Abdominal Pain

Question 1

Peritoneal vs. Visceral Pain

Answer 1

Peritoneal pain is changes with MOVEMENT (appendicitis will feel it with every stoplight in a car)

Pain from STRETCH or ISCHEMIA will not change with movement –> Visceral

Visceral is usually DULL and DIFFUSE
Pertioneal is usually SHARP, LOCALIZED

Pain fibers much more sensitive in the viscera

Question 2

Visceral Pain is based on…

Answer 2

VASCULAR SUPPLY

Organs of the CELIAC –> stomach, spleen, liver, duodenum, pancreas, gallbladder –> diffuse EPIGASTRIC pain

Organs of the SMA –> duodenum, jejunum, ileum, appendix, ascending colon, transverse colon –> UMBILICAL PAIN

Organs of the IMA –> descending colon, sigmoid colon, rectum and iliac artery organs (bladder, uterus) –> SUPRAPUBIC PAIN

Question 3

AST/ALT vs. ALK PHOS

Answer 3

AST/ALT –> Direct hepatocyte injury

ALK PHOS –> Cholestatic/Gallbladder Disease

Amylase/Lipase –> pancreatitis

Question 4

Radiographs for LIVER/GALLBLADDER/BILIARY TREE

Answer 4

Ultrasound – CHEAP and great for stones, dilation, inflammation

HIDA scan –> bile FLOW

MRCP (MRI) –> biliary ANATOMY

Question 5

Radiographs for STOMACH/DUODENUM

Answer 5

Endoscopy –> Visualize MUCOSA (peptic/duodenal ulcers)

CXR –> Rule out PERFORATION

Upper GI (swallow study) –> Visualize anatomic location and determine if malrotated (congenital)

Question 6

Radiographs for the PANCREAS/SPLEEN

Answer 6

H&P!!! Not many imaging studies available

CT for SPLEEN

Question 7

Radiographs for SMALL INTESTINE

Answer 7

KUB and Upright –> small bowel obstruction (too much air)

Small bowel follow-through – CROHN’S

CT – not useful

Question 8

Radiographs for APPENDIX

Answer 8

Ultrasound for appendicitis in KIDS and PREGGOS

CT for appendicitis otherwise

Question 9

COLON

Answer 9

H&P!

CXR to rule out PERFORATION

Question 10

Pancreatitis

Answer 10

SERUM AMYLASE ELEVATED

Along with EPIGASTRIC PAIN, EtOH consumption, RADIATION TO BACK

Question 11

What is Scleral Icteris?

Answer 11

YELLOWING of the EYES –> Tell tale sign of JAUNDICE –> build up of BILIRUBIN

Question 12

Elevated ALT/AST with no predominance?

Answer 12

NOT likely to be Cirrhosis

Question 13

Massively elevated ALK PHOS?

Answer 13

CHOLECYSTITIS

Question 14

CHARCOT’S TRIAD

Answer 14

Fever
RUQ Pain
Jaundice

OBSTRUCTION OF THE EXTRAHEPATIC BILIARY TREE –> Stones!!

Stones provide focus for infection (fever), stretches the bile ducts (pain) and prevents drainage of bile (jaundice)