Common Abdominal Complaints

These flashcards cover key concepts and medical terminology related to common abdominal problems, pain types, diagnostic algorithms, and treatment considerations.

OLDCART: Definition

An acronym for Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, and Treatment used to evaluate patient complaints and gather a comprehensive history.

Rebound tenderness: Definition

Pain that occurs after pressure is removed from the abdomen, indicating peritoneal irritation.

Rebound tenderness: Clinical Significance

This sign suggests inflammation of the peritoneum, often associated with conditions like appendicitis, peritonitis, or diverticulitis.

Rebound tenderness: Diagnosis (Assessment)

Elicited during abdominal palpation by pressing slowly and deeply, then quickly releasing pressure. The presence of pain upon release is a positive sign.

Rebound tenderness: Management/Treatment

Management is directed at the underlying cause of peritoneal irritation; often requires urgent medical evaluation and potential surgical intervention.

Guarding: Definition

Involuntary tensing of abdominal muscles to protect inflamed organs within the abdomen.

Guarding: Clinical Significance

A sign of peritoneal irritation or inflammation, indicating serious underlying pathology like appendicitis, cholecystitis, or perforated ulcer.

Guarding: Diagnosis (Assessment)

Detected during abdominal palpation; the muscles stiffen reflexively when touched, unlike voluntary tensing that can be relaxed by the patient.

Guarding: Management/Treatment

Treatment focuses on the underlying condition causing the inflammation, which may involve antibiotics, pain management, and often surgical intervention.

Visceral Pain: Definition

Pain originating from the internal organs, often described as dull, aching, or cramping.

Visceral Pain: Symptoms

• Dull, aching, or cramping quality

• Poorly localized (diffuse)

• Often felt in the midline of the abdomen

• May be referred to other areas

• Can be associated with nausea, vomiting, sweating, or pallor

Visceral Pain: Diagnosis (Evaluation)

Based on patient history describing pain quality and associated symptoms. Further diagnostic tests (imaging, endoscopy, lab work) are needed to identify the specific organ involved and its pathology.

Visceral Pain: Treatment & Management

Aimed at treating the underlying cause. Symptomatic relief may include pain relievers, antispasmodics, and addressing any autonomic symptoms.

Visceral Pain: Medications

• Analgesics (NSAIDs, opioids for severe pain)

• Antispasmodics (e.g., dicyclomine, hyoscyamine) for cramping

• Antiemetics for associated nausea and vomiting

Parietal Pain: Definition

Sharp pain that is localized and arises from the abdominal wall, specifically the parietal peritoneum.

Parietal Pain: Symptoms

• Sharp, piercing, or burning quality

• Well-localized to a specific area

• Aggravated by movement, coughing, deep breathing, or direct palpation

• Often more intense than visceral pain

Parietal Pain: Diagnosis (Evaluation)

Primarily through careful patient history and physical examination, pinpointing the exact location of tenderness. Imaging (CT, ultrasound) or specific tests may be used to identify the underlying cause (e.g., peritoneal inflammation, muscle strain).

Parietal Pain: Treatment & Management

Treatment is directed at the underlying cause. Management includes reducing inflammation and pain, often with rest and local measures.

Parietal Pain: Medications

• NSAIDs (e.g., ibuprofen, naproxen)

• Muscle relaxants (if muscle spasm is a component)

• Local anesthetic injections in some cases of localized pain

Colicky Pain: Definition

Intermittent pain caused by the contraction of smooth muscle in the intestines or other hollow organs trying to overcome an obstruction or spasm.

Colicky Pain: Symptoms

• Comes in waves, increasing to a peak then subsiding

• Often severe and incapacitating during peaks

• Patient may be restless, unable to find a comfortable position

• Associated symptoms: nausea, vomiting, sweating, pallor

Colicky Pain: Diagnosis (Evaluation)

Clinical history and physical exam. Imaging studies (ultrasound for gallstones/kidney stones, CT for bowel obstruction) and lab tests are crucial to identify the underlying cause.

Colicky Pain: Treatment & Management

Focuses on identifying and resolving the underlying obstruction or spasm. Management includes fluid replacement and pain control.

Colicky Pain: Medications

• Analgesics (NSAIDs for less severe, opioids for severe pain)

• Antispasmodics (e.g., dicyclomine)

• Medications specific to the cause (e.g., antiemetics)

CBC: Definition

Complete Blood Count; a common blood test used to assess overall health and detect a variety of disorders related to blood components (red blood cells, white blood cells, platelets).

CBC: Purpose/Diagnosis

Used to diagnose and monitor conditions such as anemia, infection, inflammation, bleeding disorders, and certain types of cancer (e.g., leukemia). It provides information on red blood cell count (RBC), hemoglobin, hematocrit, white blood cell count (WBC), and platelet count.

CBC: Management

Results guide further diagnostic workup or treatment decisions, but the CBC itself is not a treatment.

HCG test: Definition

Human Chorionic Gonadotropin test; a blood or urine test used to detect the presence and level of the hormone HCG, which is produced during pregnancy.

HCG test: Purpose/Diagnosis

Primarily used to confirm pregnancy. Can also be used to:

• Monitor early pregnancy development (quantitative HCG)
• Detect and monitor gestational trophoblastic disease (a type of tumor)
• Confirm miscarriage or ectopic pregnancy

HCG test: Management

The test result itself is not a management tool but provides crucial information for managing pregnancy, reproductive health, or specific medical conditions.

Hypotension: Definition

Abnormally low blood pressure (typically defined as systolic BP <90 mmHg or diastolic BP <60 mmHg), which can lead to inadequate perfusion of organs and potentially shock.

Hypotension: Symptoms

• Dizziness, lightheadedness, or feeling faint (presyncope/syncope)

• Blurred vision

• Nausea

• Fatigue

• Cold, clammy skin

• Rapid, shallow breathing (if severe or in shock)

• Confusion or altered mental status

Hypotension: Diagnosis

Diagnosed by measuring blood pressure. Further diagnostic workup involves identifying the underlying cause: cardiovascular assessment, fluid status evaluation, blood tests (CBC, electrolytes), and ECG.

Hypotension: Treatment & Management

• **Immediate:** Position patient supine with legs elevated, administer IV fluids (saline).

• **Long-term:** Address underlying causes (e.g., dehydration, blood loss, heart conditions, sepsis). May involve diet and lifestyle changes (e.g., increased salt and fluid intake, small frequent meals for orthostatic hypotension).

Hypotension: Medications

• **For orthostatic hypotension:** Fludrocortisone, Midodrine.

• **For shock/severe hypotension:** Vasopressors (e.g., norepinephrine, dopamine, phenylephrine) to constrict blood vessels and increase blood pressure.

Costovertebral angle (CVA) tenderness: Definition

Discomfort or pain elicited by percussion over the costovertebral angle (the angle formed by the twelfth rib and the lumbar vertebrae), indicating possible kidney issues.

CVA Tenderness: Clinical Significance/Associated Conditions

A significant sign indicative of kidney inflammation or infection, most commonly pyelonephritis (kidney infection) or sometimes kidney stones.

CVA Tenderness: Diagnosis (Assessment)

Elicited during physical examination by gently striking the area over the kidneys with a fist. Pain reported by the patient indicates a positive sign. Confirmatory tests include urinalysis, urine culture, blood tests (CBC, renal function tests), and imaging (renal ultrasound, CT scan).

CVA Tenderness: Treatment & Management

Treatment is directed at the underlying cause. For pyelonephritis, antibiotics are the primary treatment. Management includes pain relief and adequate hydration.

CVA Tenderness: Medications

Antibiotics (e.g., ciprofloxacin, levofloxacin, ceftriaxone) for pyelonephritis. Analgesics (NSAIDs, acetaminophen) for pain relief.

Borborygmi: Definition

The rumbling sound produced by the movement of gas and fluid through the intestines, commonly referred to as 'stomach growling'.

Borborygmi: Clinical Significance

Occasional borborygmi are normal. Increased sounds can indicate increased bowel activity (e.g., hunger, diarrhea, malabsorption, early bowel obstruction). Decreased or absent sounds can indicate paralytic ileus, peritonitis, or late bowel obstruction.

Borborygmi: Diagnosis (Assessment)

Assessed by auscultation of the abdomen. Interpretation is always in the context of other symptoms and physical findings. Imaging (X-rays, CT) may be needed if obstruction is suspected.

Borborygmi: Management/Treatment

No direct treatment for borborygmi itself; management focuses on treating the underlying gastrointestinal condition causing abnormal bowel sounds.

Dyspepsia: Definition

Indigestion; a persistent or recurrent pain or discomfort centered in the upper abdomen (epigastrium).

Dyspepsia: Symptoms

• Epigastric pain or burning

• Postprandial fullness (feeling full quickly after starting to eat)

• Early satiety (inability to finish a normal-sized meal)

• Bloating, belching, nausea

Dyspepsia: Diagnosis

Based on clinical symptoms. Diagnosis involves ruling out organic causes (e.g., GERD, peptic ulcer disease, gallstones, malignancy) through endoscopy, H. pylori testing, and sometimes imaging. If no organic cause is found, it's often functional dyspepsia.

Dyspepsia: Treatment & Management

• **Management:** Lifestyle modifications (dietary changes, avoid trigger foods like fatty/spicy foods, caffeine, alcohol; smaller, more frequent meals; stress reduction; weight management).

Dyspepsia: Medications

• Antacids

• H2-receptor blockers (e.g., famotidine, ranitidine)

• Proton pump inhibitors (PPIs) (e.g., omeprazole, pantoprazole)

• Prokinetics (e.g., metoclopramide) to improve gastric emptying

• Antibiotics for H. pylori infection (if present)

Icterus: Definition

Jaundice; a yellowing of the skin, sclera (whites of the eyes), and mucous membranes due to high levels of bilirubin in the blood (hyperbilirubinemia).

Icterus: Symptoms/Associated Findings

• Yellow discoloration of skin and eyes

• Dark urine (due to conjugated bilirubin excretion)

• Pale or clay-colored stools (due to lack of bilirubin in intestines from obstruction)

• Pruritus (itching)

• Fatigue, nausea, abdominal pain (symptoms of underlying liver disease)

Icterus: Diagnosis

Confirmed by physical exam and blood tests (total and direct bilirubin levels), liver function tests (LFTs), CBC. Further investigation includes viral hepatitis panels, autoimmune markers, and imaging (ultrasound, CT, MRI of abdomen/liver) to identify the cause of hyperbilirubinemia.

Icterus: Treatment & Management

Treatment is entirely dependent on the underlying cause of the hyperbilirubinemia. Management often involves supportive care, addressing pruritus, and specific interventions for liver disease or biliary obstruction.

Icterus: Medications

Medications are for the underlying cause: antivirals for hepatitis, corticosteroids for autoimmune hepatitis, ursodeoxycholic acid for cholestatic conditions, cholestyramine for pruritus.

Hyperbilirubinemia: Definition

Excess bilirubin in the blood, often indicating liver dysfunction, excessive red blood cell breakdown (hemolysis), or a problem with bilirubin excretion.

Hyperbilirubinemia: Symptoms

Often manifests as icterus (jaundice). Other symptoms depend on the cause and may include dark urine, pale stools, pruritus, fatigue, nausea, and abdominal pain.

Hyperbilirubinemia: Diagnosis

Blood tests measuring total, direct (conjugated), and indirect (unconjugated) bilirubin levels. Further tests include LFTs, CBC, viral hepatitis serology, autoimmune markers, and imaging (ultrasound, CT, MRI) to find the cause.

Hyperbilirubinemia: Treatment & Management

Treatment focuses on resolving the specific cause of elevated bilirubin, whether it's liver disease, hemolytic anemia, or biliary obstruction. Phototherapy for neonatal hyperbilirubinemia.

Hyperbilirubinemia: Medications

Depends on the cause: antivirals, corticosteroids, cholesytearmine for pruritus, or medications to treat hemolytic conditions.

Melena: Definition

Black, tarry, foul-smelling stools, indicating upper gastrointestinal bleeding (usually from the esophagus, stomach, or duodenum).

Melena: Symptoms

Passage of characteristic stools (black, sticky, offensive odor). May be accompanied by symptoms of blood loss: fatigue, pallor, dizziness, weakness, syncope, tachycardia, hypotension.

Melena: Diagnosis

Physical exam (including digital rectal exam for stool color/consistency), stool guaiac test (detects occult blood), CBC (often shows anemia), blood urea nitrogen (BUN) to creatinine ratio (often elevated in UGIB). Definitive diagnosis is usually via upper endoscopy (Esophagogastroduodenoscopy - EGD).

Melena: Treatment & Management

• **Immediate:** IV fluid resuscitation, blood transfusion if needed (packed red blood cells, platelets, FFP).

• **Definitive:** Endoscopic therapy (e.g., clipping, cautery, epinephrine injection) to stop the bleeding. Surgery in cases of refractory bleeding or complications.

Melena: Medications

• Proton pump inhibitors (PPIs, e.g., omeprazole, pantoprazole) via IV for acid suppression.

• Octreotide for variceal bleeding.

Dysphagia: Definition

Difficulty in swallowing, which can involve problems with the oral, pharyngeal, or esophageal phases of swallowing.

Dysphagia: Symptoms

• Sensation of food sticking in the throat or chest

• Coughing or choking during or after meals

• Regurgitation of food

• Drooling

• Odynophagia (painful swallowing)

• Unexplained weight loss

• Recurrent pneumonia (from aspiration)

Dysphagia: Diagnosis

Clinical history (distinguishing oropharyngeal vs. esophageal dysphagia). Diagnostic tests include barium swallow study, upper endoscopy (EGD), esophageal manometry, and Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

Dysphagia: Treatment & Management

• **Management:** Dietary modifications (soft foods, pureed diet, thickened liquids), swallowing therapy with a speech-language pathologist, maintaining good oral hygiene.

• Treatment of underlying cause: dilation of strictures, surgery for tumors or diverticula.

Dysphagia: Medications

• PPIs or H2 blockers for reflux-related dysphagia.

• Prokinetics for certain motility disorders.

• Botox injections for achalasia.

• Medications to treat underlying conditions like myasthenia gravis.

Antidopaminergics: Definition

A class of medications that block dopamine receptors in the brain and periphery.

Antidopaminergics: Therapeutic Uses

Primarily used as antiemetics to treat nausea and vomiting. Also used as antipsychotics, and to improve gastric motility in some conditions.

Antidopaminergics: Medications (Examples)

• Metoclopramide (Reglan)

• Prochlorperazine (Compazine)

• Promethazine (Phenergan)

• Domperidone (Motilium - not available in the U.S.)

• Certain antipsychotics (e.g., haloperidol) for severe nausea/vomiting

Enteral feeding: Definition

Providing nutrition directly into the gastrointestinal (GI) tract via a tube, for patients who are unable to meet their nutritional needs orally but have a functional GI tract.

Enteral feeding: Indications/Management

Used for patients with:

• Dysphagia (difficulty swallowing)
• Severe malnutrition
• Critical illness (e.g., burns, trauma)
• Hypermetabolic states
• Neurological impairments affecting feeding

Administered via nasogastric (NG) tube, gastrostomy (G-tube), or jejunostomy (J-tube).

Enteral feeding: Formulas (Considerations)

Various types of formulas are available, adapted to patient-specific needs (e.g., high protein, low residue, diabetic formulas, elemental formulas). Selection depends on the patient's caloric and nutrient requirements, GI function, and specific medical condition.