Abdominal Pain

Question 1

Colicky RUQ pain with radiations to R shoulder and upper back, worse after eating a fatty meal

Answer 1

Cholelithiasis (gallstones)

Question 2

Sharp pain that starts periumbilical and localizes to the RLQ.

Answer 2

Appendicitis

Question 3

Inability to pass stool or flautus, nausea, vomiting, history of surgery, abdominal distension, hyper or hypoactive bowel sounds.

Answer 3

Bowel Obstruction - usally small bowel

Question 4

Sharp substernal pain, relieved by eating, Melena. History of NSAID use.

Answer 4

PUD

Question 5

Long history of intermittent pain, relieved by defecation or associated with diarrhea

Answer 5

IBS

Question 6

Acute episodes of PERSISTENT RUQ pain, FEVER, with normal bilirubin, LFT’s, and lipase.

Answer 6

Cholecystitis

Question 7

Persistent RUQ pain, fever, increased bilirubin, lipase, and/or LFT’s

Answer 7

Duct obstruction - Choledocolithiasis, ascending cholangitis, or pancreatitis.

Question 8

RUQ, epigastric pain, dark urine, fever, rigors

Answer 8

Ascending cholangitis

Question 9

RUQ pain, etoh abuse, nausea, dark urine, elevated AST, ALT

Answer 9

Hepatitis

Question 10

Flank or groin pain, hematuria

Answer 10

Renal colic, nephrolithiasis

Question 11

Pain, diaphoresis, orthostatic hypotension, moderate diffuse tenderness without rebound or guarding.

Answer 11

Think AAA. Palpate for pulsatile mass, but physical cannot rule it out, so order bedside ultrasound or stat CT, and surgical consult.

Question 12

LLQ pain, diarrhea, fever.

Answer 12

Diverticulitis.