Tables 18-2 and 18-3

Question 1

Usual pain characteristics: Initially periumbical or epigastric; colicky; later becomes localzied to the RLQ often at Mc Burneys Point

Possible associated signs and symptoms: Guarding, tenderness; + Iliopsoas and + obturator signs, RLQ skin hyperesthesia; anorexia, nausea or vomiting after onset of pain, low grade fever, Positive Aaron sign, Rovsing, Markle, and McBurney signs

Answer 1

Appendicitis

Question 2

Usual pain characteristics: onset sudden or gradual; pain generalized or localized; dull or severe and unrelenting; guarding; pain on deep inspiration.

Possible associated signs: shallow respiration, + Blumberg, Markle, balance signs; reduced or absent bowel sounds, nausea vomiting; positive obturator and iliopsoas signs

Answer 2

Peritonitis

Question 3

Usual pain characteristics: Severe, unrelenting RUQ or epigastric pain; may be referred to right subscapular area

Possible associated signs: RUQ tenderness and rigidity: positive Murphy sign, palpable gallbladder, anorexia, vomiting, fever, possible jaundice

Answer 3

Cholecystitis

Question 4

Usual pain characteristics: dramatic, sudden, excruciating LUQ, epigastric or umbilical pain; may be present in one or both flanks; may be referred to left shoulder and penetrates to back

Possible associated signs and symptoms: epigastric tenderness, vomiting; fever, shock. Grey Turner sign, Cullen sign, both signs occur 2-3 days after onset

Answer 4

Pancreatitis

Question 5

Usual pain characteristics: lower quadrant, worse on left

Possible associated signs and symptoms: nausea, vomiting, fever, suprapubic tenderness, rigid abdomen, pain on pelvic examination

Answer 5

Salpingitis

Question 6

Usual pain characteristics: lower quadrant, increases with activity

possible associated signs and symptoms: tender adnexa and cervix, cervical discharge, dyspareunia

Answer 6

Pelvic inflammatory disease

Question 7

Usual pain characteristics: epigastric; radiating down left side of abdomen especially after eating; may be referred to back

Possible associated signs and symptoms: flatulence, borborygmus, diarrhea, dysuria, tenderness on palpation

Answer 7

Diverticulitis

Question 8

Usual pain characteristics: Abrupt RUQ; may be referred to shoulders

Possible associated signs and symptoms: abdominal free air and distension with increased resonacne over liver, tenderness in epigastrium or RUQ, rigid abdominal wall; rebound tenderness

Answer 8

Perforated gastric or duodenal ulcer

Question 9

Usual pain characteristics: abrupt, severe, colicky, spasmodic, referred to epigastrium, umbilicus

Possible associated signs and symptoms: Distension, minimal rebound tenderness, vomiting, localized tenderness, visible peristalsis, bowel sounds absent (with paralytic obstruction) or hyperactive high pitched (with mechanical obstruction)

Answer 9

Intestinal obstruction

Question 10

Usual pain characteristics: referred to hypogastrium and umbilicus

Possible associated signs and symptoms: distension, nausea, vomiting, guarding, sigmoid loop volvulus may be palpable

Answer 10

Volvulus

Question 11

Usual pain characteristics: steady throbbing midline over aneurysm; may penetrate to back or flank.

Possible associated signs and symptoms: nausea vomiting, abdominal mass, bruit

Answer 11

Leaking abdominal aneurysm

Question 12

Usual pain characteristics: episodic, severe, RUQ, or epigastrium lasting 15 minutes to several hours; may be lower

Possible associated signs and symptoms: RUQ tenderness, soft abdominal wall, anorexia, vomiting, jaundice, subnormal temperature

Answer 12

Biliary stones, colic

Question 13

Usual pain characteristics: intense, flank, extending to groin and genitals, may be episodic

Possible associated signs and symptoms: Fever, hematuria + Kehr Sign

Answer 13

Renal calculi

Question 14

Usual pain characteristics: lower quadrant, referred to shoulder, with rupture is agonizing

Possible associated s/s: Hypogastric tenderness, symptoms of pregnancy, spotting, irregular menses, soft abdominal wall, mass on bimanual pelvic examination, ruptured; shock, rigid abdominal wall, distension, + Kehr and Cullen signs

Answer 14

Ectopic pregnancy

Question 15

Usual pain characteristics: lower quadrant, steady, increases with cough or motion

Possible associated s/s: vomiting, low grade fever, anorexia, tenderness on pelvic examination

Answer 15

Ruptured ovarian cyst

Question 16

Usual pain characteristics: Intense, LUQ, radiating to shoulder; may worsen with foot of bed elevated

Possible associated s/s: Shock, pallor, lowered temperature

Answer 16

Splenic rupture

Question 17

Usual pain characteristics: hypogastric pain, crampy, variable, infrequent, associated with bowel function.

Possible associated s/s: Unremarkable physical exam, pain associated with gas, bloating, distension relief with passage of flatus, feces

Answer 17

Irritable bowel syndrome

Question 18

Usual pain characteristics: crampy pain after drinking milk or eating milk products

Possible associated s/s: associated diarrhea, unremarkable physical exam

Answer 18

Lactose intolerance

Question 19

usual pain characteristics: localized pain

Possible associated s/s: abdominal tenderness, fever

Answer 19

Diverticular disease

Question 20

Usual pain characteristics: colicky or dull and steady pain that does not progress and worsen

Possible associated s/s: fecal mass palpable, stool in rectum

Answer 20

Constipation

Question 21

Usual pain characteristics: pain related to menses, intercourse

Possible associated s/s: palpable myoma(s)

Answer 21

Uterine fibroids

Question 22

Usual pain characteristics: localzied pain that increases with exertion or lifting

Possible associated s/s: hernia on physical examination

Answer 22

Hernia

Question 23

Usual pain characteristics: burning or gnawing pain in midepigastrium, worsens with recumbency and certain foods

Possible associated s/s: unremarkable physical exam

Answer 23

Esophagitis/Gastroesophageal reflux disease

Question 24

Usual pain characteristics: burning or gnawing pain

Possible associated s/s: may have epigastric tenderness on palpation

Answer 24

Peptic ulcer

Question 25

usual pain characteristics: constant burning pain in epigastrium

Possible associated s/s: may be accompanied by n/v, diarrhea, or fever, unremarkable physical exam

Answer 25

Gastritis