B5-015 Big Case: Abdominal Pain

Question 1

transmitted by C fibers in muscle, peritoneum, mesentery, periosteum, and viscera

Answer 1

visceral pain

Question 2

highly sensitive to distension (stretch) or ischemia

Answer 2

visceral pain

Question 3

dull, cramping, burning, gnawing, squeezing, deep, sickening

Answer 3

visceral pain

Question 4

poorly localized, gradual onset

Answer 4

visceral pain

Question 5

foregut pain localizes to

Answer 5

epigastric area

Question 6

midgut pain localizes to

Answer 6

periumbilical area

Question 7

hindgut pain localizes to

Answer 7

suprapubic area

Question 8

what type of secondary autonomic effects accompany visceral pain?

Answer 8

sweating, nausea, vomiting, restlessness, pallor

Question 9

mediated by alpha gamma fibers that are distributed to skin and muscle

Answer 9

somatic-parietal pain

Question 10

sharp, stabbing, well localized

Answer 10

somatic parietal pain

Question 11

why is lateralization of parietal pain possible?

Answer 11

only one side of the nervous system innervates that part of the parietal peritoneum

Question 12

diaphragmatic irritation from a subphrenic hematoma or splenic rupture perceived as shoulder pain

Answer 12

Kehr’s sign

Question 13

PMH of cardiovascular disease may raise suspicion for

Answer 13

mesenteric ischemia

Question 14

patient lying still in bed, fetal position, reluctant to move, appears distressed

Answer 14

peritonitis

Question 15

bluish periumbilical discoloration indicates

Answer 15

intrabdominal bleeding

Question 16

high pitched tinkling bowel sounds may indicate

Answer 16

early bowel obstruction

intestinal fluid and air under pressure

Question 17

decreased bowel sounds may indicate

2

Answer 17

peritonitis or paralytic ileus

Question 18

normal amount of bowel sounds per minute

Answer 18

5-30

Question 19

friction rub, high pitched bowel sounds associated with inspiration, may indicate

Answer 19

inflammation of peritoneal surface

tumor, infection, infarct

Question 20

bruits in aorta, renal, iliac, femoral artery may indicate

Answer 20

abdominal aneurysm

Question 21

absence of bowel sounds is established after […] minutes of continous listening

Answer 21

5

Question 22

tympany throughout the abdominal area may indicate

Answer 22

obstruction/distension in ileus

Question 23

dullness to percussion of the liver may indicate

Answer 23

ascites, hepatomegaly

Question 24

outpouchings that grow in the colon as we age

Answer 24

diverticula

Question 25

* LLQ abdominal pain * middle age man * pain constant over a few days * change in bowel habits * may be able to palpate fullness | classical presentation of...

Answer 25

acute diverticulitis

Question 26

nutrition management of diverticulitis

Answer 26

high fiber, low fat diet

Question 27

painless, hematochezia suggests

Answer 27

bleeding diverticulosis

Question 28

one third the distance from anterior superior iliac spine toward the umbilicus

Answer 28

McBurney's point

Question 29

what does the imaging indicate?

Answer 29

obstruction

Question 30

high BUN normal creatinine | may indicate

Answer 30

upper GI bleed

Question 31

* gradual onset achey pain in the periumbilical area * localizes to RLQ

Answer 31

appendicitis

Question 32

acute RUQ constricting pain localized to scapula

Answer 32

cholecystitis

Question 33

* acute onset epigastric boring pain * may radiate to midback

Answer 33

pancreatitis

Question 34

gradual LLQ achey pain

Answer 34

diverticulitis

Question 35

sudden burning epigastric pain

Answer 35

perforated peptic ulcer

Question 36

gradual cramping periumbilical pain

Answer 36

small bowel obstruction or gastritis

Question 37

sudden agonizing periumbilical pain

Answer 37

mesenteric ischemia

Question 38

sudden tearing abdominal, back or flank pain

Answer 38

ruptured AAA

Question 39

gradual spasmodic periumbilical pain

Answer 39

gastroenteritis or obstruction

Question 40

* gradual achey LQ/pelvis pain * may radiate to upper thigh

Answer 40

PID

Question 41

sudden, sharp LQ/pelvic pain in women

Answer 41

ruptured ectopic pregancy

Question 42

pain relieved by food

Answer 42

duodenal ulcer

Question 43

pain worsened by food

Answer 43

gastric ulcer, mesenteric ischemia

Question 44

pain relieved by sitting up or leaning forward

Answer 44

pancreatitis

Question 45

PMH of recent surgery/procedure may raise suspicision for

Answer 45

obstruction, abcesses, complication of surgery

Question 46

NSAIDS increase the risk of | 2

Answer 46

ischemia peptic ulcer disease

Question 47

# what type of pain does this describe? * poorly localized * referred pain * increased autonomic response * likely to be remembered

Answer 47

visceral

Question 48

# what type of pain does this describe? * well localized * minimally referred * decreased autonomic response

Answer 48

somatic parietal

Question 49

pain is almost exclusively conducted by [...] fibers

Answer 49

sympathetic

Question 50

in the GI tract, visceral receptors that are distal to the midway point of the sigmoid colon convey both physiologic and nociceptive signal back to the CNS via [...] nerves

Answer 50

parasympathetic pelvic nerves

Question 51

visceral receptors inferior to the [...] convey both physiologic and nociceptive signals via [...] nerves

Answer 51

pelvic pain line parasympathetic

Question 52

positive Carnett's is associated with

Answer 52

MSK pain

Question 53

positive McBurney's is associated with

Answer 53

appendicitis

Question 54

Grey Turner is a bruising that occurs on the flank indicating

Answer 54

retroperitoneal hemorrhage

Question 55

positive McMurphy's indicates

Answer 55

cholecystitis

Question 56

in IBS, the colonoscopy results are usually

Answer 56

normal

Question 57

* **unintentional weight loss** * abdominal pain * rectal bleeding * changes in bowel pattern | typical presentation of

Answer 57

colon cancer

Question 58

* rectal bleeding * diarrhea * abdominal pain * maybe: bloating, nausea, gradual weight loss | typical presentation of

Answer 58

Chron's/ulcerative colitis

Question 59

* abrupt onset peritonitis * rigid flat abdomen | indicates

Answer 59

perforated peptic ulcer

Question 60

* pain beginning in midline, transitioning to lower quadrant * progressively worse pain

Answer 60

appendicitis

Question 61

progressive RUQ pain may be associated with nausea and vomiting

Answer 61

acute cholecystitis

Question 62

progressive pain with nausea and vomiting tinkling bowel sounds

Answer 62

small bowel obstruction

Question 63

melena is most consistent with a bleed in what part of GI tract?

Answer 63

upper

Question 64

what diagnostic test is appropriate for peptic ulcer disease?

Answer 64

EGD

Question 65

what diagnostic imaging is appropriate for gallstones?

Answer 65

US

Question 66

symptoms of dyspepsia

Answer 66

epigastric pain and bloating after meals

Question 67

heartburn regurgitation sour taste in mouth chest pain dysphagia

Answer 67

GERD

Question 68

nausea, vomiting food particulate seen on endoscopy reflux symptoms

Answer 68

gastroparesis