Sandbox:Shivani: Difference between revisions
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! rowspan="3" |Presentation | ! rowspan="3" |Presentation | ||
! colspan="6" |Symptoms | ! colspan="6" |Symptoms | ||
! colspan=" | ! colspan="8" rowspan="1" | '''Signs''' | ||
! rowspan="3" | '''Lab findings''' | ! rowspan="3" | '''Lab findings''' | ||
! rowspan="3" |Preferred diagnostic test | ! rowspan="3" |Preferred diagnostic test | ||
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! rowspan="2" |Rigidity | ! rowspan="2" |Rigidity | ||
! rowspan="2" |Rebound tenderness | ! rowspan="2" |Rebound tenderness | ||
! rowspan="2" |Shock | |||
|- | |- | ||
!Superficial | !Superficial | ||
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!Spontaneous bacterial peritonitis | !Spontaneous bacterial peritonitis | ||
!✔ | !✔ | ||
!✘ | !✔/✘ | ||
!✔/✘ | !✔/✘ | ||
!✘ | !✘ | ||
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!✘ | !✘ | ||
!✘ | !✘ | ||
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!Ascitic fluid PMN>250cells/mm3 | !Ascitic fluid PMN>250cells/mm3 | ||
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!✔ | !✔ | ||
!✘ | !✘ | ||
!✔ | !✔ | ||
!✘ | !✘ | ||
!✘ | !✘ | ||
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!✔ | !✔ | ||
!✔ | !✔ | ||
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!Fulfillment of 2/3 runyon's criteria: | !Fulfillment of 2/3 runyon's criteria: | ||
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!✘ | !✘ | ||
!✘ | !✘ | ||
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!Ultrasound, CT, ERCP, MRCP, PTC | !Ultrasound, CT, ERCP, MRCP, PTC | ||
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!✘ | !✘ | ||
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!Ultrasound | !Ultrasound | ||
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!✘ | !✘ | ||
!✘ | !✘ | ||
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!Serum amylase/lipase | !Serum amylase/lipase | ||
!CT scan | !CT scan | ||
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!✔right lower quadrant | !✔right lower quadrant | ||
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!✔left lower quadrant | !✔left lower quadrant | ||
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!Acute salpingitis | !Acute salpingitis | ||
!✔ | !✔ | ||
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!periumbilical and crampy, with paroxysms of pain occurring every 4-5minutes.Pain progresses from crampy to constant and more severe indicating impending strangulation | !periumbilical and crampy, with paroxysms of pain occurring every 4-5minutes.Pain progresses from crampy to constant and more severe indicating impending strangulation | ||
!Dissension of the abdomen | !Dissension of the abdomen | ||
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!✔ in sigmoid volvulus | !✔ in sigmoid volvulus | ||
!steady pain, with a superimposed colicky component | !steady pain, with a superimposed colicky component | ||
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!right upper quadrant | !right upper quadrant | ||
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!colicky and radiates to the flank or groin | !colicky and radiates to the flank or groin | ||
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!Severe pain out of proportion to examination | !Severe pain out of proportion to examination | ||
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!Acute ischemic colitis | !Acute ischemic colitis | ||
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! rowspan="2" |Hemorrhagic | ! rowspan="2" |Hemorrhagic | ||
!Ruptured abdominal aortic aneurysm | !Ruptured abdominal aortic aneurysm | ||
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|- | |- | ||
!Intraabdominal or Retroperitoneal hemorrhage | !Intraabdominal or Retroperitoneal hemorrhage | ||
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!lower abdominal pain | !lower abdominal pain | ||
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!focal,unilateral lower abdominal pain accompanied by light vaginal bleeding | !focal,unilateral lower abdominal pain accompanied by light vaginal bleeding | ||
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!✘ | !✘ | ||
!✘ | !✘ | ||
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!urine b-hcg +, | !urine b-hcg +, | ||
Revision as of 16:00, 8 February 2017
Acute abdomen:
Classification of acute abdomen
based on the etiology |
Presentation | Symptoms | Signs | Lab findings | Preferred diagnostic test | Additional findings | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fever | Jaundice | Nausea/
Vomiting |
Diarrhea | Constipation | Abdominal
Pain Location |
General
Appearance |
Bowel Sounds | Abdominal tenderness | Shifting dullness | Rigidity | Rebound tenderness | Shock | |||||||
Superficial | Deep | ||||||||||||||||||
Common causes of peritonitis | Primary peritonitis | Spontaneous bacterial peritonitis | ✔ | ✔/✘ | ✔/✘ | ✘ | ✘ | diffuse | lies supine motionless
tense abdomen due to ascites |
diminished | ✔ | ✘ | ✔ | ✘ | ✘ | Ascitic fluid PMN>250cells/mm3
Single organism on culture of the ascitic fluid |
ascitic fluid PMN count | Altered mental status usually seen. | |
Inflammatory disorders and perforations causing Secondary peritonitis | Perforated gastro-duodenal ulcers | ✔ | ✘ | ✔ | ✘ | ✘ | right upper quadrant | Scaphoid, tense abdomen | ✘ | ✔ | ✘ | ✘ | ✔ | ✔ | Fulfillment of 2/3 runyon's criteria:
glucose < 50mg/dl total protein > 1g/dl LDH ascites > normal LDH serum |
upright chest x-ray, CT scan | |||
Acute cholangitis | ✔ | ✔ | ✘ | ✘ | ✘ | Right upper quadrant | Toxic look | normal | ✘ | ✘ | ✘ | ✘ | ✘ | Ultrasound, CT, ERCP, MRCP, PTC | Charcot triad ( RUQ pain, jaundice,fever)
Reynold pentad ( RUQ pain, jaundice,fever, confusion,shock) | ||||
Acute cholecystitis | ✔ | ✔ | ✘ | ✘ | Right upper quadrant or epigastrium may radiate to the right shoulder or back | ✔ right upper abdomen | ✘ | ✘ | ✘ | ✘ | Ultrasound | Murphy's sign (pain on inspiration causing a cessation of breathing) may be present | |||||||
Acute pancreatitis | ✔ | ✔ | midepigastrium, right upper quadrant, diffuse, or, infrequently, confined to the left side with a band-like radiation to the back | ✔epigastrium | ✘ | ✘ | ✘ | ✘ | Serum amylase/lipase | CT scan | |||||||||
Acute appendicitis | ✔ | ✘ | ✘ | vague periumbilical initially that eventually localises to right lower quadrant | ✔right lower quadrant | CT scan, ultrasound | |||||||||||||
Acute diverticulitis | ✔ | ✘ | ✔ | ✔/✘ | ✔/✘ | Left lower quadrant pain | ✔left lower quadrant | CT scan | leukocytosis | ||||||||||
Acute salpingitis | ✔ | ||||||||||||||||||
Hollow Viscous Obstruction | small Intestinal obstruction | ✔ | periumbilical and crampy, with paroxysms of pain occurring every 4-5minutes.Pain progresses from crampy to constant and more severe indicating impending strangulation | Dissension of the abdomen | Flat and upright film, CT scan | ||||||||||||||
Volvulus | ✔ | ✔ in sigmoid volvulus | steady pain, with a superimposed colicky component | ||||||||||||||||
Biliary Colic | ✔ | right upper quadrant | CT scan | hepatomegaly and a palpable gallbladder(courvoisier sign) pancreatic head tumor | |||||||||||||||
Renal Colic | colicky and radiates to the flank or groin | Hematuria | |||||||||||||||||
Vascular disorders | Ischemic | Mesenteric ischemia | ✔ | severe periumbilical pain out of proportion to physical examination findings | Soft duffy fullness | Severe pain out of proportion to examination | increased lactic acid and leukocytosis | Abdominal x-ray, CT Angiogram, MRI | |||||||||||
Acute ischemic colitis | CT scan,
Colonoscopy |
||||||||||||||||||
Hemorrhagic | Ruptured abdominal aortic aneurysm | cullen sign(bruising around the umbilicus) | |||||||||||||||||
Intraabdominal or Retroperitoneal hemorrhage | Grey turner sign(bruising in the flank) | ||||||||||||||||||
Gynecologic Causes | Ovarian Cyst Complications | Torsion | ✔ | lower abdominal pain | |||||||||||||||
Rupture | focal,unilateral lower abdominal pain accompanied by light vaginal bleeding | measurement of human chorionic gonadotropin and alpha-fetoprotein | transvaginal ultrasonography | ||||||||||||||||
Ruptured Ectopic Pregnancy | ✘ | ✘ | ✔/✘ | ✘ | ✘ | lower abdominal quadrant and pelvis | toxic look | normal | ✘ | ✘ | ✘ | ✘ | ✘ | urine b-hcg +, | transvaginal ultrasonography and serial testing of hCG | Amenorrhea and vaginal bleeding. |