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Chapter 18 ♦ Acute Abdominal Surgical Emergencies

III. LUQ pain

A. Peptic ulcer disease B. Gastritis C. Splenic rupture or inflammation: Pain can be focal, referred, or diffuse. D. Hiatal hernia: Majority asymptomatic, can present with reflux or chest pain. E. Boerhaave syndrome: Usually sudden onset severe pain after repeated retching/vomiting. F. Mallory – Weiss tear: Pain with associated hematemesis. IV. LLQ pain A. Diverticulitis: Can present with inflammation, abscess, perforation, or bleeding. B. Sigmoid volvulus: Pain with torsion of the sigmoid colon. C. Colon cancer D. UTI, nephrolithiasis, pyelonephritis E. Gynecologic, prostatitis, testicular torsion V. Medical conditions masquerading as a surgical abdomen A. Pneumonia B. Myocardial infarction C. Pericarditis D. Malignancy E. Diabetic ketoacidosis F. Acute hepatitis G. Rare causes: Rheumatic fever, porphyria, sickle cell crisis, and lead intoxication.

Quick Cuts • “Emergent” means immediate; “urgent” means with minimal delay.

• Specific locations and signs often give clues to intra-abdominal pathology. • “Free air” generally means a patient needs an emergency laparotomy. • A key concept is to maintain a broad differential for abdominal pain: upper abdominal pain may be due to problems in the chest, and GI and GU symptoms overlap.

OBSTRUCTION History and Physical Exam I. Signs and symptoms A. Nausea, vomiting, crampy abdominal pain, and decreased or absent flatus and stool. B. Emesis character (bilious, nonbilious, feculent) can suggest location of obstruction.