Autonomics and Pain Cases

Question 1

How does Acute Cholecystitis present?

Answer 1

foregut visceral pain

somatic pain in RUQ

Tender RUQ and +Murphy’s sign

referred pain to R. shoulder

N/V and fever

Question 2

How does Acute Appendicitis present?

Answer 2

Midgut visceral pain

Somatic pain in RLQ

Tender RLQ

N/V and fever

*if ruptured, will have signs of localized peritonitis in RLQ*

Question 3

How does Adhesive Small Bowel Obstruction present?

Answer 3

H/o previous abdominal surgery

Midgut colicky visceral pain

Vomiting, no flatus or bowel movement

possibly dehydration

distended soft abdomen, non-tender

may have increased bowel sounds

Question 4

How does passage of a kidney stone present?

Answer 4

sudden onset of colicky severe pain from loin to groin

severe back pain

writhing/pacing with pain

possible hematuria

soft abdomen, no fever

tender CVA

Question 5

How does obstructing cancer of descending colon present?

Answer 5

older age

weight loss

hindgut visceral colicky pain

no flatus or feces

distended abdomen

possible mass in LLQ

increased bowel sounds

Question 6

How does ruptured ectopic pregnancy present?

Answer 6

woman of childbearing age

missed LMP

sudden onset of severe pain in hypogastrium radiating to sacral area

afebrile

localized peritonitis in suprapubic region

tenderness in rectouterine pouch on DRE or vaginal exam

Question 7

How does a leaking aortic aneurysm present?

Answer 7

elderly male with with h/o atherosclerotic diseases (HTN, cardiac disease-can affect women too)

sudden onset of severe back pain

pale/shock, hypotensive

tender epigastrium

palpable impulse from aneurysm in epigastrium