1. Abdominal Pain Flashcards
Name cardiac DDX : Abdominal Pain (5)
- ACS
- Pericarditis
- Aortic dissection
- Mesenteric ischemia
- Sickle cell crisis
Name pulmonary DDX : Abdominal Pain (2)
- Pneumonia
- Embolus
Name Biliary DDX : Abdominal Pain (3)
- Cholecystitis
- Cholelithiasis
- Cholangitis
Name GASTRIC DDX : Abdominal Pain (4)
- Esophagitis
- Gastritis
- Peptic ulcer
- Small-bowel mass or obstruction
Name COLONIC DDX : Abdominal Pain (7)
- Appendicitis
- Colitis
- Diverticulitis
- IBD
- Bowel obstruction
- Peritonitis
- Celiac disease
Name HEPATIC DDX : Abdominal Pain (3)
Hepatitis
Abscess, mass
Name PANCREATIC DDX : Abdominal Pain (2)
Pancreatitis, mass
Name RENAL DDX : Abdominal Pain (3)
Cystitis
Nephrolithiasis
Pyelonephritis
Name SPLENIC DDX : Abdominal Pain (1)
Abscess
Name SPLENIC DDX : Abdominal Pain (8)
- Ectopic pregnancy
- Ovarian mass
- Ovarian torsion
- PID
- Fibroids
- Endometriosis
- Ovulatory pain
- Ruptured ovarian cyst
Name ABDOMINAL WALL DDX : Abdominal Pain (3)
- Herpes zoster
- Muscle strain
- Hernia
Name METABOLIC DDX : Abdominal Pain (6)
- Uremia
- DKA
- Porphyria
- Adrenal insufficiency
- Narcotic withdrawal
- Heavy metal poisoning
Name PSYCH DDX : Abdominal Pain (6)
IBS
Describe hx : Abdominal pain (7)
- Acute vs. Chronic
- Fever, stools (diarrhea, bloody), vomiting (bilious, bloody)
- Malignancy (early satiety, weight loss, night sweats, changes in stools)
- Alcohol, smoking, drugs
- NSAIDs
- Past surgeries (obstruction)
- Females (pregnancy), Vaginal bleeding/discharge, LMP
Describe physical exam : Abdominal pain (5)
- Vitals
- Chest/Lung
- Abdo
- Pelvic/Genital exam
- Rectal exam
Describe investigations : Abdominal pain (6)
- Labs (eg. CBC, ALT/AST, amylase/lipase, lytes (glucose, creat), UA, bhCG)
- Ultrasound
- X-ray (CXR, AXR)
- Endoscopy/Colonoscopy
- ERCP
- Urea breath test
Describe choice of imaging in abdominal pain
- Ultrasound (gallbladder, gyne) if RUQ/suprapubic
- Otherwise, CT
Consider IV contrast for RLQ, non-localized (r/o appendicitis)
Consider Oral + IV contrast LLQ (r/o sigmoid diverticulitis)
Describe use of X-ray
- Free air (if upright), Perforation
- Calcifications : 10% of gallstones, 90% of kidney stones, and 5% appendicoliths
- Multiple dilated loops of the bowel and air-fluid levels, Bowel obstruction or paralytic ileus
Name life-threatening dx of acute pelvic pain in women (3)
- Ectopic pregnancy
- Appendicitis
- Ruptured ovarian cyst
Name fertility-threatening dx of acute pelvic pain in women (3)
- PID
- Ovarian Torsion
Name redflags of abdominal pain in children (8)
- Fever (after onset of vomiting or pain)
- Bilious vomiting
- Bloody diarrhea
- Absent bowel sounds
- Voluntary guarding
- Rigidity
- Rebound tenderness
- ** Do not forget testis **
Name DDX of abdominal pain if : < 1 yo
- Common: Colic, constipation, GERD, food protein allergy
- Urgent: Acute gastroenteritis, malrotation without volvulus, pyloric stenosis
- Emergent: Trauma (abuse), midgut volvulus, NEC, omphalitis, incarcerated hernia, intussusception
Name DDX of abdominal pain if : 1 - 5 yo
- Common: UTI, constipation
- Urgent: Acute gastroenteritis, HSP, pneumonia, Meckel diverticulum
- Emergent: Trauma, appendicitis, asthma
Name DDX of abdominal pain if : 5 - 12 yo
- Common: UTI, constipation, functional
- Urgent: Acute gastroenteritis, IBD, HSP, pneumonia
- Emergent: Trauma, appendicitis, gonadal torsion, DKA, asthma
Name DDX of abdominal pain if : > 12 yo
- Urgent: Gastroenteritis, IBD, pneumonia, hepatitis, pancreatitis, nephrolithiasis, PID
- Emergent: Trauma, appendicitis, gonadal torsion, ectopic pregnancy, DKA, asthma
Describe : Investigation in children with abdominal pain
- Consider urinalysis, CBC, pregnancy test, ESR/CRP
- Consider ultrasound prior to proceeding with abdominal CT
Elderly are at an increase risk of which ddx of abdominal pain ?
- holecystitis
- pancreatitis
- diverticulitis
- obstructions (adhesions, malignancy)
