Abdominal Pain Flashcards
REBOUND TENDERNESS is key finding of ____
acute peritonitis (appendicitis, pancreatitis, cholecystitis)
1 on the differential diagnosis of RUQ pain is ____
Acute cholecystitis
1 on the differential diagnosis of RLQ pain is ____
Appendicitis
Which of the following is NOT on the differential diagnosis of RUQ pain? A. Biliary Colic B. Hepatomegaly C. Peptic ulcer disease (duodenal ulcer) D. Pancreatitis E. Lower right lobe pneumonia
D. Pancreatitis is epigastric pain
Which of the following is NOT on the differential diagnosis of epigastric pain? A. Peptic ulcer disease B. Acute cholecystitis C. Appendicitis D. Cardiac pain - ischemia E. Abdominal aortic aneurysm
C. Appendicitis is periumbilical pain
Which of the following is NOT on the differential diagnosis of LUQ pain? A. Acute Pancreatitis B. Diverticulitis C. Peptic ulcer disease- gastric ulcer D. Splenic enlargement E. Lower left lobe pneumonia
B. Diverticulitis is #1 on differential of LLQ pain
Which of the following is NOT on the differential diagnosis of LLQ pain? A. Ectopic pregnancy B. Pelvic Inflammatory Disease C. Ureteral Calculi D. Hernia E. Ovarian disease
ALL are on differential diagnosis of LLQ pain
Which of the following is NOT on the differential diagnosis when eating makes the pain worse? A. Pancreatitis B. Gastric ulcer C. Duodenal ulcer D. Mesenteric ischemia
C. Duodenal ulcer gets better with eating.
Which of the following is on the differential diagnosis when eating makes the pain better? A. Pancreatitis B. Duodenal ulcer C. Bowel obstruction D. Biliary colic
B
A. Pancreatitis: worse w/ eating and associated w/ nausea and vomiting
C, D. Bowel obstruction, biliary colic: associated w/ nausea and vomiting
Which of the following is NOT on the differential diagnosis when pain radiates to back? A. Pancreatitis B. Duodenal ulcer C. Biliary colic D. Gastric ulcer
C. Biliary colic radiates to the shoulder
Name the 2 possible causes of pain radiating to the right shoulder
Biliary colic
Cholecystitis
Name the possible cause of pain radiating to the left arm or neck
Myocardial ischemia
Ureteral obstruction may have referred pain to ____
testicular pain
Biliary disease may have referred pain to ____
right infrascapular pain
Acute coronary syndrome may have referred pain to ____
epigastric, jaw or upper extremity pain
When you suspected bowel obstruction or free air, you should order ____
abdominal xray (limited utility)
Abdominal aortic aneurysm can be diagnosed with ___
ultrasound
Acute cholecystitis can be visualized with _____
ultrasound
Which one of the following is NOT CT abdomen/pelvis WITHOUT contrast used for? A. Kidney stones B. Abscess C. Free air D. Bowel obstruction
B. Abscess should use WITH contrast
KIDNEY STONES definitely use CT WITHOUT contrast
T/F: Infection and inflammation is best visualized with CT abdomen/pelvis WITH contrast.
True
Also to exclude malignancy
Most common causes of elderly abdominal pain (2)
Cholecystitis
Diverticulitis
Which of the following is NOT a feature of mesenteric ischemia?
A. Severe pain alleviated by medication
B. Abdominal exams are usually normal
C. Diagnosis by mesenteric angiography or CT angiography
D. Consider in patients w/ afib, atherosclerosis, hypercoagulable
A. Pain is refractory to meds
What's the diagnosis? What next? 24 yo male RLQ pain for 1 day Radiates to groin Hypoactive bowel sounds Tender to palpation with mild guarding
Appendicitis
Confirmed on CT
What’s the diagnosis? What next?
66 y/o woman with two days of LLQ pain
Diarrhea, fever and chills, nausea, vomiting
Tender to palpation in LLQ
Diverticulitis
Confirmed with contrast CT
1 on the differential diagnosis of LLQ pain is ____
Diverticulitis
What’s the diagnosis? What next?
46 y/o man present with a 3-day history of severe upper abdominal pain
Nausea and vomiting.
Drinks 4-6 shots of rum per night + beer over weekends.
He smokes 2 packs/day.
PE: Obviously sick, tender to palpation in the epigastric area.
Acute pancreatitis—- can be deadly, lead to volume depletion, needs to be admitted
What’s the diagnosis? What next?
45 y/o woman presents with a 24-hour history of nausea and vomiting along with generalized abdominal pain.
History positive for hysterectomy.
No fevers/chills, +anorexia.
Last stool 2 days ago.
Diffusely tender and distended abdomen, hypoactive bowel sounds, rebound tenderness.
Small bowel obstruction due to adhesions from previous surgery
abdominal Xray
What’s the diagnosis? What next?
48 y/o woman with one day history of RUQ pain after eating.
Intermittent and cramping pain, 6/10 intensity.
She also has nausea and vomiting. No diarrhea.
Had a similar episode 6 months ago after eating.
Positive Murphy’s
Cholecystitis
Start with an Ultrasound.
Always check for pancreatitis too because stone could block both
What’s the diagnosis? What next?
34 y/o man presents with a 4-hour history of sudden onset left flank pain, nausea and vomiting.
No prior hx of similar symptoms. No fevers/chills.
Reports difficulty urinating, no hematuria. Feels like he has to urinate but cannot.
Kidney stone
NON contrast CT scan
