Abdominal Pain Lecture Powerpoint

Question 1

3 basic causes of abdominal pain

Answer 1

• muscular contraction/distention of hollow viscus (crescendo/decrescendo type pain that comes and goes, described as sharp or crampy or colic)
• Visceral pain (dull, achy, diffuse poorly localized pain)
• Parietal peritoneum (sharp and localized, increased by coughing, etc)

Question 2

4 questions always listed in a GI history

Answer 2

• Does eating make it better or worse
• does defecating make it better or worse
• last menstrual cycle?
• did something trigger this episode?

Question 3

Benign causes of appearing melena or hematochezia (2)

Answer 3

• pepto bisthmol

- beets

Question 4

Melena vs hematochezia

Answer 4

Melena is dark black tarry stool indicative of a deeper bleed while hematochezia is bright red blood indicative of colon bleed

Question 5

Recall the physical exam for the abdomen order

Answer 5

Inspection, auscultation, perussion, palpation (in all 4 quadrants)

Question 6

Diabetic and female patients with MI may present with…

Answer 6

….abdominal pain

Question 7

Perforated viscus (peptic ulcer often) common presentation (4)

Answer 7

• sudden onset severe abdominal pain
• worse with movement
• pain with breathing
• abdominal series x ray showing free air below the diaphragm

Question 8

Most common surgical emergency of abdomen

Answer 8

Acute appendicitis

Question 9

Acute appendicitis presentation (5)

Answer 9

• right lower quadrant pain
• nausea and vomiting
• periumbilical/epigastric migrates to RLQ
• symptoms <48 hours, often resolve very quickly
• rovsing, obturator, psoas signs

Question 10

Tenderness to percussion with abdominal exam raises concern for…

Answer 10

…more serious etiology

Question 11

Acute appendicitis imaging (2)

Answer 11

• Abdominal CT

- Ultrasound second line

Question 12

Mesenteric infarction definition

Answer 12

-clot in the mesenteric vasculature with bloody diarrhea, fever, low BP, tachycardia, and N/V often presenting with pain out of proportion to the exam and unresponsive to anelgesics, surgical emergency to remove ischemic portion and revascularize

Question 13

Ruptured abdominal aortic aneurysm (AAA) definition

Answer 13

Rupture that may present with frank shock, is diagnosed with ultrasound, often have high pre hospital mortality rate requiring surgical repair and rarely is the patient stable

Question 14

Ectopic pregnancy definition

Answer 14

Pregnancy implanted out of the uterus, presents with positive hCG with ultrasound showing absence of intrauterine pregnancy, or presence of adnexal mass, surgical emergency for treatment

Question 15

Ectopic pregnancy classic triad

Answer 15

• abdominal pain
• amenorrhea
• vaginal bleeding

Question 16

GERD/esophagitis most common symptom

Answer 16

burning pain that is worse with lying down

Question 17

Biliary colic presentation

Answer 17

1-5 hours constant right upper quadrant/epigastric pain hours after meal (often specific meal) that may radiate to the right scapula, has associated with N/V and may awake the patient from sleep

Question 18

Acute cholecystits definition and presentation

Answer 18

Develops in 20% of patients with untreated biliary colic, presents with right upper pain radiating to the right scapula and is initially colicky before becoming constant

Question 19

Complications of untreated cholecystitis (3)

Answer 19

• jaudnice
• empyema
• peritonitis

Question 20

Choledocholithiasis/ascending cholangitis charcot’s triad

Answer 20

• fever
• right upper quadrant pain
• jaundice

Question 21

Biliary dyskinesia presentation and treatment (1)

Answer 21

Recurrent right upper quadrant pain in absence of gallstones that occurs typically 30-60 min after eating food lasting 1-4 hours, does not radiate and causes nausea, treated by a c cholecystectomy

Question 22

IBD (UC/crohn’s) presentation symptoms (3)

Answer 22

Bloody diarrhea, abdominal pain, weight loss

Question 23

Ischemic colitis cause, presentation, diagnostic study

Answer 23

A self limiting transient lack of blood flow to the colon causing transient pain and bloody diarrhea, diagnosed via colonoscopy

Question 24

Most common cause of small bowel osbtruction

Answer 24

Intra-abdominal adhesions

Question 25

Small bowel obstruction presentation and treatment

Answer 25

Crampy and intermittent abdominal pain with vomiting preceding abdominal pain and constipation, has tinkling high pitched bowel sounds
-AVOID surgery as best as possible as most common cause is adhesions which might be worsened by surgery, so manage conservatively

Question 26

Acute diverticulitis risk factors (3)

Answer 26

• previous abdominal surgery
• malignancy
• IBD

Question 27

Acute diverticulitis presentation

Answer 27

Crampy abdominal pain typically lower left quadrant, tenderness, guarding, N/V/constipation

Question 28

Bacteria, parasites, viruses, and toxins relation to acute gastroenteritis

Answer 28

• Antibiotics not indicated and can be even harmful
• parasites or bacteria usually cause blood or mucus in stool
• diarrhea and vomiting is usually bacterial

Question 29

Acute hepatitis presentation (4)

Answer 29

• jaundice
• dark urine
• icterus
• rising INR, encephalopathy

Question 30

IV vancomycin for C diff is useless because…

Answer 30

….it is not absorbed that way into the gut and therefore must be taken orally

Question 31

Pelvic inflammatory disease diffrentiation from gastroenterological disease (2)

Answer 31

• cervical motion test

- abnormal vaginal discharge

Question 32

Ovarian torsion definition and how is it ruled out?

Answer 32

Twisting of the ovary around its axis along the fallopian tubes with lower abdominal pain being the only presenting symptom, may resolve spontaneously but if not can infarct, can only be ruled out with ultrasound

Question 33

Endometriosis definition

Answer 33

Endometrial tissue in a different location that is repsonsive to hormones resulting in dysmenorrhea, dyschezia, and dyspareunia, frequently causes chronic pain