GPA - Abdominal Pain Flashcards
1
Q
Key PE for Abdominal pain:
A
Heart, Lung, Full abdominal,
Murphy, Psoas, obturatory, CVA, Rectal and pelvic exam
2
Q
DDX - Abdominal Pain sudden onset colicky rt side flank pain Radiate to testicles N/V Hematuria CVA tenderness
A
Nephrolithiasis: colicky pain
Pyelonephritis: CVA, N/V, Hematuria
Renal cell carcinoma: CVA
Appenticitis: right side, N/V
3
Q
Workup - Abdominal Pain sudden onset colicky rt side flank pain Radiate to testicles N/V Hematuria CVA tenderness
A
UA: Culture and sensitivity BUN/CR: kidney function Ultrasound: Renal CMP: electrolites CT: abdomen
4
Q
DDX - Abdominal Pain Dull epigastric pain, radiate to back Wt loss Dark urine Clay colored stool Heavy drinker, smoker
A
Pancratic cancer Hepatitis: acute Pancreatitis: chronic Cholecystitis/choledocholithiasis Peptic ulcer disease Abdominal Aortic aneurysm
5
Q
Workup - Abdominal Pain Dull epigastric pain, radiate to back Wt loss Dark urine Clay colored stool Heavy drinker, smoker
A
Rectal exam: CA CBC Electrolytes, Amylase, Lipase, Bilirubin, Alk Phos: pancreas US abdomen: Stones CT abdomen
6
Q
DDX - Abdominal Pain Sever mid-epigastric radiates to back Improves when lean foreward anorexia, N/v Alcholic, 3 day bender
A
Acute pancreatitis: mid epigastric to back, better leaning foreward. PUD Cholecystitis Choledocholithiasis Gastritis: Abdominal aortic aurism Mesenteric ischemia Mallory weiss tear
7
Q
Workup - Abdominal Pain Sever mid-epigastric radiates to back Improves when lean foreward anorexia, N/v Alcholic, 3 day bender
A
Rectal exam: CA
CBC,
Electrolytes, BUN:CR,
Amylase, Lipase, Bilirubin, Alk Phos: pancreas
US abdomen: Stones
CT abdomen
HIDA scan: liver gall bladder, bile ducts
8
Q
DDX - Abdominal Pain 41, female, obease RUQ pain, radiate to rt scapula N/V, Fever: 101.5 onset after fatty food previous last a few hours \+ murphy sign
A
Ascending cholangitis: infection of bile duct (fever)
Acute: cholecystitis: inflammation of GB probably from stone in duct
Hepatitis
Choledocholithisitis: stone in common bile duct
Sclerosing cholangitis: fibrosing obstruction of bile ducts
Fits Hugh Curtis syndrome
9
Q
Workup - Abdominal Pain 41, female, obease RUQ pain, radiate to rt scapula N/V, Fever: 101.5 onset after fatty food previous last a few hours \+ murphy sign
A
CBC: infection
CMP: AST, ALT, biliruben, Alk phos
Hepatitis serologies
US: abdominal
MRCP: Magnetic resonance cholangiopancreatography
ERCP: study the bile ducts, pancreatic duct and gallbladder
10
Q
DDX - Abdominal Pain 25yo F RUQ pain Fever, N/V anorexia Dark urine, clay stoole
A
Hepatitis: acute (dark urin, clay stool) Cholecystitis: acute ascending cholangitis Choledococystitis Pancreatitis: Acute glomerulonephritis (kidneay in RUQ)
11
Q
Workup - Abdominal Pain 25yo M/F RUQ pain Fever, N/V anorexia Dark urine, clay stoole
A
Rectal exam,pelvic CBC: infection CMP: AST, ALT, biliruben, Alk phos Hepatitis serologies US: abdominal UA: in case of kidney
12
Q
DDX - Abdominal Pain 35yo M Burning epigastric pain 2-3 hrs after meals, Releaved by food and antacids
A
PUD: Buring pain Gastritis GERD: buring pain Cholecystitis: food worse Chronic pancreatitis : food worsee Mesenteric ischemia:food worse MI
13
Q
Workup - Abdominal Pain 35yo M Burning epigastric pain 2-3 hrs after meals, Releaved by food and antacids
A
Rectal exam,pelvic CMP: AST, ALT, biliruben, Alk phos Endoscopy H. Pylori testing Upper GI series, Xray, barium
14
Q
DDX - Abdominal Pain Sever epigastric pain N/V, mild fever Toxic appearance Hx of intermittend releaved by food and antacids Smoker takes arcid
A
PUD perforation Acute pancreatitis; Sever pain Cholecystitis Choledocholithiasis Hepatitis Mesenteric ischemia: smoker
15
Q
Workup - Abdominal Pain Sever epigastric pain N/V, mild fever Toxic appearance Hx of intermittend releaved by food and antacids Smoker takes arcid
A
Rectal exam,pelvic CMP: AST, ALT, biliruben, Alk phos KUB: Xray Kidney, ureter, bladder CT abdoment Upright CXR Endoscopy H. Pylori testing
16
Q
DDX - Abdominal Pain
18yo boxer, sever LUQ pain
Raidate to left scapula
Mono 3 weeks abo
A
Splenic rupture Kidney stone rib racture Pneumonia PUD Splenic infarct
17
Q
Workup - Abdominal Pain
18yo boxer, sever LUQ pain
Raidate to left scapula
Mono 3 weeks abo
A
Rectal exam CBC, electrolytes CXR CT abdomen US abdomen
18
Q
DDX - Abdominal Pain 40yo M crampy abdominal pain Vomiting abdominal disention no flatus, no stool Hx of abdominal surgery
A
Intestinal Obstruction Small bowel or colon cancer Vovulus Gastroenteritis Food poisoning Ileus Hernia: can strangulate
19
Q
Workup - Abdominal Pain 40yo M crampy abdominal pain Vomiting abdominal disention no flatus, no stool Hx of abdominal surgery
A
Rectal exam CBC, Electrolytes Abdominal X ray CT - abdomen/pelvis CXR
20
Q
DDX - Abdominal Pain 70y acute severe cramping abdominal pain Vomit Massive dark bowel movement hx of CHF, Atrial fib Digitalis Pain is out of proportion t oexam
A
mesenteric ischemia: afib with clots Diverticulitis: PUD: bleeding ulcers Gastroenteritis Acute pancreatitis Cholecystitis MI
21
Q
workup - Abdominal Pain 70y acute severe cramping abdominal pain Vomit Massive dark bowel movement hx of CHF, Atrial fib Digitalis Pain is out of proportion t oexam
A
CBC, amylase, lipase, lactate ECG, CPK-MP, troponin: heart AXR: abdominal x ray CT abdomen Mesenteric angiography Barrium enema: (lower GI bleeding, diverticulitis)0
22
Q
DDX - Abdominal Pain 21 yp f acute sever RLQ pain N/V No fever, urinary sx or vag bleeding No STD hx of STD no OCP
A
Ovarian torsion: sever pain, unilateral Ectopic pregnancy: sever pain, unilateral Appendicitis: Right side PID: Ruptured ovarian cyst
23
Q
workup - Abdominal Pain 21 yp f acute sever RLQ pain N/V No fever, urinary sx or vag bleeding No STD hx of STD no OCP
A
urinary hGC Pelvic ultrasound, Abdominal CT: CBC UA Pelvic exam and rectal exam
24
Q
DDX - Abdominal Pain 68yom LLQ pain, fever, chills x 3 days alternating constipation and diarrhea Low fiber, high fat diet
A
Diverticulitis
Chrones disease
Ulcertive cholitis
Gastroenteritis
25
Q
Workup - Abdominal Pain 68yom LLQ pain, fever, chills x 3 days alternating constipation and diarrhea Low fiber, high fat diet
A
Rectal exam CBC, Electrlytes Abdominal x ray CT abdomen US abdomen
26
Q
DDX - Abdominal Pain 20yo m, RLQ abd pain N/v onset around umbilicus, migrate to RLQ positive psoas and Mc burney
A
Appendicitis Diverticulitis Gastroenteritis Chrones diseasee Nephrolithiasis volvulus or obstruction
27
Q
Workup - Abdominal Pain 20yo m, RLQ abd pain N/v onset around umbilicus, migrate to RLQ positive psoas and Mc burney
A
Rectal
CBC electrolytes
Abdominal ultrasound, and CT
28
Q
DDX - Abdominal Pain 30 yo f: periumbilical pain for 6 months Releaved by defication doesn't wake her up Worse when shes upset alternating constipation, diarrhea negative for nausea, weight loss or anorexia
A
Irritable bowel syndrome Crohns disease Celiac disease Chronic pancreatitis Parasitic infection Endometriosis
29
Q
Workup - Abdominal Pain 30 yo f: periumbilical pain for 6 months Releaved by defication doesn't wake her up Worse when shes upset alternating constipation, diarrhea negative for nausea, weight loss or anorexia
A
Occult blood Ova parasite: stool testing CBC, electrolytes Colonoscopy CT; abdomen, pelvis Pelvic exam, rectal exam Urine hGC
30
Q
DDX - Abdominal pain
24 yo F
Bilateral lower abdominal pain start on day one of period
Fever, thick green yellow vaginal discharge
Promiscus sexual activity
A
PID Endometrious Dysmenorrhea vaginitis cystitis pyelo
31
Q
Workup - Abdominal pain
24 yo F
Bilateral lower abdominal pain start on day one of period
Fever, thick green yellow vaginal discharge
Promiscus sexual activity
A
CBC Pelvic with wet prep GCCT UA with reflex culture and sensitivity Urine hGC US pelvis
