Exam 3 Abdominal Pain

Question 1

Characteristics of Visceral pain? (3)

Answer 1

Dull, ache, colic
Poorly localized, periumbilical
Distention or spams of hollow organ

Question 2

Characteristics of Parietal (Somatic) pain? (3)

Answer 2

Sharp
Well demarcated
Peritoneal irritation/Somatic innervation

Question 3

Characteristics of Referred pain? (2)

Answer 3

Distant site, somatic, similar nn level

Aching, perceived near body surface

Question 4

Sharp/localized pain a/w? (3)

Answer 4

ischemia, inflamm, stretch of peritoneum

Question 5

Dull/diffuse pain a/w?

Answer 5

Visera: wall of hollow organs, capsules of solid organs

Question 6

Obstruction presents as? (8)

Answer 6

Pain
Anorexia
Bloating
N/V
Obstipation
High-pitched or no BS
Tympany percussion
Dilated proximal bowel loops

Question 7

Emergencies? (7)

Answer 7

Perforation
Ruptured AAA or Ectopic
Obstruction
Toxic mega colon
Appendicitis
Ovarian torsion
Acute mesenteric ischemia

Question 8

Urgent? (5)

Answer 8

Cholecystitis/Cholangitis
Pancreatitis
Hepatitis
Diverticulitis
PUD/Gastritis

Question 9

Abd pain labs? (6)

Answer 9

CBC w/ diff
CMP
LFT: AST/ALT, Alk Phos, Total Bili
Amyl, Lipase
UA!
Preggo

Question 10

Abd pain imagining? (3)

Answer 10

XRay
CT (better for obstruction)
US

Question 11

Abd pain exam should include? (8)

Answer 11

Vitals
Appearance/level of discomfort
Position while in pain
Movement or lack of
Eyes
Lungs
Heart
Abd

Question 12

Abd pain ABDOMINAL exam should include?

Answer 12

Inspection
BS
Percussion
Palp noting guarding/rigidity
RECTAL
PELVIC

Question 13

Abd pain ABX?

Answer 13

Cefazolin
Cefotin
Cefotetan
Ampicillin-Sulbactam (UNASYN)

Question 14

Abd pain DDX: RUQ? (9)

Answer 14

Cholecyctitis
Cholangitis
Biliary colic
Pancreatitis
Hepatitis
PNA
Abscess
Hepatic congestion
Budd-Chiari

Question 15

Abd pain DDX: LUQ? (6)

Answer 15

Spleen abscess or inflamm
Gastritis
Gastric ulcer
Pancreatitis
PNA
MI

Question 16

Abd pain DDX: RLQ? (8)

Answer 16

Appendicitis
Salpingitis
Ectopic preg
Inguinal hernia
Nephrolithiasis
IBD
Mesenteric adenitis
Tiflitis/Cecitis

Question 17

And pain DDX: LLQ? (8)

Answer 17

Diveriticulitis
Salpingitis
Overian cyst rupture
Ectopic preg
Inguinal hernia
Nephrolithiasis
IBS
IBD

Question 18

Epigastric pain DDX? (9)

Answer 18

PUD
GE reflux
Esophagitis
Hiatal hernia
Gastritis
Pancreatitis
MI
Pericarditis
AAA

Question 19

Periumbilical pain DDX? (4)

Answer 19

Early appendicitis
Gastroenteritis
Bowel obstr
AAA

Question 20

Low Mid Abd pain DDX? (2)

Answer 20

Bladder distention

Cystitis

Question 21

Diffuse abd pain DDX? (8)

Answer 21

Gastroenteritis
Mesenteric Ischemia
Metabolic
Malaria
FMF
Peritonitis
IBD
Obstruction

Question 22

Appendicitis primary imaging?

Answer 22

CT

Question 23

Mesenteric Adenitis is?

Presents?

Tx?

Answer 23

Inflamm of mesenteric lymph nodes

Mimics appendicitis

No surgery needed

Question 24

Typhlitis is?

Presents?

Tx?

Answer 24

Inflammation of the cecum from necrotizing enterocolitis

Mimics appendicitis

Abx
Surgery only if complicated

Question 25

SBO Extraluminal causes? (6)

Answer 25

Adhesions
CA
Hernia
Bands
Malrotation
Abscess

Question 26

SBO Intrinsic causes? (4)

Answer 26

Intussception
CA
Crohn’s
Inflamm/Ischemic strictures

Question 27

SBO initial management?

Answer 27

NG tube
IV fluids w/ e-
Serial exams: physical, imaging
Surgery if sxs worsen, peritoneal signs, unresolved w/ NG tube

Question 28

Acute Abd Pain management? (6)

Answer 28

NPO
IV NS
Pain meds
No NSAIDS
PPI
Phenergan/Zofran

Question 29

Pain meds for acute abd pain?

Answer 29

Dilaudid
Morphine Sulfate
Demerol
Toradol (renal stones)

Question 30

Pain before vomiting U a/w?

Pain after vomiting U a/w?

Answer 30

surgical abd

non-surgical illness

Question 31

Pain lasting > 6 hrs should be considered what?

Answer 31

acute abd until proven otherwise