21 Abdominal Pain Flashcards
45yo M presents with sudden onset of colicky right sided flank pain that radiates to the testicles, accompanied by nausea, vomiting, hematuria and CVA tenderness
NEPHROLITHIASIS
Renal cell carcinoma
pyelonephritis
GI etiology (e.g. appendicitis)
UA, urine culture and sensitivity, urine cytology BUN/Cr CT-abd US renal KUB IVP Blood culture
60yo M presents with dull epigastric pain that radiates to the back, accompanied by weight loss, dark urine, and clay-colored stools. He is a heavy dinner and smoker. He appears jaundiced on exam
PANCREATIC CANCER cholangiocarcinoma acute viral hepatitis acute alcoholic hepatitis chronic pancreatitis cholecystitis/choledocholithiasis abdominal aortic aneurysm peptic ulcer disease
cbc electrolytes amylase, lipase ast/alt/bili/alkphos ct abd us abd
56yo M presents with severe midepigastric abdominal pain that radiates to the back and improves when he leans forward. He also reports anorexia, nausea, and vomiting. He is an alcoholic and has spent the past 3 days binge drinking.
ACUTE PANCREATITIS peptic ulcer disease cholecystitis/choledocholithiasis gastritis AAA mesenteric ischemia alcoholic hepatitis boerhaave syndrome
cbc electrolytes, BUN/Cr amylase, lipase ast/alt/bili/alkphos US abdomen CT abd upper endoscopy ecg
41yo obese F presents with RUQ abdominal pain that radiates to the right scapula and is associated with nausea, vomiting and a fever of 101.5. The pain started after she ate fatty food. She has had similar but less intense episodes that lasted a few hours. Exam reveals a positive murphy’s sign
ACUTE CHOLECYSTITIS choledocholithiasis hepatitis ascending cholangitis peptic ulcer disease Fitz-Hugh-Curtis syndrome acute sub hepatic appendicitis
cbc ast/alt/bili/alkphos us abd ct abd blood culture
43yo obese F presents with RUQ abdominal pain, fever, jaundice. She was diagnosed with asymptomatic gall stones 1 year ago. She is found to be hypotensive on exam.
ASCENDING CHOLANGITIS acute gallstone cholangitis acute cholecystitis hepatitis sclerosing cholangitis fitz-hugh-curtis syndrome
cbc ast/alt/bili/alkphos blood culture viral hepatitis serologies US abd MRCP ERCP
25yo M presents with RUQ pain, fever, anorexia, nausea, and vomiting. He has dark urine and clay colored stool
ACUTE HEPATITIS acute cholecystitis ascending cholangitis choledocholithiasis pancreatitis acute glomerulonephritis
cbc amylase,lipase ast/alt/bili/alkphos vira hepatitis serologies UA US abd
35yo M presents with burning epigastric pain that starts 2-3h after meals. The pain is relieved by food and antacids
PEPTIC ULCER DISEASE gastritis gerd cholecystitis chronic pancreatitis mesenteric ischemia
rectal exam, stool for occult blood amylase, lipase, lactate ast/alt/bili/alkphos upper endoscopy (including Hpylori testing) upper GI series
37yo M presents with severe epigastric pain, nausea, vomiting and mild fever. He appears toxic. He has a history of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a daily basis.
PERFORATED PEPTIC ULCER acute pancreatitis hepatitis cholecystitis gallstone cholangitis mesenteric ischemia
rectal exam cbc electrolytes amylase, lipase, lactate ast/alt/bili/alkphos cxr kub ct abd upper endoscopy including Hpylori testing blood culture
1870M boxer presents with severe LUQ abdominal pain that radiates to the left scapula. He had infectious mono 3 weeks ago
SPLENIC RUPTURE kidney stone rib fracture pneumonia perforated peptic ulcer splenic infarct
cbc electrolytes cxr ct abd us abd if hemodynamically unstable
40yo M presents with cramp abdominal pain, vomiting, abd distention, and inability to pass flatus or stool. He has a history of multiple abdominal surgeries
INTESTINAL OBSTRUCTION small bowel or colon cancer volvulus gastroenteritis food poisoning ileus hernia
rectal exam cbc electrolytes axr ct abd/pelvis with contrast colonoscopy
70yo F presents with acute onset of severe, cramp abdominal pain. She recently vomited and had a massive dark bowel movement. She has a history of CHF and atrial fibrillation, for which she has received digitalis. Her pain is out of proportion to the exam.
MESENTERIC ISCHEMIA/INFARCTION diverticulitis PUD gastroenteritis acute pancreatitis cholecystitis
rectal exam cbc amylase, lipase, lactate ecg axr ct abd mesenteric angiography barium enema
21yo F presents with acute onset of severe RLQ pain, nausea, and vomiting. She has no fever, urinary symptoms or vaginal bleeding and has never taken OCPs. Her LMP was regular and she has no history of STDs. She has been told that she had a cyst on her right ovary
OVARIAN TORSION appendicitis nephrolithiasis ectopic pregnancy ruptured ovarian cyst pid bowel infarction or perforation
pelvic exam urine hCG doppler US pelvis rectal exam ua cbc ct abd laparoscopy chlamydia and gonorrhea testing, vdrl/rpr
68yo M presents with LLQ abd pain, fever and chills for the past 3 days. He also reports recent onset of alternating diarrhea and constipation. He consumes a low-fiber, high fat diet
DIVERTICULITIS crowns disease UC gastroenteritis abscess
rectal exam cbc electrolytes cxr axr ct abd blod cultre
20yo M presents with severe RLQ abd pain, nausea and vomiting. His discomfort started yesterday as a vague pain around the umbilicus. As the pain worsened, it became sharp and migrated to the RLQ. McBurney’s and psoas signs are positive.
ACUTE APPENDICITIS gastroenteritis diverticulitis crohns nephrolithiasis volvulus or other intestinal obstruction perforation acute cholecysitits
cbc electrolytes ct abd axr US abd blood culture
30 yo F presents with periumbilical pain for 6 months. The pain never awakens her from sleep. It is relieved by defecation and worsens when she is upset. She has alternating constipation and diarrhea but no nausea, weight loss, or anorexia.
IRRITABLE BOWEL SYNDROME Crohn's disease celiac disease chronic pancreatitis GI parasitic infection (amebiasis, giardiasis) Endometriosis
rectal exam, stool for occult blood pelvic exam urine hCG cbc electrolytes colonscopy CT-abdomen/pelvis stool for ova and parasitology, entamoeba histolytic antigen
