Abdominal Pain Flashcards
Name some ddx for RUQ pain
Duodenal ulcer
Hepatitis
Hepatomegaly
Pneumonia
Cholecystitis
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
Name some ddx for peri umbilical pain
Intestinal obstruction
Acute pancreatitis
Early appendicitis
Mesenteric thrombosis
Aortic aneurysm
Diverticulitis
Name some ddx for LUQ pain
Ruptured spleen
Gastric ulcer
Aortic aneurysm
Perforated colon
Pneumonia
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
What red flag condition are you worried about with signs/sx of peritonitis?
Perforation or ruptured appendix
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
What red flag condition are you worried about with back pain also present?
Ruptured abdominal aortic aneurysm
Describe the type of abdominal pain that may indicate emergency
Acute onset getting progressively worse
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
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
Name the abdominal pain ddx:
Sudden onset of persistent cramping in lower quadrant
Signs of shock, hemorrhage
Ectopic pregnancy
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)
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
Name the abdominal pain ddx:
Upper or diffuse abdominal pain
N/V
Dyspepsia
HTN/hypotension
MI
Appendicitis workup
CBC with differential, ultrasound, CT
Emergency referral
Ectopic pregnancy workup
HCG, ultrasound, immediate emergency referral
Peptic ulcer perforation workup
Radiograph, emergency referral
Dissecting aortic aneurysm workup
CT/MRI
Emergency referral
MI workup
ECGs, cardiac enzymes, emergency referral
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
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
