Abdominal Pain Flashcards
I say RUQ pain, you say (for this exam at least)
Duodenal Ulcer
I say Epigastric pain, you say:
PUD Hernia GERD Gastritis Esophagitis Aortic Aneurysm (always the answer)
Describe an Aortic Aneurysm vs. Dissection
Aneurysm: often painless unless ruptures, then you die. Risk associated with size of aneurysm. Males 65-75 who smoke at risk
Dissection: Caused by circumferential tear that forms a false lumen. Atypical chest pain, WIDENED MEDIASTINUM
I say LUQ pain, you say:
GU
Gastritis
Perforated Subdiaphragmatic Viscus (??)
RLQ pain, you say:
Appendicits Ectopic pregnancy (RLQ and LLQ) IBD Ogilivie Syndrome Meckel's
Describe an appendicitis
Most common between 10-30
Blockage of appendix (fecalith) that causes infection
Tests: McBurney’s, Psoas, Obturator, Heel strike, rebound tenderness
What procedure is protective against UC?
Appendectomy before 21
24 year old female presents with LLQ pain. She describes it as stabbing, intermittent, and non radiating. You run a blood hCG and it is high, but the Ultrasound tech doesn’t detect a pregnancy. Ddx?
Ectopic pregnancy most common in the isthmus
After a really hard crossfit workout, a female presents with right side lower abdominal pain. It happened suddenly, and treatment is surgery. What does she have?
Ovarian Torsion- most occur after exertion
Spontaneous massive dilation of the cecum/right colon without obstruction is indicative of:
Ogilvie syndrome
Avoid drugs that slow motility
Neostigmine is a treatment
LLQ Ddx
Diverticulitis Ischemic colitis Ectopic pregnancy Ovarian torsion IBD Colon Cancer
Diverticulitis vs. Diverticulosis
- itis= infection
- osis= outpouch (not necessarily a problem)
Patient presents with constipation, but says their stool is more watery. LLQ pain is felt. Ddx?
Diverticulitis.
Constipation first, then infection, which causes narrowing of colon so only liquid is getting through
Should you perform an endoscopy for suspected diverticulitis?
No, risk of perforation
Periumbilical/Suprapubic pain Ddx
mesenteric artery ischemia
Bowel Obstruction
IBD
Describe Mesenteric Ischemia
Patient reports excruciating pain, but your PE does not show it. Also has thumbprint sign on XR similar to Ischemic Colitis.
Chronically called Abdominal Angina- can lead to fear of food because it is painful to eat.
What is the most common cause of intestinal obstruction?
Peritoneal Adhesions
Diverticulitis
Crohn’s
Describe primary peritonitis
Most common in cirrhotic patients
E. COLI, Strep, Enterococci, and pneuma are common agents to cause it.
Diagnosed when PMN’s are above 250/uL
Secondary Peritonitis
Caused by a perforation
Patients are motionless, curled up into a ball to avoid pain (all of us after the GI exam)
What is the definition of unintentional weight loss?
Loss of 5-10% of body weight over 6 months
Physical exams all men/women should have if unintentional weight loss is present
Men: DRE with prostate
Women: Pelvic
Both: Stool testing for bleeding
