Abdominal Pain Flashcards by tia meechan

Name some ddx for RUQ pain

Duodenal ulcer
Hepatitis
Hepatomegaly
Pneumonia
Cholecystitis

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Name some ddx for RLQ pain

Appendicitis
Scalping it is
Ovarian cyst
Ruptured ectopic pregnancy
Renal/ureteral stone
Strangulated hernia
Meckel diverticulitis
Regional ileitis
Perforated cecum

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Name some ddx for peri umbilical pain

Intestinal obstruction
Acute pancreatitis
Early appendicitis
Mesenteric thrombosis
Aortic aneurysm
Diverticulitis

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Name some ddx for LUQ pain

Ruptured spleen
Gastric ulcer
Aortic aneurysm
Perforated colon
Pneumonia

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Name some ddx for LLQ pain

Sigmoid diverticulitis
Salpingitis
Ovarian cyst
Ruptured ectopic pregnancy
Renal/ureteral stone
Strangulated hernia
Perforated colon
Regional ileitis
Ulcerative colitis

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What red flag condition are you worried about with signs/sx of peritonitis?

Perforation or ruptured appendix

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What are the signs/sx of peritonitis

P - pain - front, back, sides, shoulders
E - electrolytes fall, shock
R - rigidity/rebound
I - immobile pt
T - tenderness w guarding
O - obstruction
N - nausea/vomiting
I - inc pulse, dec BP
T - temp falls>rises, tachypnea
I - inc girth of abdomen
S - silent abdomen

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What red flag condition are you worried about with back pain also present?

Ruptured abdominal aortic aneurysm

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Describe the type of abdominal pain that may indicate emergency

Acute onset getting progressively worse

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What PEs would you do for a CC of abdominal pain?

Note general appearance
Vitals
Abdominal - observation, bowel sounds, percussion, light + deep palpation, mcburneys and Murphys
CVA tenderness
Check Femoral pulses
state pelvic exam or DRE if indicated
Heart + lung

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Name the abdominal pain ddx:

Sudden onset colicky pain that progresses to constant
Periumbilical > RLQ
Pain worse with movement or coughing
N/V
Guarding
RLQ tenderness
Rebound tenderness

Appendicitis

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Name the abdominal pain ddx:

Sudden onset of persistent cramping in lower quadrant
Signs of shock, hemorrhage

Ectopic pregnancy

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Name the abdominal pain ddx:

Sudden onset intense epigastric pain that can radiate to sides, back, or right shoulder
Burning, gnawing pain that worsens w empty stomach

peptic ulcer disease/perforated peptic ulcer (would also have rebound tenderness, absent bowel sounds)

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Name the abdominal pain ddx:

Sudden onset excruciating pain that can be felt in chest or abdomen and can radiate to legs or back
Shock signs
Difference or deficit in femoral pulses

dissection of aortic aneurysm

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Name the abdominal pain ddx:

Upper or diffuse abdominal pain
N/V
Dyspepsia
HTN/hypotension

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Appendicitis workup

CBC with differential, ultrasound, CT
Emergency referral

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Ectopic pregnancy workup

HCG, ultrasound, immediate emergency referral

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Peptic ulcer perforation workup

Radiograph, emergency referral

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Dissecting aortic aneurysm workup

CT/MRI
Emergency referral

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MI workup

ECGs, cardiac enzymes, emergency referral

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Name the abdominal pain ddx:

Sudden onset of severe pain that is diffuse and worsens with movement or coughing
Guarding, rebound tenderness
Bowel sounds dec or absent

peritonitis

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Peritonitis workup

CBC w differential
Abdominal radiographs

Name the abdominal pain ddx:

Steady pain, same in all positions
LUQ, radiates to back
N/V, diaphoresis
Appear acutely ill
Abdominal distention
Decreased bowel sounds
Diffuse rebound tenderness

Acute pancreatitis

Acute pancreatitis workup

CBC with differential
Serum amylase and lipase
Ultrasound

Name the abdominal pain ddx: RLQ pain, mimics appendicitis Fever Elevated WBC

Mesenteric adenitis

Name the abdominal pain ddx: RUQ colicky pain progressing to contact Can radiate to right scapula Constant, rises to plateau, falls N/V Dark urine, light stools Tender to palpation RUQ Murphy sign

Cholecystitis/cholelithiasis

Cholecystitis/Lithiasis workup

CBC w diff Ultrasound Serum amylase and lipase

Name the abdominal pain ddx: Sudden onset of excruciating colicky pain > constant Lower abdomen and flank, radiates to groin N/V, distention, chills, fever CVA tendernesss Hematuria Frequency

Ureterolithiasis

Ureterolithiasis workup

UA CT

Name the abdominal pain ddx: Sexually active women Progressive lower abdominal pain Abdominal tenderness, CMT, adnexal tenderness Fever, irregular bleeding/dc, vomiting

PID/salpingitis

PID wrkup

CBC, ESR, DNA probes, cultures, gram staining

Name the abdominal pain ddx: Sudden onset raspy pain in umbilical area Vomiting (early small, late large) Obstipation or diarrhea Hyperactive, high pitched bowel sounds Palpable mass Abdominal distention

Bowel obstruction

Bowel obstruction workup

DRE Abdominal radiographs

Cholecystitis/lithiasis treatment

Referral

Ureterolithiasis treatment

Alpha blockers Chanca piedra (stone breaker)

UTI/pyelo tx

Antibiotics D-mannose Corn silk tea

PID tx

Antibiotics

Name the abdominal pain ddx: Crampy hypogastric pain variable duration Gas, bloating, distention Relief with feces/flatulence Normal abdominal exam

IBS

IBS workup

Fecal occult blood

IBS treatment

Peppermint Antispasmodic drugs Digestive enzymes

Name the abdominal pain ddx: Abdominal pain/cramping Abdominal tenderness Diarrhea Possible blood in diarrhea

Crohns

Crohns tx

Anti-inflammatory meds Immunomodulating meds Ginger, turmeric

Name the abdominal pain ddx: Intermittent localized pain worse with exertion or lifting

Hernia

Hernia workup

Valsalva CT/MRI to rule out strangulation/obstruction

Hernia tx

Surgery referral

Name the abdominal pain ddx: Hx trauma Ecchymosis or swelling Pain with muscle wall stress

Abdominal wall disorder

Name the abdominal pain ddx: Epigastric burning, gnawing pain Worse empty stomach, stress, alcohol intake Soreness, hunger Steady Epigastric tenderness to palpation

Peptic ulcer

Peptic ulcer workup

Endoscopy, h pylori testing

Peptic ulcer tx

proton pump inhibitors Antibiotics if h pylori present Licorice root

Name the abdominal pain ddx: Diffuse, crampy pain N/V, diarrhea, fever Hyperactive bowel sounds

Gastroenteritis

Gastroenteritis tx

Electrolytes Bland diet ER if signs of severe dehydration (tachycardia, altered mental status, skin tenting, dry mucous membranes), or no improvement in 48 hours

Name the abdominal pain ddx: Episodic periumbilical pain Nausea/vomiting Photophobia Headache Fhx migraine

Abdominal migraine

Name the abdominal pain ddx: GI sx with no pathological condition

Functional dyspepsia