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Differential Abdominal Pain
Transcript of Differential Abdominal Pain
Typical Signs and Symptoms
Changes in bowel habits
Typical EMS Treatment
Quadrants with multiple possibilities...
Tour of the Belly!
Right Lower Quadrant
Inflammation of the appendix
RLQ or Umbilical pain
Renal Calculus (kidney Pebble)
Radiates to Lower quadrant
Sharp "traveling" pain
Difficulty/pain with urination
Blood in urine
This is what the fuss is about!?!
Left Lower Quadrant
Peak incidences in 10-12 year old
Starts as dull pain in umbilical region
Usually progresses in 4-6 hours
Localizing to RLQ of abdomen
Sudden pain relief... May indicate rupture of appendix!
Pain most often in LLQ
Changes in bowel habits
Mild rectal bleeding
Inflammation of intestines
Don't Mock Me!
Irritable bowel Syndrome (IBS)
Symptom based diagnosis characterized by chronic abdominal pain, bloating, and alteration of Bowel habits.
Onset is more likely to occur after an infection
a stressful life event.
Diet- Liquid (give intestine a break) then high fiber
Antibiotics- initial IV then PO
Worse Case Scenario:
Surgery- remove portion of intestine (Resection)
collection of fluid, surrounded by a thin wall, within an ovary
What is it?
Phosphates, oxalates, & Urates
Crystal aggregation formed in kidneys from dietary minerals in the urine
Dull aching pain in lower abdomen
Increase to sharp pain
Affects women of all ages
Most common during childbearing years
Can be smaller then a pea
or as big as an Orange!
Sudden improvement of pain
Usually indicates cyst rupture
Usually harmless and resolve on own
Some can cause bleeding (Hemorrhagic cyst)
1/4 of massive cysts become Cancerous
considered for Symptomatic Cysts larger then 5cm
In 1905 a record was set and maintains today...
Right Upper Quadrant
inflammation of the gallbladder
Age- around 40 years
low fluid intake
Medications- prolonged PPI usage
Usually caused by
Bile contains too much cholesterol & not enough bile salts
Decreased Gallbladder motility
Elevated Estrogen levels
Can have them and never know (80%)
Have symptoms when stone >8mm
Small as grain sand or Big as golf ball
Endoscopic Retrograde Cholangiopancreatography
But stones can keep coming back...
Hepatitis: Inflammation of the liver.
Infectious vs non infectious
Acute vs chronic
Cirrhosis: Greek for "yellowish"
Decreased liver function
Same for both as cirrhosis is the chronic disease process if hepatitis goes untreated or is irreversible
Infectious: Viral (Hep C)
Non Infectious: ETOH, Toxins/Medications, Obstruction, NASH,
Liver's purpose is for detox, protein synthesis and metabolize lipids and carbs
Acute: "flu like symptoms"
Signs & Symptoms
Signs: poor appetitie, Jaundice, itching, Ascites, Confusion, engorged liver with palpation, bruising
Treat the cause
If enters Cirrhosis stage... typically not reversible!
Focus on preventing progression and complications
Left Upper Quadrant
Inflammation of pancrease
Multifunctional glandular organ that produces insulin to regulate the blood sugar
and secrets digestive enzymes to
Pancreatitis occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine,
Sharp Upper Mid abdominal pain
Increase pain with eating
Changes in stool
Signs & Symptoms
Treating the Cause:
Remove obstruction- ERCP
Pain & Nausea medication
obstruction of the intestines, preventing the normal transit of the products of digestion.
Pain (localized or general)
Medicate: pain & nausea
Narcotics can reduce gut mobility
NG Tube: suction
Remember that each cardiac patient has their own symptoms...
Urinary Tract Infection
Refers to the rotation of the ovary to such a degree as to occlude the ovarian artery and/or vein
Occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the testicle's blood supply
Urinary Tract Infection
Pain with urination
Lower abdominal pain
Not always just a simple UTI...
Left untreated can turn in to Pyelonephritis (kidney infection)
Especially in the elderly can quickly turn in to Sepsis
Can mimic Neuro symptoms (Altered mental status)
How could she not know!?!
History is SO important!
Last menstrual period
Known to be pregnant?
Number of Weeks
Spontaneous end of a pregnancy
Lower abdominal Cramping
Need inform ER if note large clots
Common for excessive bleeding
More intense and frequent cramps
the more likely miscarriage imminent
Anxiety of loss of baby
Fear that did something wrong & of unknown
complication where embryo implants outside of the uterus
Typically implants in fallopian tube
Potentially life threatening event
Typically between 4-8 weeks pregnant
Lower abdominal pain & Minimal Vaginal bleeding
The most common complication is rupture with internal hemorrhage which may lead to hypovolemic shock
Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
Can take 24-48 hours to appear
If fallopian tube ruptures can tear the Ovarian artery, causing internal bleeding
Referred shoulder pain
inflammation of the epididymis
a curved structure at the back of the testicle in which sperm matures and is stored
Slow onset (several days)
Swelling to one testicle
Urethral discharge prior
Typically STD related
2/3 of cases related to Chlamydia
Both instances would require surgical intervention
Both run risk of loosing ovary or testicle
if delay in seeking treatment
If treated in <6 hrs 90% success rate
If treated >12 hrs <50% success rate
12-18 year old boys account for 65% of torsions
Most common on cold nights
Negative Cremasteric Reflex
Testicle will rotate toward mid line of body
Testicle usually swollen, tender, and "high riding"
Sometimes able to manually manipulate to untwist
There is always the
By pairing the symptoms with the location of the pain... you can deduce the probable cause
Let's talk ACUTEly
Pain after eating
Location and duration of Pain
Past Medical/Surgical History
We will be discussing the "typical"
However, not all bellies comply with the "typical"!
Died from Pancreatic Cancer in 2009
Acute pancretitis was first described in an autopsy in 1882
Releases bacteria and feces into the abdominal cavity
Risks for: Peritonitis
In 2017 largest intact cyst removed from
24 year old in Mexico
Approximately 70 pounds!
Abdominal Aortic Aneurysm
Monitor-Surveillance is indicated in small asymptomatic aneurysms (less than 5.5 cm
Medications- BP and Cholesterol Management
Surgery- Risks vs Benefits
With aortic rupture of the AAA, treatment
is immediate surgical repair
Aortic aneurysms were the primary cause of 9,863 deaths in 2014
About two-thirds of people who have an aortic dissection are male
Recommend that men aged 65–75 years who have ever smoked should get an ultrasound screening for abdominal aortic aneurysms, even if they have no symptoms.
Is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs
Typically caused by an infection from intestinal perforation
Diffuse abdominal rigidity ("abdominal guarding") is often present, especially in generalized peritonitis
pain in your abdomen that gets more intense with motion or touch
Development of intestinal paralysis, which also causes nausea, vomiting and bloating.
Finding underlying cause
Monitor patient closely- turn septic fast!