Beruflich Dokumente
Kultur Dokumente
Outline
• Clinical pearls
2/15/2016
RMO Training – Acute Abdomen
3
Types of Abdominal Pain
2/15/2016
RMO Training – Acute Abdomen
4
Outline
Outline
• Types of pain
• Clinical pearls
2/15/2016
RMO Training – Acute Abdomen
5
History and Physical
2/15/2016
RMO Training – Acute Abdomen
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History and Physical
2/15/2016
RMO Training – Acute Abdomen
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History and Physical
Differential Diagnosis
It’s Huge!
Use history and physical exam to narrow it down
Rule out life-threatening pathology
Half the time you will send the patient home with a diagnosis of nonspecific abdominal pain (NSAP or
Abdominal Pain – NOS)
90% will be better or asymptomatic at 2-3 weeks
2/15/2016
RMO Training – Acute Abdomen
10
History and Physical
Differential Diagnosis
Gastritis, ileitis, colitis, esophagitis Hemilith infestation
Ulcers: gastric, peptic, esophageal Porphyrias
Biliary disease: cholelithiasis, cholecystitis ACS
Hepatitis, pancreatitis, Cholangitis Pneumonia
Splenic infarct, Splenic rupture Abdominal wall syndromes: muscle strain, hematomas,
Pancreatic psuedocyst trauma,
Neuropathic causes: radicular pain
Hollow viscous perforation
Non-specific abdominal pain
Bowel obstruction, volvulus
Group A beta-hemolytic streptococcal pharyngitis
Diverticulitis Rocky Mountain Spotted Fever
Appendicitis Toxic Shock Syndrome
Ovarian cyst Black widow envenomation
Ovarian torsion Drugs: cocaine induced-ischemia, erythromycin, tetracyclines,
Hernias: incarcerated, strangulated NSAIDs
Kidney stones Mercury salts
Pyelonephritis Acute inorganic lead poisoning
Hydronephrosis Electrical injury
Inflammatory bowel disease: crohns, UC Opioid withdrawal
Gastroenteritis, enterocolitis Mushroom toxicity
pseudomembranous colitis, ischemia colitis AGA: DKA, AKA
Tumors: carcinomas, lipomas Adrenal crisis
Meckels diverticulum Thyroid storm
Testicular torsion Hypo- and hypercalcemia
Epididymitis, prostatitis, orchitis, cystitis Sickle cell crisis
Constipation Vasculitis
Abdominal aortic aneurysm, ruptures aneurysm Irritable bowel syndrome
Aortic dissection Ectopic pregnancy
PID
Mesenteric ischemia
Urinary retention
Organomegaly
Ileus, Ogilvie syndrome
2/15/2016
RMO Training – Acute Abdomen
11
History and Physical
Differential Diagnosis
2/15/2016
RMO Training – Acute Abdomen
12
History and Physical
Differential Diagnosis
Most Common Causes in Abdominal Pain in the UGD
Differential Diagnosis
Most Common Causes in Abdominal Pain in the UGD
Outline
• Clinical pearls
2/15/2016
RMO Training – Acute Abdomen
15
Labs and imaging
2/15/2016
RMO Training – Acute Abdomen
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Outline
Outline
• Clinical pearls
2/15/2016
RMO Training – Acute Abdomen
17
Clinical Perils
Clinical Perils
Significant abdominal tenderness should never be attributed to gastroenteritis
Incidence of gastroenteritis in the elderly is very low
In older patients with renal colic symptoms, exclude AAA
Severe pain should be taken as an indicator of serious disease
Pain awakening the patient from sleep should always be considered significant
Sudden, severe pain suggests serious disease
Pain almost always precedes vomiting in surgical causes; converse is true for
most gastroenteritis and NSAP
Acute cholecystitis is the most common surgical emergency in the elderly
A lack of free air on a chest x-ray does NOT rule out perforation
Signs and symptoms of PUD, gastritis, reflux and nonspecific dyspepsia have
significant overlap
If the pain of biliary colic lasts more than 6 hours, suspect early cholecystitis
2/15/2016