Abdominal Pain

Question 1

mechanisms of abdominal pain

Answer 1

1) parietal (somatic) pain
2) visceral pain
3) referred pain

Question 2

parietal (somatic) abdominal pain

Answer 2

*where you feel it is exactly where the pathology is
*character: sharp, constant, precisely localized

Question 3

visceral abdominal pain

Answer 3

*location follows embryonic derivation
*character: dull, crampy, burning, poorly localized

Question 4

referred abdominal pain

Answer 4

*location goes to dermatome that shares an ascending track in the spinal cord with the painful organ
*character: dull, constant, poorly localized

Question 5

ddx for epigastric pain

Answer 5

*GERD
*gastric ulcer
*duodenal ulcer
*non-ulcer dyspepsia
*gastroparesis
*biliary tract disease
*pancreas disease

Question 6

ddx for RUQ pain

Answer 6

*biliary colic
*acute cholecystitis
*ascending cholangitis
*hepatic abscess
*hepatitis

Question 7

ddx for LUQ pain

Answer 7

*splenic rupture
*splenic abscess
*pancreatitis
*pancreas cancer

Question 8

ddx for periumbilical pain

Answer 8

*small bowel :
-obstruction
-ischemia
-infarction

Question 9

ddx for RLQ pain

Answer 9

*appendicitis
*Crohn’s disease

Question 10

ddx for suprapubic pain

Answer 10

*cystitis
*prostatitis
*pelvic inflammatory disease

Question 11

ddx for LLQ pain

Answer 11

*diverticulitis
*ulcerative colitis
*infectious colitis
*ischemic colitis
*colon cancer

Question 12

ddx for abdominal pain exacerbated by eating

Answer 12

*GERD
*gastric ulcer
*non-ulcer dyspepsia
*partial small bowel obstruction
*biliary colic
*pancreatitis
*mesenteric ischemia

Question 13

ddx for abdominal pain relieved with eating

Answer 13

duodenal ulcer

Question 14

ddx for abdominal pain associated with blood loss

Answer 14

*GERD
*PUD
*cancer
*inflammatory bowel disease
*enteroinvasive infection
*ischemic gut syndromes

Question 15

lab evaluation in evaluation of patients with abdominal pain

Answer 15

*CBC
*LFTs
*amylase, lipase
*urinalysis
*pregnancy test
*troponin I, ECG

Question 16

imaging in the evaluation of patients with abdominal pain

Answer 16

*acute abdominal series (plain films)
*ultrasound
*CT
*endoscopy

Question 17

alarm symptoms for abdominal pain

Answer 17

*weight loss
*blood loss
*dysphagia
*nocturnal symptoms
*new-onset GI symptoms after age 50
*jaundice

Question 18

choose ultrasound as imaging modality in abdominal pain when…

Answer 18

*biliary tract disease is strongly suspected
*the patient is (or may be) pregnant

Question 19

choose CT as imaging modality in abdominal pain when…

Answer 19

*the predominant symptom is severe pain (possible perforation is suspected)
*solid organ disease is suspected

Question 20

choose endoscopy as imaging modality in abdominal pain when…

Answer 20

*there is evidence of GI blood loss
*hollow organ disease is suspected