GI 101 Buttaro EXAM 2/3475 [100% VERIFIED]

GI 101 Buttaro EXAM 2/3475 [100% VERIFIED] GI RED FLAGS *Ans* AAA Obstruction Ruptured spleen Ruptured ectopic pregnancy Visceral perforation & peritonitis Ischemic bowel Testicular/ovarian torsion Visceral pain *Ans* is poorly localized - involves hollow organs (eg. early appendicitis) Parietal pain *Ans* is well localized - involves abd wall (eg. late appendicitis/peritonitis) Less impressive sx in elderly - don't be fooled Abdominal PEARLS *Ans* Should do rectal & pelvic for full assessment Female of reproductive age - R/O ectopic Note previous abd surgeries - may suggest bowel obstruction Don't forget the cardiac, pulmonary, renal, rectal, & pelvic areas Constipation preceding abd pain = colon/rectal problem Diarrhea is associated w infectious GE, IBD, diverticulitis & early intestinal obstruction Vomiting w onset of pain suggests peritoneal irritation or perforation of viscus Pain relieved by vomiting suggests infectious GE, biliary colic, or pancreatic disease High fever, > 102 w accompanying lethargy & chills may signal impending septic shock or advanced peritonitis McBurney's point *Ans* Appendicitis presentation *Ans* Common cause of acute abd pain Most cases before age 30 Presentation * Pain increasing in intensity over 24-48 hour period; localizing - initially vague, periumbilical; later - specific RLQ - McBurney's point; rebound * A/N/V, constipation * Low-grade fever, leukocytosis Pearls Pain first; then vomiting Sx > 72 hr usually not appendicitis No anorexia; T > 102 or < 99.5 less likely to be appendicitis Abd pain w/o other sx is rarely a serious problem appendicitis DX *Ans* CBC; CT w contrast (93-98% accuracy)