General Surgery/GIT _ Abdominal Pain

Question 1

DDX for RUQ pain

Answer 1

• 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)

Question 2

Epigastric pain DDX

Answer 2

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

Question 3

RLQ Pain DDX

Answer 3

• 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

Question 4

LLQ pain DDX

Answer 4

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

Question 5

Abdominal Wall

Answer 5

• Muscle strain
• herpes zoster
• hernia

Question 6

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

Answer 6

• Narcotic withdrawal
• sickle cell crisis
• porphyria
• heavy metal poisoning

Question 7

What are risk factors for pancreatic cancer?

Answer 7

• Smoking
• family history of pancreatic cancer
• history of pancreatitis
• diabetes mellitus

Question 8

What are the typical presenting symptoms of pancreatic cancer?

Answer 8

• painless jaundice
• depression
• LOW
• abdo pain later in the disease

Question 9

What are the most common risk factors for pancreatitis?

Answer 9

• alcohol use
• gallstones

Question 10

A normal wcc rules out appendicitis. True or false?

Answer 10

False

Question 11

Imaging study of choice for acute RUQ pain

Answer 11

Ultrasonography

Question 12

Imaging study of choice for acute RLQ

Answer 12

CT

Question 13

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

Answer 13

Ultrasonography

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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

Question 16

What is the classic finding in appendicitis?

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

Constipation

Question 19

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

Answer 19

Colic

Question 20

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

Answer 20

Carnett sign

Question 21

What are the classic findings in cholecystitis?

Answer 21

• Murphy sig
• RUQ pain
• fever
• jaundice

Question 22

What is the definition of constipation?

Answer 22

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

Question 23

What is the first-line treatment of constipation?

Answer 23

Increase

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

Question 24

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

Answer 24

Hirschsprung disease

Question 25

what is intssusception?

Answer 25

Telescoping of one part of small bowel over another

Question 26

What are the signs and symptoms of intussusception?

Answer 26

* Crampy abdominal pain * vomiting * blood and mucus in the stool (currant jelly stool)

Question 27

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?

Answer 27

Meckel diverticulum

Question 28

Meckel diverticulum is an embryologic remnant of what structure?

Answer 28

Omphalomesenteric duct

Question 29

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

Answer 29

* 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