Abdominal Pain

Question 1

I say RUQ pain, you say (for this exam at least)

Answer 1

Duodenal Ulcer

Question 2

I say Epigastric pain, you say:

Answer 2

PUD
Hernia
GERD
Gastritis
Esophagitis
Aortic Aneurysm (always the answer)

Question 3

Describe an Aortic Aneurysm vs. Dissection

Answer 3

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

Question 4

I say LUQ pain, you say:

Answer 4

GU
Gastritis
Perforated Subdiaphragmatic Viscus (??)

Question 5

RLQ pain, you say:

Answer 5

Appendicits
Ectopic pregnancy (RLQ and LLQ)
IBD
Ogilivie Syndrome
Meckel's

Question 6

Describe an appendicitis

Answer 6

Most common between 10-30
Blockage of appendix (fecalith) that causes infection
Tests: McBurney’s, Psoas, Obturator, Heel strike, rebound tenderness

Question 7

What procedure is protective against UC?

Answer 7

Appendectomy before 21

Question 8

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?

Answer 8

Ectopic pregnancy most common in the isthmus

Question 9

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?

Answer 9

Ovarian Torsion- most occur after exertion

Question 10

Spontaneous massive dilation of the cecum/right colon without obstruction is indicative of:

Answer 10

Ogilvie syndrome
Avoid drugs that slow motility
Neostigmine is a treatment

Question 11

LLQ Ddx

Answer 11

Diverticulitis
Ischemic colitis
Ectopic pregnancy
Ovarian torsion
IBD
Colon Cancer

Question 12

Diverticulitis vs. Diverticulosis

Answer 12

• itis= infection

- osis= outpouch (not necessarily a problem)

Question 13

Patient presents with constipation, but says their stool is more watery. LLQ pain is felt. Ddx?

Answer 13

Diverticulitis.

Constipation first, then infection, which causes narrowing of colon so only liquid is getting through

Question 14

Should you perform an endoscopy for suspected diverticulitis?

Answer 14

No, risk of perforation

Question 15

Periumbilical/Suprapubic pain Ddx

Answer 15

mesenteric artery ischemia
Bowel Obstruction
IBD

Question 16

Describe Mesenteric Ischemia

Answer 16

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.

Question 17

What is the most common cause of intestinal obstruction?

Answer 17

Peritoneal Adhesions
Diverticulitis
Crohn’s

Question 18

Describe primary peritonitis

Answer 18

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

Question 19

Secondary Peritonitis

Answer 19

Caused by a perforation

Patients are motionless, curled up into a ball to avoid pain (all of us after the GI exam)

Question 20

What is the definition of unintentional weight loss?

Answer 20

Loss of 5-10% of body weight over 6 months

Question 21

Physical exams all men/women should have if unintentional weight loss is present

Answer 21

Men: DRE with prostate
Women: Pelvic
Both: Stool testing for bleeding