13 - Abd Pain and Constipation

Question 1

abdominal referred pain:
cholecystitis >
pancreatitis and perf GU >

Answer 1

chole > shoulders/scapula

pancreatitis and perf > back

Question 2

3 signs of peritonitis

Answer 2

rigid abdomen
rebound tenderness
absent bowel sounds

Question 3

Murphy’s sign

Answer 3

push on RUQ and tell pt to take deep breath. if it hurts, they probably have biliary dz

Question 4

typical biliary dz pain desc

Answer 4

postpraindial RUQ pain

Question 5

4 Fs of biliary dz

Answer 5

fat, forty, female, fertile

Question 6

95% of acute cholecystitis is due to

Answer 6

cholelithiasis

Question 7

choledocholithiasis

Answer 7

stone in common bile duct - can cause pancreatitis

Question 8

cholangitis - 2 eponyms for constellation of sx

Answer 8

Charcot’s triad - pain, jaundice, fever

Reynold’s pentad - Charcot’s + hypotension + altered mental status

Question 9

desc of PUD pain

Answer 9

epigastric, improved after eating

Question 10

MC causes (2) of acute pancreatitis

Answer 10

alcohol, gallstones

Question 11

desc of acute pancreatitis pain

Answer 11

epigastric pain radiating to back

+N/V

Question 12

lab test that indicates pancreatitis

Answer 12

elevated lipase or amylase

Question 13

tx of acute pancreatitis

Answer 13

NPO, IVF, opiates

Question 14

MCC acute abdominal pain in US

Answer 14

appendicitis

Question 15

desc of appendicitis pain

Answer 15

periumbilical pain + anorexia +/- vomiting

migrates to RLQ

Question 16

presentation of diverticulitis

Answer 16

LLQ pain, fever, obstipation, leukocytosis

Question 17

presentation of mesenteric ischemia

Answer 17

sudden severe abd pain (diffuse)
vomiting
pain is out of proportion to exam findings

Question 18

presentation of small bowel obstruction

Answer 18

crampy, intermittent, midabdominal pain
vomiting
distension
obstipation

Question 19

imaging of small bowel obstruction

Answer 19

dilated loops of small bowel w/ air fluid levels

Question 20

conditions that can cause diarrhea

Answer 20

metab - hypercalcemia, hypothyroid, diabetes
neuor - parkonsonism, SC lesions
meds - antacids, opiates, iron, CCBs

Question 21

alarm symptoms related to constipation

Answer 21

blood in stool, wt loss, sudden onset of sx

Question 22

when do you do a colonoscopy for constipation?

Answer 22

alarm sx or age > 50

Question 23

Sitz marker study

Answer 23

capsule w/ markers ingested and do serial xrays to determine if constipation is due to slow transit or pelvic floor dysfunction

Question 24

types of laxatives and examples

Answer 24

bulk - fiber
emollient (softener) - docusates
osmotic - MgOH, PEG
stimulants - senna, bisacodyl

Question 25

lubiprostone

Answer 25

chloride secretagogue used for constipation

inc luminal fluid secretion

Question 26

methylnaltrexone

Answer 26

blocks opioid receptors in gut - dec opiate induced constipation