Abdo pain

Question 1

Perforated viscus

Answer 1

Any GI organ can perforate.
e.g. IO, Peptic ulcer, appendix, diverticula, HCC

Question 2

Ruptured AAA

Answer 2

Severe peritonitis and hypotension.

Question 3

Ruptured ectopic pregnancy

Answer 3

Classic vaginal bleeding + abdo pain

Vaginal bleeding not always present

Question 4

Spontaneous bacterial peritonitis + Peritoneal dialysis related peritonitis

Answer 4

Patients on PD can get bacterial infection of intra-peritoneal fluid.
Present with generalized peritonitis.

Question 5

Testicular torsion

Answer 5

High-riding tender testes lying transversely with loss of cremasteric reflex.

Question 6

Epididymo-orchitis

Answer 6

Positive Prehn’s sign
Gradual pain onset
A/w UTI symptoms

Question 7

Cholecystitis

Answer 7

RUQ pain lasting hours. May radiate to right shoulder.
May have low-grade fever.
Murphy’s sign classic

No jaundice

Question 8

Acute cholangitis

Answer 8

Charcot triad = RHC pain, Fever, Jaundice
Raynaud Pentad = Neurological symptoms, hypotension

Pt is sicker than in cholecystitis.

Cholecystic liver enzyme pattern = ALP GGT > AST ALT

Question 9

Acute hepatitis

Answer 9

Fever, jaundice, tender hepatomegaly
Non-specific symptoms e.g. N/V.

ALT AST > ALP

Question 10

Hepatic abscess

Answer 10

Fever
sometimes with jaundice or hepatomegaly

Question 11

Acute pancreatitis

Answer 11

Steady epigastric and periumbilical pain, radiating to back.
Relieved on bending forward
Persistent nausea, frequent vomiting.

Look out for signs of haemorrhagic pancreatitis

Question 12

Appendicitis

Answer 12

Classic dull periumbilical (referred) pain migrating to RIF.
Localized RIF guarding + rebound tenderness.
Anorexia -> abdo pain -> vomiting -> fever

Alvarado score for assessment.

Question 13

Diverticulitis

Answer 13

Low-grade fever
Possible tender, palpable mass
Change in bowel habits
Sometimes urinary urgency and frequency + sterile pyuria

Rarely hematochezia.
Acute abdo suggests perforation and peritonitis

Question 14

Meckel’s diverticulum

Answer 14

Indistinguishable from acute appendicitis

Question 15

Intestinal obstruction

Answer 15

Abdo distension
Abdominal colic
No bowel output
N/V

Question 15

Constipation colic

Answer 15

Diagnosis of exclusion. Common in elderlies.

Question 16

Adhesion colic

Answer 16

Common with prior surgery
Intermittent colic pain
Diagnosis of exclusion

Adhesions are between bowel loops

Question 17

Mesenteric ischemia

Answer 17

Severe generalized non-specific pain.
Classic scenario is someone with AF or other embolic RFs.
Abdo exam is normal. But with ischemia progression, **bowel sounds become sluggish, abdominal distension develops. **
Peritoneal signs develop and patient turns hypotensive.

Lactate will be raised.

Question 18

Urolithiasis

Answer 18

Loin to groin colic. Often severe. Higher obstruction can cause flank pain.

Consider pyonephrosis if there are signs of infection.

Question 19

Pyelonephritis

Answer 19

Flank pain
Fever
Positive renal punch

Consider pyonephrosis if there is obstructed system

Question 20

Pelvic Inflammatory disease

Answer 20

Young sexually active lady. With lower abdo pain and features of infection.
Exam finds cervical excitation, adnexal tenderness, adnexal masses. Vaginal speculum may find vaginal discharge.

Question 21

Ovarian torsion
Ruptured ovarian cyst

Answer 21

Acute-onset unilateral pelvic pain.
Can have adnexal mass.

Question 22

Hypercalcemia

Answer 22

Abdo pain is cardinal feature, tgt with altered mental state, urolithiasis, bony pain and constipation.

Question 23

Adrenal crisis

Answer 23

Can present with abdo pain.
Other clues include borderline hypotension, postural hypotension, hypoNa, HyperK and hypoglycemia

Question 24

Biliary colic

Answer 24

Episodic RHC pain
Often post-fatty meals, can have N/V
No jaundice. Liver enzymes normal

Question 25

GERD

Answer 25

Post-prandial heartburn-like discomfort.
Worse on supine. Can have cough

Question 26

Dyspepsia

Answer 26

Mostly functional causes.
Look out for red flags such as malignancy signs

Question 27

Irritable Bowel Syndrome

Answer 27

Recurrent abdo pain.
Classically relieved by defecation, with changes in stool frequency and consistency

Question 28

Inflammatory bowel disease

Answer 28

Present with flares of abdo colic and bloody diarrhoea

Question 29

Dysmenorrhoea

Answer 29

Cause of cyclical pelvic pain.
Can be 1! or 2! to endometriosis or leiomyoma.
Can have heavy menstrual bleeding.
Exam can find Pouch of Douglas tenderness, adnexal masses or enlarged uterus

Question 30

Chronic pancreatitis

Answer 30

Steatorrhoea, new-onset or worsening diabetes..
Patients can have significant weight loss, mimicking pancreatic Ca.

Abdo imaging shows pancreatic calcification

Question 31

Other cancers or masses!!! All abdo pain