Abdominal Pain

Question 1

RUQ DDx

Answer 1

biliary disease
hepatitis
pancreatitis
renal colic (usually w/ flank pain)

Question 2

LUQ DDx

Answer 2

renal colic

splenic infarct or rupture

Question 3

epigastrum DDx

Answer 3

biliary disease
pancreatitis
peptic ulcer
DKA

Question 4

diffuse periumbilical DDx

Answer 4

AAA
appendicitis
acute mesenteric ischemia
bowel obstruction
chronic mesenteric ischemia
gastroenteritis
IBD
IBS
splenic rupture
DKA

Question 5

RLQ DDx

Answer 5

appendicitis
ectopic pregnancy
ovarian torsion
PID

Question 6

LLQ DDx

Answer 6

diverticulitis
ectopic pregnancy
ovarian torsion
PID

Question 7

DDx w/ abdominal pain AND unexplained hypotension- 3 mechanisms

Answer 7

need to measure orthostatics w/ ab pain

hemorrhage- AAA rupture, atopic pregnancy rupture, splenic rupture

sepsis (long list, inflammatory processes)- AMI, appendicitis, ascending colangitis, bowel infarction, cholecystitis, diverticulitis, IBD, ischemic colitis, pancreatitis, PID, PUD, SBP

Other- adrenal insufficiency, DKA, MI

Question 8

DDx w/ abdominal pain and distension

Answer 8

free air: appendicitis, bowel infarct (SBO, AMI), diverticulitis, PUD w/ perforation

luminal air: LBO, SBO

ascites fluid: pancreatitis, SBP

hemorrhage fluid: AAA, spleen, ectopic

Question 9

classic presentation of appendicitis

Answer 9

initially diffuse pain, intensifies and migrats to RLQ to mcburney point (medial to iliac crest), often w/ bloating and anorexia