Abdominal pain Flashcards
A 24-year-old male complains of severe epigastric pain following an alcoholic binge. There is a bluish discoloration in the flanks and marked tenderness in the epigastric region. CBC shows a leukocytosis with raised neutrophils. Serum amylase is elevated.
Pancreatitis
A 43-year-old overweight mother of three complains of constant right upper quadrant pain which radiates to the right infrascapular region. There is also nausea and vomiting. On examination, there is fever and marked tenderness in the right upper quadrant. Murphy’s sign is positive. CBC shows elevated WBCs with raised neutrophils. Plain abdominal x-ray is normal. Ultrasound of the abdomen shows numerous stones in the right upper quadrant.
Cholecystitis
A 45-year-old male presents with recurrent epigastric pain which is worse when he eats foods and when he is under stress. On examination, there is moderate tenderness in the epigastric region. Urease breath test is positive. Endoscopy show an ulcer along the lesser curvature of the stomach.
Peptic Ulcer Disease
A 10-year-old child develops periumbilical pain. Fever and vomiting followed the abdominal pain. The pain shifts to the right iliac fossa. On examination, there is marked tenderness over McBurney’s point. Rovsing test is positive. However, both the Psoas and Obturator Internus tests are negative. CBC shows an elevation in the WBC with neutrophilia. Spiral CT scan shows a swollen, edematous appendix.
Appendicitis
A 65-year-old male presents with severe left lower abdominal pain, nausea, vomiting and diarrhea with flecks of red blood in the stool. On examination, there is marked tenderness in the left iliac fossa, with local guarding and rebound tenderness present. CBC shows a marked elevation in the WBCs and raised neutrophils.
Diverticulitis
A 23-year-old female presents with lower abdominal pain and fever. She reports being sexually active, and a mucopurulent discharge from her cervix is present with tenderness on movement of the cervix. CBC shows a marked elevation in the WBCs and raised neutrophils. Gram stain of the cervical discharge shows Gram negative intracellular diplococci which grew best in the Thayer-Martin chocolate agar.
Pelvic Inflammatory Disease
A 25-year-old female presents with recurrent abdominal pains that are relieved by defecation. There is no weight loss, blood in the stool or fever. No abnormalities on physical exam. CBC, ESR and CMP are normal. FOB is negative.
Irritable Bowel Syndrome
A 23-year-old white female presents with recurrent abdominal pain in the right iliac fossa and diarrhea. Mild tenderness in the right iliac fossa observed. Rovsing and psoas tests are negative. CBC shows anemia with an increase in the MCV. MCHC is normal. There are numerous hypersegmented neutrophils. Colonoscopy reveals skip lesions and a cobblestone appearance of the mucosa of the terminal ileum.
Crohn’s Disease
A 24-year-old female presents with recurrent left lower quadrant abdominal pain and bouts of bloody diarrhea. Symptoms seem to be worse whenever she eats spicy foods. On examination, there is mild tenderness in her left iliac fossa. CBC shows a mild microcytic hypochromic anemia. Colonoscopy reveals multiple shallow ulcers in her rectum and sigmoid colon.
Ulcerative Colitis
A 19-year-old female presents with severe dysmenorrhea. She reports no sexual activity. She has lower abdominal pains with her periods, but no fever. Mild white, non-odorous vaginal discharge. Nodules are felt in the adnexal regions. Ultrasound of her pelvis shows numerous cysts in her pelvis and on her ovaries. Laparoscopy shows multiple chocolate-colored cysts in her pelvis.
Endometriosis
A 21-year-old female reports lower abdominal pain the last few weeks. She also says she experiences bouts of nausea, vomiting and dizziness, as well as right shoulder pain. She reports that she has experienced several weeks of amenorrhea, and that she is sexually active. Ultrasound shows no fetus in the uterus, but hCG levels are rising.
Ectopic pregnancy
