Rebound tenderness - Pain upon removal of pressure to the abdomen.
Peritonitis
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.
Peritonitis
Cough sign
Blumberg's sign
absent bowel sounds
Bulging flanks
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
False positive.
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
or antacids.
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
position.
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.
Renal Colic
radiates to back, scapula, or right shoulder.
Gallbladder pain
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?
True
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 PANCREATITIS:
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
PANCREATIC CARCINOMA
Do ETOH
– Bloating and cramps; flatus and diarrhea
LACTASE DEFICIENCY
– Defecation relieves the pain.
IBD
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.
ANOREXIA
• Differential diagnosis:
– Neoplasms
– Chronic Renal Failure
– Psychiatric: Anorexia nervosa, depression
– Infections: Hepatitis, chronic infections.
Seen in hyperthyroidism,
malabsorption syndromes, especially
pancreatic insufficiency
