Acute Abdomen and Referred Pain Flashcards
what is the differential diagnosis for RUQ?
cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumors, gastritis, hepatic abscess, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis (especially during pregnancy), thoracic causes (pleurisy/pneumonia), PE, pericarditis, MI (especially inferior MI)
what is the differential diagnosis for LUQ?
PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurysm, thoracic causes, pyelonephritis, nephrolithiasis, hiatal hernia (strangulated paraesophageal hernia), Boerhaave’s syndrome, Mallory-Weiss tear, splenic artery aneurysm, colon disease
what is the differential diagnosis for LLQ?
diverticulitis, sigmoid volvulus, perforated colon, colon cancer, URI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic causes, appendicitis (rare)
what is the differential diagnosis for RLQ?
appendicitis! same as LLQ, plus mesenteric lymphadenitis, cecal diverticulitis, Meckel’s diverticulum, intussusception
What is the differential diagnosis of epigastric pain?
PUD, gastritis, MI, pancreatitis, biliary colic, gastric volvulus, Mallory-Weiss tear
what is the unique differential diagnosis for the patient with AIDS and abdominal pain?
- CMV (most common)
- Kaposi’s sarcoma
- Lymphoma
- TB
- mycobacterium avian intracellulare
what is the classic referred pain location for cholecystitis?
right sub scapular pain (also epigastric)
what is the classic referred pain location for appendicitis?
early: periumbilical
rarely: testicular
what is the classic referred pain location for diaphragmatic irritation (from spleen, perforated ulcer, or abscess)?
shoulder pain (+ Kehr’s sign on the left)
what is the classic referred pain location for pancreatitis/cancer?
back pain
what is the classic referred pain location for rectal disease?
pain in the small of the back
what is the classic referred pain location for nephrolithiasis?
testicular pain/flank pain
what is the classic referred pain location for rectal pain?
midline small of back pain
what is the classic referred pain location for small bowel?
periumbilical pain
what is the classic referred pain location for uterine pain?
midline of small of back pain
what is the classic diagnosis for: abdominal pain out of proportion to exam?
rule out mesenteric ischemia
what is the classic diagnosis for: hypotension and pulsatile abdominal mass?
ruptured AAA; go to the OR
what is the classic diagnosis for: fever, LLQ pain, and change in bowel habits?
diverticulitis
classically, what endocrine problems can cause abdominal pain?
- Addisonian crisis
- Diabetic KetoAcidosis (DKA)
what is the most likely diagnosis for: 22yo woman with acute onset lower abdominal pain, hypotension, tachycardia, adnexal mass, and free fluid on vaginal ultrasound?
ectopic pregnancy rupture
what is the most likely diagnosis for: 21yo woman with fever, leukocytosis, lower abdominal pain, + chandelier sign?
pelvic inflammatory disease (PID)
what is the most likely diagnosis for: 54yo male smoker with c/o right-sided abdominal pain, hematuria, and a mass in the right side of the abdomen?
renal cell carcinoma
what is the most likely diagnosis for: abdominal pain ‘out of proportion to exam’?
mesenteric ischemia
what is the most likely diagnosis for: 67yo man with hypotension, abdominal pain, and an abdominal mass that pulsates?
ruptured abdominal aortic aneurysm
what is the most likely diagnosis for: 67yo female smoker with a history of 25-lb weight loss over 3mo due to abdominal pain after eating; contender abdomen on exam?
chronic mesenteric ischemia
