0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1
0
0
100%
0%
Evidence
2
0
0
Topic
Snapshot
  • A 30-year-old G0P0 woman presents to the emergency room for acute onset abdominal pain and nausea. She recently had unprotected sex with 2 different partners. On physical exam, she has involuntary guarding and tenderness to percussion. A urine pregnancy test is positive, and a transvaginal ultrasound shows a ruptured ectopic pregnancy.
Introduction
  • Overview
    • acute abdomen is characterized by acute onset of severe abdominal pain that requires urgent surgical evaluation
      • management depends on etiology
  • Epidemiology
    • incidence
    • etiologies
      • hemorrhage
        • abdominal aortic aneurysm rupture
        • bleeding gastric ulcer
        • ruptured ectopic pregnancy
      • ischemia
        • ischemic bowel disease
      • perforated bowel/peritonitis
        • perforated peptic ulcer
        • bowel obstruction
        • diverticular disease
        • inflammatory bowel disease
        • perforated appendicitis
  • Pathogenesis
    • mechanism
      • hemorrhage will often lead to hypovolemic shock, requiring swift intervention
      • ischemia results in elevated lactate and also requires early intervention
      • perforated bowel causes inflammation of the peritoneum or peritonitis
Presentation
  • Symptoms
    • common symptoms
      • dehydration
      • sudden-onset abdominal pain
      • pain out of proportion to exam
        • ischemic bowel disease
  • Physical exam
    • inspection
      • pallor
      • hypovolemia
      • tachycardia
    • motion
      • rigid abdomen
      • tenderness to percussion
      • involuntary guarding
      • may have reduced or absent bowel sounds
Imaging
  • Chest radiograph
    • indications
      • to look for free air under the diaphragm
    • findings
      • free air under the diaphragm, indicating bowel perforation
  • Abdominal radiograph
    • indications
      • if bowel obstruction is suspected
    • findings
      • dilated loops of bowel
  • Abdominal ultrasound
    • indications
      • if biliary or hepatic etiology is suspected
      • if tubo-ovarian pathology is suspected
      • if appendicitis is suspected
      • if aneurysm is suspected
      • evaluate for hemorrhage
  • CT abdomen and pelvis
    • indications
      • if mesenteric ischemia, diverticulitis, or bowel perforation are suspected
Studies
  • Serum labs
    • lactate
    • arterial blood gas
    • urinalysis
    • pregnancy test
    • blood cultures
      • to rule out infection
    • amylase and lipase
      • if pancreatitis is suspected
    • complete blood count
    • electrolytes
    • liver function panel
Differential
 
Differential by Location of Abdominal Pain
Generalized
  • Bowel obstruction
  • Mesenteric ischemia
Right Upper Quadrant Epigastric Left Upper Quadrant
  • Acute cholecystitis
  • Hepatitis
  • Liver abscess
  • Acute cholangitis
  • Peptic ulcer disease
  • Myocardial infarction
  • Pancreatitis
  • Gastric ulcer
  • Splenic rupture
Right Lower Quadrant Periumbilical Left Lower Quadrant
  • Appendicitis
  • Bowel obstruction
  • Appendicitis
  • Abdominal aortic aneurysm
  • Diverticulitis
Lower Abdomen
  •  
    •  
      •  
        •  
          •  
            •  
              •  
                • Inguinal hernia
    •  
      •  
        •  
          •  
            •  
              •  
                • IBD
    •  
      •  
        •  
          •  
            •  
              •  
                • UTI
    •  
      •  
        •  
          •  
            •  
              •  
                • Pelvic inflammatory disease
    •  
      •  
        •  
          •  
            •  
              •  
                • Ectopic pregnancy
    •  
      •  
        •  
          •  
            •  
              •  
                • Testicular torsion
 
Treatment
  • Management approach
    • depends on the etiology of acute abdomen
  • Medical
    • supportive care
      • indications
        • all patients
      • modalities
        • intravenous hydration
        • analgesia
        • anti-emetics
        • nasogastric decompression if necessary
        • bowel rest
        • NPO
        • blood transfusion if necessary
  • Surgical
    • surgical intervention
      • indications
        • irreversible pathologies such as appendicitis, mesenteric ischemia, and perforated bowel
Complications
  • Septic shock
  • Death

Please rate topic.

Average 5.0 of 3 Ratings

Questions (1)

(M2.GN.15.1) A 17-year-old woman presents to the emergency department with abdominal and pelvic pain. She states it started 3 days ago and it has been getting gradually worse. She states it is diffuse and is located over her abdomen, pelvis, and inside her vagina. She also endorses vaginal pruritus and a discharge from her vagina. The patient works in an ice cream parlor and is sexually active with multiple different partners. Her temperature is 98.0°F (36.7°C), blood pressure is 122/80 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for a foul smelling vagina with a thin, white discharge. Her abdomen is diffusely tender. The patient is noted to be itching her vagina during the exam. Which of the following is the most appropriate initial step in management?

QID: 100511
1

Cervical swab and culture

100%

(1/1)

2

CT abdomen/pelvis

0%

(0/1)

3

KOH prep

0%

(0/1)

4

Urine hCG

0%

(0/1)

5

Wet mount

0%

(0/1)

M 6 E

Select Answer to see Preferred Response

Evidence (2)
EXPERT COMMENTS (8)
Private Note