General Surgery/GIT _ Abdominal Pain Flashcards
DDX for RUQ pain
- 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)
Epigastric pain DDX
- Myocardial infarction (MI) or pericarditis
- biliary disease
- esophagitis
- gastritis or peptic ulcer
- pancreatic mass or pancreatitis
- aortic dissection
- mesenteric ischemia
RLQ Pain DDX
- 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
LLQ pain DDX
- Diverticulitis
- colitis
- or sigmoid volvulus
- ectopic pregnancy
- fibroids
- ovarian mass
- ovarian torsion
- PID
- nephrolithiasis or pyelonephritis
- hernia
Abdominal Wall
- Muscle strain
- herpes zoster
- hernia
What are unusual casues for acute abdominal pain in a patient without obvious cause?
- Narcotic withdrawal
- sickle cell crisis
- porphyria
- heavy metal poisoning
What are risk factors for pancreatic cancer?
- Smoking
- family history of pancreatic cancer
- history of pancreatitis
- diabetes mellitus
What are the typical presenting symptoms of pancreatic cancer?
- painless jaundice
- depression
- LOW
- abdo pain later in the disease
What are the most common risk factors for pancreatitis?
- alcohol use
- gallstones
A normal wcc rules out appendicitis. True or false?
False
Imaging study of choice for acute RUQ pain
Ultrasonography
Imaging study of choice for acute RLQ
CT
What is the imaging of choice for evaluating pregnant women with RLQ pain
Ultrasonography
In what circumstances are plain radiographs of the abdomen helpful in evaluation of abdominal pain?
- Detecting free air under diaphragm
- finding abnormal calcifications (such as kidney stones)
- diagnosing bowel obstruction with multiple dilated loops and air-fluid levels
What two tests combined are 95% sensitive for ectopic pregnancy?
- Transvaginal ultrasonography
- Human chorionic gonadotropin level greater than 25 mIU per mL
What is the classic finding in appendicitis?
- RLQ pain, or migration of pain from the periumbilical area to the RLQ
What physical exam maneuvers are used to assess a patient with possible appendicitis?
- Rovsing sign
- Psoas sign
- Obturator sign
- pain at McBurney point (1/3 of the distance from the anterior superior iliac spine to the umbilicus)
What finding has the highest positive predictive value for a bowel obstruction?
Constipation
What is the name for sharp, localized abdominal pain that increases, peaks, and subsides and is associated with diseases of hollow viscera?
Colic
When a supine patient has increased pain upon lifting their head and shoulders off the exam table, what sign is positive?
Carnett sign
What are the classic findings in cholecystitis?
- Murphy sig
- RUQ pain
- fever
- jaundice
What is the definition of constipation?
- Passage of fewer than three stools in a week
- often with passage of hard difficult to pass stools
What is the first-line treatment of constipation?
Increase
- intake of fluid
- bulk food (cereal, vegetables)
- pitted fruits and juices
What diagnosis do you not want to miss in a newborn with delayed passage of meconium or a child with chronic constipation?
Hirschsprung disease
what is intssusception?
Telescoping of one part of small bowel over another
What are the signs and symptoms of intussusception?
- Crampy abdominal pain
- vomiting
- blood and mucus in the stool (currant jelly stool)
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?
Meckel diverticulum
Meckel diverticulum is an embryologic remnant of what structure?
Omphalomesenteric duct
What is the “rule of twos” with regard to the diagnosis of Meckel diverticulum?
- 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
