General Surgery/GIT _ Abdominal Pain Flashcards

1
Q

DDX for RUQ pain

A
  • Biliary disease
  • colitis
  • hepatic abscess or mass
  • pulmonary infection or embolus
  • renal stone or infection
  • pelvic inflammatory disease with liver capsule inflammation (Fitz-Hugh-Curtis Syndrome)
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2
Q

Epigastric pain DDX

A
  • Myocardial infarction (MI) or pericarditis
  • biliary disease
  • esophagitis
  • gastritis or peptic ulcer
  • pancreatic mass or pancreatitis
  • aortic dissection
  • mesenteric ischemia
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3
Q

RLQ Pain DDX

A
  • Appendicitis
  • colitis
  • irritable bowel syndrome/inflammatory bowel disease (IBS/IBD) or diverticulitis
  • ectopic pregnancy
  • fibroids
  • ovarian mass
  • ovarian torsion
  • pelvic inflammatory disease (PID)
  • nephrolithiasis or pyelonephritis
  • hernia
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4
Q

LLQ pain DDX

A
  • Diverticulitis
  • colitis
  • or sigmoid volvulus
  • ectopic pregnancy
  • fibroids
  • ovarian mass
  • ovarian torsion
  • PID
  • nephrolithiasis or pyelonephritis
  • hernia
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5
Q

Abdominal Wall

A
  • Muscle strain
  • herpes zoster
  • hernia
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6
Q

What are unusual casues for acute abdominal pain in a patient without obvious cause?

A
  • Narcotic withdrawal
  • sickle cell crisis
  • porphyria
  • heavy metal poisoning
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7
Q

What are risk factors for pancreatic cancer?

A
  • Smoking
  • family history of pancreatic cancer
  • history of pancreatitis
  • diabetes mellitus
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8
Q

What are the typical presenting symptoms of pancreatic cancer?

A
  • painless jaundice
  • depression
  • LOW
  • abdo pain later in the disease
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9
Q

What are the most common risk factors for pancreatitis?

A
  • alcohol use
  • gallstones
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10
Q

A normal wcc rules out appendicitis. True or false?

A

False

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11
Q

Imaging study of choice for acute RUQ pain

A

Ultrasonography

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12
Q

Imaging study of choice for acute RLQ

A

CT

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13
Q

What is the imaging of choice for evaluating pregnant women with RLQ pain

A

Ultrasonography

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14
Q

In what circumstances are plain radiographs of the abdomen helpful in evaluation of abdominal pain?

A
  • Detecting free air under diaphragm
  • finding abnormal calcifications (such as kidney stones)
  • diagnosing bowel obstruction with multiple dilated loops and air-fluid levels
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15
Q

What two tests combined are 95% sensitive for ectopic pregnancy?

A
  1. Transvaginal ultrasonography
  2. Human chorionic gonadotropin level greater than 25 mIU per mL
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16
Q

What is the classic finding in appendicitis?

A
  • RLQ pain, or migration of pain from the periumbilical area to the RLQ
17
Q

What physical exam maneuvers are used to assess a patient with possible appendicitis?

A
  • Rovsing sign
  • Psoas sign
  • Obturator sign
  • pain at McBurney point (1/3 of the distance from the anterior superior iliac spine to the umbilicus)
18
Q

What finding has the highest positive predictive value for a bowel obstruction?

A

Constipation

19
Q

What is the name for sharp, localized abdominal pain that increases, peaks, and subsides and is associated with diseases of hollow viscera?

A

Colic

20
Q

When a supine patient has increased pain upon lifting their head and shoulders off the exam table, what sign is positive?

A

Carnett sign

21
Q

What are the classic findings in cholecystitis?

A
  • Murphy sig
  • RUQ pain
  • fever
  • jaundice
22
Q

What is the definition of constipation?

A
  • Passage of fewer than three stools in a week
  • often with passage of hard difficult to pass stools
23
Q

What is the first-line treatment of constipation?

A

Increase

  • intake of fluid
  • bulk food (cereal, vegetables)
  • pitted fruits and juices
24
Q

What diagnosis do you not want to miss in a newborn with delayed passage of meconium or a child with chronic constipation?

A

Hirschsprung disease

25
Q

what is intssusception?

A

Telescoping of one part of small bowel over another

26
Q

What are the signs and symptoms of intussusception?

A
  • Crampy abdominal pain
  • vomiting
  • blood and mucus in the stool (currant jelly stool)
27
Q

What is the name for a true outpouching of the small bowel that has the potential to become inflamed, ulcerate/perforate, or cause bowel obstruction in children?

A

Meckel diverticulum

28
Q

Meckel diverticulum is an embryologic remnant of what structure?

A

Omphalomesenteric duct

29
Q

What is the “rule of twos” with regard to the diagnosis of Meckel diverticulum?

A
  • it occurs in 2% of population
  • is usually 2 in long
  • is located within 2 ft of the ileocecal valve
  • contains two types of tissue (gastric and pancreatic)
  • causes symptoms around 2 years of age
30
Q
A