Abdomen- Ab pain

Question 1

Ab pain- cancer of stomach (process)

Answer 1

Predominantly adenocarcinoma (90-95%)

Question 2

Ab pain- cancer of stomach (location)

Answer 2

Increasingly in ‘cardia’ and GE junction; also in distal stomach

Question 3

Ab pain- cancer in stomach (timing)

Answer 3

Shorter than peptic ulcer, pain is persistent and slowly progressive

Question 4

Ab pain- cancer in stomach (factors aggregate/relieve)

Answer 4

Aggravates- food

Relieves- NOT relieved by food or antacids

Question 5

Ab pain- cancer in stomach (associated symptoms)

Answer 5

Anorexia, nausea, early satiety, weight loss, sometimes bleeding. Ages 50-70 commonly

Question 6

Ab pain- acute pancreatitis (process)

Answer 6

Acute inflammation of the pancreas

Question 7

Ab pain- acute pancreatitis (location)

Answer 7

Epigastric, may radiate to the back or other parts of the abdomen; may be poorly localized

Question 8

Ab pain- acute pancreatitis (quality)

Answer 8

Usually steady

Question 9

Ab pain- acute pancreatitis (timing)

Answer 9

Acute onset, persistent pain

Question 10

Ab pain- acute pancreatitis (aggregate/relieve)

Answer 10

Aggravate- lying supine

Relieve- leaning forward with trunk flexed

Question 11

Ab pain- acute pancreatitis (symptoms/setting)

Answer 11

Nausea, vomiting, ab distention, fever. Often history of previous attacks and alcohol abuse or gallstones

Question 12

Ab pain- chronic pancreatitis (process)

Answer 12

Fibrosis of the pancreas secondary to recurrent inflammation

Question 13

Ab pain- chronic pancreatitis (location)

Answer 13

Epigastric, radiating through the back

Question 14

Ab pain- chronic pancreatitis (quality)

Answer 14

Steady, deep

Question 15

Ab pain- chronic pancreatitis (timing)

Answer 15

Chronic or recurrent course

Question 16

Ab pain- chronic pancreatitis (aggregate/relieve)

Answer 16

Aggregate-alcohol, heavy or fatty metals

Relieve- possibly leaning forward with trunk flexed; often intractable

Question 17

Ab pain- chronic pancreatitis (symptoms/setting)

Answer 17

Decreased pancreatic function; diarrhea with fatty stools (steatorrhea) and diabetes mellitus

Question 18

Ab pain- cancer of the pancreas (process)

Answer 18

Predominantly adenocarcinoma (95%)

Question 19

Ab pain- cancer of the pancreas (location)

Answer 19

Epigastric and in either upper quadrant; often radiates to the back

Question 20

Ab pain- cancer of the pancreas (quality)

Answer 20

Steady, deep

Question 21

Ab pain- cancer of the pancreas (timing)

Answer 21

Persistent pain; relentlessly progressive illness

Question 22

Ab pain- cancer of the pancreas (aggregate/relieve)

Answer 22

Relieve- same as chronic pancreatitis

Question 23

Ab pain- cancer of the pancreas (symptoms/setting)

Answer 23

Anorexia, nausea, vomiting, weight loss, jaundice; depression

Question 24

Ab pain- biliary colic (process)

Answer 24

Sudden obstruction of the cystic duct or common bike duct by gallstone

Question 25

Ab pain- biliary colic (location)

Answer 25

Epigastric or RUQ; may radiate to R scapula and shoulder

Question 26

Ab pain- biliary colic (quality)

Answer 26

Steady, aching; NOT colicky

Question 27

Ab pain- biliary colic (timing)

Answer 27

Rapid onset over a few minutes, lasts one to several hours and subsides gradually. Often recurrent

Question 28

Ab pain- biliary colic (settings/symptoms)

Answer 28

Anorexia, nausea, vomiting, restlessness

Question 29

Ab pain- acute cholecystitis (process)

Answer 29

Inflammation of the gallbladder, usually from obstruction of the cystic duct by a gallstone

Question 30

Ab pain- acute cholecystitis (location)

Answer 30

RUQ or R abdominal; may radiate to R scapular area

Question 31

Ab pain- acute cholecystitis (quality)

Answer 31

Steady, aching

Question 32

Ab pain- acute cholecystitis (timing)

Answer 32

Gradual onset, course longer than in biliary colic

Question 33

Ab pain- acute cholecystitis (aggregate/ relieve)

Answer 33

Aggravate- jarring, deep breathing

Question 34

Ab pain- acute cholecystitis (symptoms/setting)

Answer 34

Anorexia, nausea, vomiting, fever

Question 35

Ab pain- acute diverticulitis (process)

Answer 35

Acute inflammation of the colonic diverticulum, a saclike mucosal outpouring through the colonic muscle

Question 36

Ab pain- acute diverticulitis (location)

Answer 36

LLQ

Question 37

Ab pain- acute diverticulitis (quality)

Answer 37

May be cramping at first, but becomes steady

Question 38

Ab pain- acute diverticulitis (timing)

Answer 38

Often a gradual onset

Question 39

Ab pain- acute diverticulitis (symptoms/setting)

Answer 39

Fever, constipation. There may be initial brief diarrhea

Question 40

Ab pain- acute appendicitis (process)

Answer 40

Acute inflammation of the appendix with distention or obstruction

Question 41

Ab pain- acute appendicitis (location)

Answer 41

- poorly localized peri umbilical pain followed usually by | - RLQ pain

Question 42

Ab pain- acute appendicitis (quality)

Answer 42

- Mild but increasing, possibly cramping | - steady and more severe

Question 43

Ab pain- acute appendicitis (timing)

Answer 43

- Lasts roughly 4-6 hours | - Depends on intervention

Question 44

Ab pain- acute appendicitis (aggregate/relieve)

Answer 44

Aggravate- movement or cough | Relieve- if it subsides temporarily, suspect perforation of the appendix

Question 45

Ab pain- acute appendicitis (symptoms/setting)

Answer 45

Anorexia, nausea, vomiting, which typically follow the onset of pain; low fever

Question 46

Ab pain- acute mechanical intestinal obstruction (process)

Answer 46

Obstruction of the bowel lumen, most commonly caused by: - adhesions or hernias (small bowel) - cancer and diverticulitis (colon)

Question 47

Ab pain- acute mechanical intestinal obstruction (location)

Answer 47

- Small bowel: periumbilical or upper abdominal | - Colon: lower abdominal or generalized

Question 48

Ab pain- acute mechanical intestinal obstruction (quality)

Answer 48

Cramping in both

Question 49

Ab pain- acute mechanical intestinal obstruction (timing)

Answer 49

- Small bowel: paroxysmal; may decrease as bowel mobility is impaired - Colon: paroxysmal, though typically milder

Question 50

Ab pain- acute mechanical intestinal obstruction (symptoms/setting)

Answer 50

- Small bowel: vomiting of bile and mucus (high obstruction) or fecal material (low obstruction); obstinate on develops - Colon: obstipation early. Vomiting late if at all. Prior symptoms of underlying cause

Question 51

Ab pain- mesenteric ischemia (process)

Answer 51

Blood supply to the bowel and mesentery blocked from thrombosis or embolus (acute arterial occlusion), or reduced from hypoperfusion

Question 52

Ab pain- mesenteric ischemia (location)

Answer 52

May be periumbilical at first, then diffuse

Question 53

Ab pain- mesenteric ischemia (quality)

Answer 53

Cramping at first, then steady

Question 54

Ab pain- mesenteric ischemia (timing)

Answer 54

Usually abrupt onset, then persistent

Question 55

Ab pain- mesenteric ischemia (symptoms/setting)

Answer 55

Vomiting, diarrhea (sometimes bloody), constipation, shock