E Med

• Deep, dull, aching pain
• poorly localized
• epigatric or periumbilical

• sensation conducted via peripheral nerves
• sharp, more intense pain
• moving or coughing aggravates

Pain felt at a distance from its source

• Tachycardia
• hypotension
• tachypnea

• UA and HCG(males testicular CA)
• CBC
• LFT - no amylase
• Plain films
• Helical CT
• Ultrasound

stone which can be found in the hepatic bile canliculi, intra/extrahepatic bile ducts, CBD, and gallbladder

• absorption of fats and fat soluble nutrients
• It is produced in the canaliculi

increased age, female gender, massive obesity, rapid weight loss, cystic fibrosis, parity, drugs, familial tendancies

• form in the GB
• more common in elderly
• made up of calcium
• associated with disease causing intravascular hemolysis

• associated with infection
• form in intra/extrahepatic bile duct
• contains Ca+
• can be seen on Xray

• RUQ pain - referred to right scapula
• N/V
• Prior history of something similar but less severe

• Increased Temp
• tachycardia
• RUQ tenderness/epigastric
• guarding/rebound tenderness
• + Murphys Sign

• Increased WBC
• LFTs CAN BE elevated (but not always)
• ULTRASOUND * Most usefull
• HIDA scan - most specific

• Inflammation of the gallbladder without the prescence of stones
• usually elderly
• complication of HIV with infection from CMV
• usually high mortality rate

• Linear/punctuate calcifications within the GB wall
• found in females in their 50s
• high carcinoma rate - most common malignancy

palpable gallbladder

• Divided in severity based on organ failue or local complications
• Gallstones are most common obstructive cause - 45%
• Chronic ETOH abuse is 2nd common cause
• More common in men, after heavy drinking

• epigastric, LUQ, RUQ pain
• rapid onset - minutes
• Pain is constant and severe
• Pain radiates to mid back
• N/V
• Little relief with position change

• Moderate distress
• rales - pleural effusion possible
• jaundice
• Cullens or Turners sign

• Amylase 70% specific but 100% specific if 3-5x normal
• Lipase 60% specific but 100% specific if 5x normal
• Xray - exclude other things, may show effusions or atelectasis
• CT/US - oral contrast

• vague, epigastric pain
• RLQ at McBurneys point
• Pain before vomitting
• no history
• Pt. feels constipated

• sign for appendicitis
• Push in at point of pain, pull away after 30 seconds
• Pt. should be in pain

• push deeply in LLQ
• pull away, pain should be felt in RLQ

• Test for appendicitis
• Psoas-patient supine, pull leg up upon resistance
• Obturator - flexing knee and internal rotate
• *Both cause psoas muscle to rub inflamed appendix

• WBC count
• C-Reative Protein
• Interleukin - 6

• Abdominal plain films
• Barium enema
• Ultrasound
• CT scan
• MRI
• Laproscopy

• no radiation, or contrast
• low cost
• widely available
• may find other diagnosis

• Confounding findings
• Nonvisualization of perforated appendix
• limited view in obese patients
• operator-dependent

• Finds alternative diagnoses
• not-operator dependent
• useful in obese patients
• widely available

• Radiation, contrast
• increased cost
• potential false negatives

fecal matter sequestered in a sac and becomes hard forming a fecolith which compromises the blood supply

• depends on amount of decontamination resulting from perforation
• LLQ
• low grade fever, change in bowel habits
• malaise
• Urinary sx - secondary

• LLQ tenderness
• Distention is common
• Rectal bleeding may be seen - more common diverticulosis

• CT scan* test of choice
• Barium enema-excludes other colonic pathology and check for complications

Elevated WBC with bands

• Most resolve with meds
• Tx of peritonitis, perforation or gas in bowel wall = surgery
• abseccess larger then 5cm = surgery

lumen is partially or completely occluded at one or more points, producing distention but no compromise of the blood supply

• bowel obstructed at two sequential sites, usually twisted on an adhesion or hernia opening
• high change of compromising blood flow - strangulation obstruction

• ADHESIONS #1
• inflammatory, neoplasm, trauma
• foreign body, gallstones, barium

• Crampy pain
• recurrent bouts of poorly localized pain

• several hours of severe colicky pain
• vomitting
• mild distention

• A day or two of progressively worsening pain
• more prominent abdominal distention

• Age >50
• Previous surgery
• Abdominal distention
• Increased Bowel sounds
• History of Constipation
• Vomitting

• Peritoneal signs - pain with cough, shaking or moving
• Tachycardia
• Hypotension
• fever

• Plain films - supine and upright
• CT - high accuracy

• Usually elderly
• Carcinoma
• diverticulitis
• volvulus

LBO is less common then SBO

• high pitched bowel sounds
• fever
• abdominal tenderness
• possibly peritonitis

• Plain films - supine and upright - see dilated bowel
• CT - less helpful in LBO

• Most below renal arteries
• Most ruptured AAA's have diametes of >5cm
• Most of true aneurysms - involve all three layers
• Men > Women

• pain in abdomen, back, or flank
• abdominal mass or fullness
• vague dull, quality, gradual onset of pain
• Most Pt. are Asymptomatic

• Pain, Hypotension, Mass
• pain in abdomen, back, flank

• plain films, will be seen if large enough
• Cross-table lateral of lumber spine
• *Ultrasound - 100% sensitive
• *CT-100% acurate for diagnosis for stable pt. only
• Pt. with ruptured AAA need to be cross clamped before stable