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Rebound tenderness - Pain upon removal of pressure to the abdomen.
Test for appendicitis
- Psoas Sign - by resistance of knee flexion
- Obturator Sign - Raise right leg, internally rotate.
- Rovsing's sign - LLQ pressure LRQ referred pain.
Pushing on abdomen in LLQ elicits pain on both left and right side or just left.
bladder, uterus, descending (left) colon, fallopian tubes, ovaries, or other structures.
- Cough sign
- Blumberg's sign
absent bowel sounds
DX: Fluid wave test, Shifting dullness
Checking for ascites
When checking for ascites using Shifting dullness. The following can cause what complication?
– Mesenteric fat
– Feces in bowel
– < 500cc of fluid
Burning or gnawing pain,
epigastric, may radiate to the back.
• Precipitated by long periods of no food or skipping meals.
• Often feel pain early in morning, which is relieved by intake of food
Peptic Ulcer Disease (PUD)
– Chronicity, Rhythmicity, Periodicity
Burning, epigastric or xiphisternal. Radiates to the retrosternum.
• Precipitated by over-eating, bending over, or being in a reclined
GastroEsophageal Regurgitation Disorder (GERD):
Cannot get comfortable
- ~Kidney pain
- Bowel obstruction
Cannot move due to ab pain.
- Peritoneal pain
- Perforated bowel
radiates to the groin.
radiates to back, scapula, or right shoulder.
radiates to back.
- Splenic pain
- Pancreatic pain
LOCALIZING PAIN to INTRAABDOMINAL SITES
INVOLUNTARY GUARDING AND MUSCLE RIGIDITY:
- – Perforated ulcer
- – Perforated bowel - doesn't want to move
- – Peritonitis
Diabetic Ketoacidosis and other metabolic disorders can simulate an acute abdomen?
Paroxysms sharp colicky RUQ pain, radiating to back, right mid-abdomen.
Intolerance to greasy foods may be found.
Ultrasound is usually diagnostic.
CHOLELITHIASIS and BILIARY COLIC
Often accompanied by nausea, emesis, and early satiety. Pain is worsened by eating.
DELAYED GASTRIC EMPTYING
Chronic abdominal pain
– Caused by alcoholism
– May be exacerbated by eating
Chronic abdominal pain
– Weight loss, abdominal pain, anorexia, weakness / fatigue, diarrhea common
– Pain is variable in quality, and often ameliorated by sitting in knee-chest position
– Bloating and cramps; flatus and diarrhea
– Defecation relieves the pain.
If tightening of abdominal wall relieved symptoms or were done as a guarding action, then that would be visceral pain.
• Causes: Herpes Zoster, Hernias,Neuromas.
• Differential diagnosis:
- – Neoplasms
- – Chronic Renal Failure
- – Psychiatric: Anorexia nervosa, depression
- – Infections: Hepatitis, chronic infections.
Seen in hyperthyroidism,
malabsorption syndromes, especially
Delayed Gastric emptying possible causes.
- Pyloric Outlet Obstruction: Ulcers, pyloric stenosis, Crohn's Disease, neoplasms.
- Neuromuscular: Scleroderma, vagotomy, demyelinating diseases (MS), Polio
- Metabolic: Diabetic gastroparesis, hypothyroidism.
- Drugs: Anti-cholinergics, ganglionic blockers, opiates
- Psychiatric: Anorexia Nervosa
– CVA, stroke
– Reflux Esophagitis
– Esophageal rings and webs
– Esophageal Tumors
– Candidiasis (e.g. in AIDS)
Odnyophagia: Painful difficulty swallowing.Common Causes:
Excretion of more than 300 g of stool per
MC cause is viral
Symptom Cluster: Fever, myalgia, chills, nausea, vomiting, diarrhea, cramping abdominal pain.
- Infectious agent is MC
- – Lactose Intolerance
- – Antibiotic-associated (loss of normal flora)
- – Inflammatory bowel
- – Dietary habits (coffee)
- – Parasitic infection: giardiasis, amebiasis.
- – Inflammatory bowel disease
- – Diabetes Mellitus
- – Previous rectal or perirectal surgery.
- – Errant episiotomy from a traumatic childbirth.
– Lifelong constipation
– Ocassional passage of enormous stools
– Absence or marked dimunition of ganglion cells in rectal tissue
- not coughing up blood
- – PUD or erosive Gastritis
- – Mallory-Weiss Tear of esophagus
- – Esophageal varices, portal hypertension
Occult blood in stool.
- – Possible Causes
- – Colorectal carcinoma
- – Shigella, Salmonella, Campylobacter, invasive E. Coli may all cause hematochezia.
- – Hemorrhoids
- – Chronic diverticular disease
Passage of black or very dark stool, reflecting hemebreakdown products in stool. Causes?
- drugs, bismuth-containing drugs, charcoal, lots of black cherries.
Unstable vitals due to large amount of blood loss.
Tympany: Increased tympany is heard
upon percussion of the abdomen in cases of?
partial bowel obstruction
Normal Liver Span
10-12 cm in men, 8-11cm in women.
RUQ pain aggravated by inspiration
Murphy's sign Gallbladder
Gallbladder is palpable in 25% of cases of pancreatic carcinoma, due to painless distension.
Possible causes of palpable kidney's
- polycystic disease of kidney
- large simple cyst
- renal carcinoma (hypernephroma)
Normal-sized kidney displaced inferiorly into abnormal position; pelvic kidney.
– Absent Bowel Sounds:
– Increased Bowel Sounds
– High-pitched bowel sounds indicating small bowel obstruction.
Succussion splash after fasting?
Otherwise normal if after a large meal.
ABDOMINAL BRUITS causes
calcification of aorta,celiac compression, and alcoholic hepatitis.
– suspicion of appendicitis
– DiffDx: UTI; salpingitis; PID