PE and Diff Dx of Abdominal Pain

Question 1

Approach to Acute Abdominal Pain includes?

Answer 1

History - OLD CARTS
Physical Exam
Lab Testing
Imaging
Managment

Question 2

Examination should include what?

Answer 2

Is there fever?
Vital Signs
Inspect skin for discoloration/contour
Auscultate Bowel sounds
Palpate for organomegaly, masses, location of pain, rebound guarding (start with least tender area)
Digital Rectal exam (DRE) for color of stool, blood, tenderness
Pelvic exam (females) for uterine, tubo-ovarian abnormalities

Question 3

Examination
Vital signs: tachycardia & hypotension suggest what?

Answer 3

hemorrhage
sepsis
dehydration

Question 4

Examination
Auscultate bowel sounds:
absent bowel sounds could mean?

Answer 4

peritonitis
ileus

Question 5

Examination
Auscultate bowel sounds:
Hyperperistalsis could mean?

Answer 5

bowel obstruction
gastroenteritis

Question 6

Physical Signs of Acute Abdomen
Murphy’s Sign is?

Answer 6

cessation of inspiration RUQ exam (Cholecystitis)

Question 7

Physical Signs of Acute Abdomen
McBurney’s Sign is?

Answer 7

tenderness located midway b/t anterior/superior iliac spine & umbilicus (acute appendicitis)

Question 8

Physical Signs of Acute Abdomen
Cullen’s Sign is?

Answer 8

periumbilical bluish discoloration (RP hemorrhage, pancreatic hemorrhage, AAA rupture)

Question 9

Physical Signs of Acute Abdomen
Grey Turner’s Sign is?

Answer 9

bluish discoloration of flanks (RP hemorrhage, pancreatic hemorrhage, AAA rupture)

Question 10

Physical Signs of Acute Abdomen
Kehr’s Sign is?

Answer 10

Severe (L) shoulder pain (splenic rupture, ectopic pregnancy rupture)

Question 11

Physical Signs of Acute Abdomen
Obturator sign is?

Answer 11

pain with flexed (R) hip rotation (appendicitis)

Question 12

Physical Signs of Acute Abdomen
Psoas sign is?

Answer 12

pain with raising straight leg against resistance (appendicitis)

Question 13

Physical Signs of Acute Abdomen
Rovsing sign is?

Answer 13

Pain in RLQ upon palpation of LLQ (appendicitis)

Question 14

Laboratory Testing for Acute Abdomen includes?

Answer 14

CBC
BMP
Glucose
Amylase, lipase
LFTs
Albumin
PT/INR, PTT, U/A
Stool for pathogens
Helicobacter pylori antibodies
B-HCG

Question 15

Endoscopy (EGD) should be done if?

Answer 15

dysphagia (esophageal) to assess for strictures, malignancy, & motility disturbances
Persistent dyspepsia despite empiric therapy/H.pylori bx
UGIB due to nonvariceal bleeding to detect & localize source of bleeding & for treatment -injection (epinephrine), thermal coagulation (laser or electreocautery), or mechanical (clipping)
UGIB d/t variceal bleeding; hemostasis can be achieved via band ligation, sclerotherapy, or combo

Question 16

Colonoscopy should be done if?

Answer 16

acute or occult LGIB
Detecting mass lesions
Persistent diarrhea, especially if bloody

Question 17

U/S should be done if?

Answer 17

Imaging sold & fluid filled organs but limited in ability to penetrate gas-filled structures (bowel)
Assessing liver & biliary system if jaundice, cholestatic lab findings or for assessment of acute cholecystitis, liver lesions, cirrhosis, hepatic flow

Question 18

Radiographs should be done if?

Answer 18

concern for bowel obstruction, ileus, free air, mesenteric ischemia

Question 19

CT scan should be done if?

Answer 19

provides rapid, comprehensive, high-resolution images using PO &/or IV contrast
Indications are broad-evaluation for unexplained abdominal complaints, blunt trauma, oncologic dz, inflammatory conditions (appendicitis, diverticulitis, pancreatitis, abscesses), SBO, mesenteric venous ischemia (thrombosis)

Question 20

Mesenteric Angiography Should be done if?

Answer 20

to assess for acute mesenteric arterial embolization & nonocclusive arterial ischemia

Question 21

MRI advantages and disadvantages

Answer 21

superior soft tissue contrast resolution compared to CT scan

however imaging takes longer, more expensive, decreased availability, restrictions (implanted metal, claustrophobia)

Question 22

Differential Dx for RUQ acute abdominal pain includes?

Answer 22

Cholcystitis
Choledocolithiasis
Cholangitis
Hepatitis
Hematoma
Duodenal ulcer
RLL PNA
PE
Empyema

Question 23

Differential Dx for LUQ acute abdominal pain includes?

Answer 23

Gastritis
PUD
Splenic Infarct
Splenic hematoma
Colonic ischemia
LLL PNA
PE
Empyema
Myocardial ischemia

Question 24

Differential Dx for Epigastric acute abdominal pain includes?

Answer 24

Gastritis
Gastric Ulcer
Volvulus
Pancreatitis
Esophagitis
MI
Aortic aneurysm

Question 25

Differential Dx for Periumbilical acute abdominal pain includes?

Answer 25

Early appendicitis
SBO/ileus
ischemia
Pancreatitis
Gastroenteritis
Aortic Aneurysm

Question 26

Differential Dx for RLQ acute abdominal pain includes?

Answer 26

Appendicitis
Cecal diverticulitis
Crohn’s
Ileitis
Bowel ischemia
Ovarian cyst
Tubal pregnancy
Tubo-ovarian abscess
endometriosis

Question 27

Differential Dx for LLQ acute abdominal pain includes?

Answer 27

Diverticulitis
Inflammatory bowel disease
colonic ischemia
sigmoid volvulus
ovarian cyst
tubal pregnancy
tubo-ovarian abscess

Question 28

Differential Dx for acute flank pain includes?

Answer 28

Pyelonephritis
Renal infarct
Renal abscess
Hydronephrosis
Splenic process (L)