Gastrointestinal

Question 1

GERD

Answer 1

Process: Prolonged exposure of esophagus to gastric acid due to impaired esophageal motility or lower esophageal sphincter action. H. pylori infection often present.

Location: chest or epigastric

Quality: Burning (heartburn. Also regurgitation

Question 2

Abdominal Aortic Aneurysm (AAA)

Answer 2

+ Most are asymptomatic until rupture
+ Abdominal or back pain suggests expansion
+ The first symptom of an AAA may be thrombosis or embolization to a distal site
+ Only 50% of patients survive a ruptured AAA

Question 3

Aortic dissection, thoracic

Answer 3

Patients present with sharp, “tearing” pain in the chest, back, or abdomen. The pain is maximal at its onset, as opposed to the crescendo nature of acute myocardial infarction. The pain may move inferiority over time, which likely corresponds to extension of the aortic dissection

Question 4

Cholecystitis

Answer 4

Process: Inflammation of the gallbladder, usually from obstruction of the cystic duct by gallstone

Location: RUQ or upper abdominal; may radiate to the right scapular area

Quality: steady, aching

Question 5

Cholangitis

Answer 5

Charcot’s triad (fever, RUQ abdominal pain, and juandice) occurs in 50-75% of patients with cholangitis

Question 6

Diverticulitis

Answer 6

Process: Acute inflammation of a colonic diverticulum; a saclike mucosal outpouching through the colonic muscle

Location: LLQ

Quality: May be cramping first, but becomes steady

Question 7

Acute intestinal (mesenteric) ischemia

Answer 7

Process: Blood supply to the bowel and mesentery blocked from thrombosis or embolus (acute arterial occlusion), or reduced from hypoperfusion

Location: May be periumbilical at first, then diffuse

Quality: Cramping at first, then steady

Question 8

Acute pancreatitis

Answer 8

Process: Acute inflammation of the pancreas.

Location: Epigastric, may radiate to the back or other parts of the abdomen; may be poorly localized

Quality: Usually steady

Question 9

Celiac sprue

Answer 9

The most common symptoms include diarrhea, flatulence, weight loss, abdominal discomfort, and bloating.

Question 10

Chronic pancreatitis

Answer 10

Process: Fibrosis of the pancreas secondary to recurrent inflammation

Location: Epigastric, radiating through to the back

Quality: Steady, deep

Question 11

Endometriosis

Answer 11

Symptoms include pelvic pain, rectal pain, dysmenorrhea, and dyspareuria. Aching pain tends to begin several days before menses and worsens until menses abates. Some patients are asymptomatic. The presence or extent of endometriosis does not correlate with symptoms

Question 12

Incarcerated hernia (inguinal & femoral)

Answer 12

Most common symptom is a sensation of “heaviness” with activities that increase intra-abdominal pressure (straining or lifting). Pain should raise concern for incarceration. Peritoneal signs often accompany bowel strangulation

Question 13

Hypercalcemia

Answer 13

Hypercalecemia causes different kinds of abdominal pain, depending on the complication (constipation, nephrolithasis, or pancreatitis).

Question 14

Crohn’s Disease

Answer 14

The symptoms of Crohn’s disease are much more variable than ulcerative colitis; 80% of patients have small bowel involvement, usually in distal ileum. Common symptoms include abdominal pain, fever, weight loss, and diarrhea with or without bleeding. Up to 10% of patients do not have diarrhea

Question 15

Ulcerative Colitis

Answer 15

Symptoms are due to inflammation of the mucosal surface of the colon., which almost always involves the rectum. The disease may extend proximally and continuously to involve other parts of the colon. Bloody diarrhea is the principle symptom. Defecation may relieve the lower abdominal cramps.

Question 16

Irritable bowel syndrome

Answer 16

Common idiopathic disorder characterized by chronic abdominal pain and bloating typically relieved by a bowel movement, passage of mucous, change in number of bowel movements or stool constistency (harder or softer), and episodic diarrhea alternating with constipation. Symptoms usually worsened by stress and eating

Question 17

Pyelonephritis

Answer 17

Patients present with fever, nausea, vomiting, and flank pain. Pain can be abdominal or pelvic, and may have symptoms of urinary tract infection

Question 18

Nephrolitasis

Answer 18

May be asymptomatic. Renal stones most commonly cause pain when they pass from the pelvis into the ureter. The pain is typically paroxysmal, related to stone movement and subsequent ureteral contractions. The pain migrates as the stone moves through the ureter

Question 19

Pelvic inflammatory disease (PID)

Answer 19

Abdominal pain usually occurs bilaterally in the lower abdominal quadrants. The pain often begins during or shortly after the beginning of menses. Coitus and sudden movements may worsen the pain. Many women have minimal symptoms.

Question 20

Ectopic Pregnancy

Answer 20

Symptoms include lower quadrant abdominal pain (99%), amenorrhea (74%), and vaginal bleeding (56%)
50% of patients are asymptomatic before rupture

Question 21

Testicular torsion

Answer 21

Predominantly occurs in neonates and postpubertal boys, but nearly 40% occur in patients older than 21 years old. Sudden scrotal pain is the most common symptom.