting and weight loss

12
Q

Acute panc

MI

A

Acute, sudden onset of knife like peigastric pain radiating to the back

Mod to severe after exertion

13
Q
Biliary colic
Cholecystitis
Cholangitis
Acute hep
Urolithiasis
Pyelonerhitis
A

IM, acute pain proviked by eating in the

Acute severe and lastin 4-6 hours

Acute severe…associated with high fever and jaundice

Subacute onset of mild to mod…alcohol or esxp to hep

Spastic pain radiatiing to groin or testicld

Poorly localized with CVA tenderness