Female Abdominal Pain

Question 1

Gallstones

Answer 1

Intense, dull pain in RUQ or epigastrium that may radiate to the back (especially the right shoulder) and usually lasts 30-60 min. Assoc nausea, vomiting, and diaphoresis. Normal physical exam
Labs- incr lipase, look at CBC and LFT
*Ultrasound
Rx- surgical consult, IV fluids, antibiotics, correct electrolyte abnormalities

Question 2

Cholecystitis

Answer 2

RUQ or epigastric pain for 4-6 hours. Fever, guarding, pos. Murphy’s sign, and leukocytosis (CBC)
Admit if they have this
Labs- incr lipase, look at CBC and LFT
*Ultrasound
Rx- surgical consult, IV fluids, antibiotics, correct electrolyte abnormalities

Question 3

Cholangitis

Answer 3

Stone becomes impacted in duct and causes infection— fever, jaundice, and RUQ abdominal pain
Labs- incr lipase, look at CBC and LFT
*Ultrasound
Rx- surgical consult, IV fluids, antibiotics, correct electrolyte abnormalities

Question 4

Hepatitis

Answer 4

Fatigue, malaise, nausea, vomiting, anorexia, RUQ pain, jaundice, dark urine, and light stool
Labs- LFTs (ALT>AST)
Blood borne, tylenol, or other toxic exposure

Question 5

Fitz-Hugh-Curtis Syndrome

Answer 5

RUQ pain with a pleuritic component which can be referred to the right shoulder—- pt has PID

Question 6

Budd-Chiari syndrome

Answer 6

hepatic venous outflow obstruction. Fever, abdominal pain, ascites, lower extremity edema, jaundice, GI bleeding, and/or hepatic encephalopathy

Question 7

MI

Answer 7

epigastric pain with SOB

labs- troponins

Question 8

Pancreatitis

Answer 8

Epigastric pain that can radiate to the back, right or left or is diffuse. Nausea, vomiting, and anorexia.Hx of alcoholism, gallstones, or drugs
Labs- Lipase, amylase, CT scan
Physical exam- tachy and hypotension
Rx- NPO, IV fluids, pain meds

Question 9

Peptic Ulcer Disease/Gastritis

Answer 9

Epigastric pain, burning pain, reflux/heartburn, history of NSAIDs or alcohol, relieved (duodenal) or worsened (gastric) by eating, stool color (melena)
Dx- rectal exam for blood, CBC (look for anemia of chronic blood loss, low MCV), EGD
Rx- diet change, PPI or H2 blocker

Question 10

GERD

Answer 10

Heartburn, regurgitation, dysphagia, and/or epigastric pain

Question 11

Splenomegaly

Answer 11

LUQ pain referred to the shoulder and/or early satiety

Question 12

Appendicitis

Answer 12

Periumbilical pain that radiates to the right lower quadrant. Anorexia, nausea, and vomiting. Movement pain and guarded. Usually younger.
Labs- CBC, urinalysis, CT scan
Rx- call surgery, NPO

Question 13

Diverticulitis

Answer 13

Usually left lower quadrant pain but may be right LQ- usually constant for a few days. Low grade fever, localized tenderness, rebound, guarding, and occult blood. Can have nausea, vomiting, and change in bowel habits.
hx of diverticulosis
Dx- CT, WBC count
Rx- fluids, antibiotics. Possibly surgery and NPO

Question 14

Kidney stones (Nephrolethiasis)

Answer 14

Flank pain, back pain, or abdominal pain. Colicky pain, radiates to the groin but can travel. Hematuria** (most common symptom).
Hx of kidney stones
Dx- CT

Question 15

Pyelonephritis

Answer 15

Dysuria (painful urination), frequency, urgency, and/or hematuria as well as fever, chills, flank pain, and costovertebral angle tenderness
Labs- urinalysis with microscopic and culture, blood culture

Question 16

Cystitis

Answer 16

Dysuria (painful urination), frequency, hematuria, and/or urgency.
Labs- urinalysis with microscopic and culture, blood culture

Question 17

Bowel obstruction

Answer 17

Diffuse, crampy, and intermittent abdominal pain. Bloating, feeling of fullness, vomiting, and decreased bowel movements. Absence of bowel sounds or high pitched bowel sounds. Palpable mass. Abdominal distension and tympany on percussion. Possible hx of cancer, hernia, intussusception, or abdominal surgery
Dx - CBC and electrolytes, X-ray (look for air), and CT (look for obstruction)
Rx- fluids, surgery consult, hospital observation (admit)

Question 18

Ulcerative Colitis

Answer 18

Diarrhea with blood, frequent and small bowel movements. Colicky abdominal pain, urgency, tenesmus, and incontinence
Hx of autoimmune disease

Question 19

Crohn’s disease

Answer 19

fatigue, prolonged diarrhea with abdominal pain, weight loss, and fever. May or may not have bleeding
Hx of autoimmune disease

Question 20

Celiac

Answer 20

Diffuse abdominal pain and steatorrhea (bulky, foul-smelling, floating stools) and flatulence

Question 21

Ketoacidosis

Answer 21

Diffuse abdominal pain, nausea, and vomiting

Question 22

Adrenal insufficiencey

Answer 22

Diffuse abdominal pain, nausea, vomiting, fatigue, weight loss, and low BP

Question 23

Foodborne Disease

Answer 23

Nausea, vomiting, fever, abdominal pain, and diarrhea (can occur hours later (toxin mediated) or 24-48 hours later (bacterial colitis))
Timeline is important

Question 24

Ectopic Pregnancy

Answer 24

Abdominal pain (either side) and first trimester vaginal bleeding. Usually occurs 6-8 weeks after last period
Labs- pregnancy test (hCG), pelvic/vaginal ultrasound
Hx of endometriosis or PID

Question 25

Pelvic Inflammatory Disease

Answer 25

Lower abdominal pain, pelvic organ tenderness (cervical motion tenderness), adnexal mass, and inflammation of the genital tract. Often have cervical discharge.
Hx- IUD, multiple sex partners
Do pelvic exam

Question 26

Ovarian Cyst, Rupture or Torsion

Answer 26

Moderate to severe pelvic pain (waxes and wanes), nausea, and adnexal mass
Hx of ovarian cysts
Labs- CBC, hCG, electrolytes, ultrasound
Rx- IV fluids and NPO

Question 27

Endometriosis

Answer 27

Dysmennorhea (painful menstruation), pelvic pain, dyspareunia, and/or infertility. Can also get bowel or bladder symptoms
Labs- pelvic/vaginal ultrasound

Question 28

Additional questions to ask with abdominal pain

Answer 28

Sexual history (M/W/both), #lifetime partners, history of STDs, history of pregnancies, and vaginal discharge
Menstrual cycle- when last period, how long are they, are they heavy, spotting between cycles

Question 29

Pertinent negatives from abdominal exam

Answer 29

• contour of abdomen (flat/round/protuberant/scaphoid)
• pulsations/masses
• ascites
• skin= scars, striae, veins, rashes
• bowel sounds
• voluntary vs involuntary guarding

Question 30

Ischemic bowel

Answer 30

Hx of CVD/vascular disease, a-fib or surgical history

pain out of proportion to the exam

Question 31

Pneumonia

Answer 31

Fever, cough

Dx = chest x-ray

Question 32

AAA

Answer 32

Abdominal mass, back pain, hematuria, unequal femoral pulses
Hx - smoker, HTN, diabetes
Dx- ultrasound/CT
Rx- Medical emergency! Admit- surgery