Abdominal Pain in Primary Care Flashcards
Organs in the right hypochondriac region?
Liver, gallbaldder, right kidney, small intestine
Organs in the epigastric region?
Stomach, liver, pancreas, duodenum, spleen, adrenal gland
Organs in left hypochondriac region?
Spleen, colon, left kidney, pancreas
Organs in right lumbar region?
Gallbladder, liver, right colon
Organs in umbilical region?
Umbilicus, parts of the small intestine, duodenum
Organs in the left lumbar region?
Descending colon, sigmoid colon
Organs in right iliac region?
Appendix, cecum
Organs in hypogastric region?
Urinary bladder, sigmoid colon, female repro organs
Organs in left iliac region?
Descending colon, sigmoid colon
Right hypochondriac region pain differentials?
Lower lobe PNA, cholecystitis, cholangitis, hepatitis, abscess, pyelonephritis, nephrolithiasis, pancreatitis, duodenitis, duodenal ulcer, congestive hepatomegaly, small intestine obstruction
Epigastric region pain differentials?
ACS, cholecystitis, cholangitis, pancreatitis, AAA, dissection, gastritis, early appendicitis, hernia
Left hypochondriac region pain differentials?
ACS, MI, myocarditis, pericarditis, embolus, lower lobe PNA, pancreatitis, splenic infarction/rupture, gastritis, pyelonephritis, nephrolithiasis
Right lumbar region pain differentials?
AAA, dissection, mesenteric ischemia, psoas abscess, colic pyelonephritis
Umbilical region pain differentials?
AAA, dissection, early appendicitis, gastroenteritis, large/small intestinal obstruction
Left lumbar region pain differentials?
AAA, dissection, mesenteric ischemia, psoas abscess, colic pyelonephritis
Right iliac region pain differentials?
Appendicitis, intestinal obstruction, right diverticulitis, constipation, ulcerative colitis, Crohn’s disease, epididymo-orchitis, tessticular torsion, neprolithiasis, UTI, ectopic pregnancy, pelvic inflammatory dosease, endometriosis, hernia, psoas abscess
Hypogastric region pain differentials?
Appendicitis, diverticulitis, constipation, ulcerative colitis, Crohn’s disease, UTI, urinary retention, cystitis, ectopic pregnancy, pelvic inflammatory disease, endometriosis, hernia, Mittelschmerz
Left iliac region pain differentials?
Large/small intestinal obstruction, diverticulitis, constipation, ulcerative colitis, Crohn’s disease, epididymo-orchitis, tessticular torsion, neprolithiasis, UTI, ectopic pregnancy, pelvic inflammatory dosease, endometriosis, hernia, psoas abscess, perforated colon
3 types of abdomina pain?
- Visceral
- Parietal
- Referred
What is visceral pain?
When noxious stimuli affect a viscus such as the stomach or intestines
Describe visceral pain
Dull, poorly localized and felt in the middle
Pain from foregut: felt in epigastrium
Pain from midgut: felt in periumbilical
Pain from hindgut: felt in lower abdomen
What is parietal pain?
Noxious stimuli of the parietal peritoneum
Describe parietal pain
Sharp, intense, discrete, localized. Coughing or movement aggravates pain
What is referred pain?
Felt in remote areas supplied by the same dermatome as the affected organ
Timeframe for acute abdominal pain?
Pain lasting less than 7 days
Important history questions to get description of pain?
Location and radiation
Temporal elements
Quality
Severity
Precipitants or palliation
Associated symptoms (other GI symptoms, GU symptoms, constitutional symptoms, cardiopulmonary symptoms, other)
T/F: in the acute surgical abdomen, vomiting precedes pain
FALSE
In the acute surgical abdomen pain precedes voming, the reverse is typically true in medical conditions
Common, less common, and rare possible diagnoses for any location in abdomen?
Common, less common, and rare possible diagnoses in epigastric region?
Common, less common, and rare possible diagnoses in LUQ region?
Common, less common, and rare possible diagnoses in LLQ region?
Common, less common, and rare possible diagnoses in periumbilical region?
Common, less common, and rare possible diagnoses in RUQ region?
Common, less common, and rare possible diagnoses in RLQ region?
Common, less common, and rare possible diagnoses in suprapubic region?
What are some possible causes of sudden onset abdominal pain?
What type of abdominal pain warrants urgent evaluation?
Unstable vital signs
Signs of peritonitis on abdominal exam (eg, abdominal rigidity, rebound tenderness, and/or pain that worsens when the examiner lightly bumps the stretcher)
Concern that the abdominal pain is from a life-threatening condition (eg, acute bowel obstruction, acute mesenteric ischemia, perforation, acute myocardial infarction, ectopic pregnancy)
Evaluation components for RUQ pain?
- Complete blood count with differential
- Electrolytes, blood urea nitrogen (BUN), creatinine, and glucose
- Aminotransferases, alkaline phosphatase, and bilirubin
- Lipase and/or amylase
Patients should also have an abdominal ultrasound to evaluate for hepatobiliary etiologies
Evaluation components for epigastric pain?
- Complete blood count with differential
- Electrolytes, BUN, creatinine, and glucose
- Aminotransferases, alkaline phosphatase, and bilirubin
- Lipase and/or amylase
If there is concern for hepatobiliary pain, patients should have an abdominal ultrasound for evaluation
Evaluation components for LUQ pain?
Left upper quadrant pain can be caused by splenic etiologies imaging with either ultrasound or computed tomography (CT) scan is recommended
Evaluation components for lower abdominal pain?
- Pregnancy test
- CBC
- UA
- STI screening
- CMP
- CRP/ESR
Subacute right lower quadrant pain with diarrhea is the most characteristic presentation of ileal Crohn disease, although the presentation of inflammatory bowel disease (IBD) can be highly variable
Acute left lower quadrant pain with fever and elevated white blood cell count is suggestive of diverticulitis
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Components of chronic abdominal pain evaluation?
- Complete blood count with differential
- Electrolytes, blood urea nitrogen (BUN), creatinine, and glucose
- Calcium
- Aminotransferases, alkaline phosphatase, and bilirubin
- Lipase and/or amylase
- Serum iron, total iron binding capacity, and ferritin
- Anti-tissue transglutaminase
b. Correct
Systemic illnesses such as diverticulitis, mesenteric ischemia, and urinary retention are more common in older patients, whereas nonspecific abdominal pain is less common. Physical examination findings of guarding and rebound tenderness are less likely to be present in an older person with peritonitis. For these reasons, imaging has more utility in older patients and changes management in approximately two-thirds of cases. Because mesenteric ischemia is common and often presents with minimal examination findings, CT angiography should be considered in an older patient with a benign abdominal examination.
c. Correct
Clinical diagnosis of diverticulitis is reasonable if risk factors for complicated diverticulitis are not present. These risk factors include more than five days of symptoms, signs of peritonitis or obstruction, rectal bleeding, multiple occurrences of diverticulitis, and immunocompromise. Rebound tenderness suggests peritonitis, which is a risk factor for complicated diverticulitis and warrants imaging with CT with intravenous contrast media.
Differential diagnoses table for acute abdominal pain in all ages (flip to see)
