Acute Abdomen and Referred Pain

Question 1

what is the differential diagnosis for RUQ?

Answer 1

cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, liver tumors, gastritis, hepatic abscess, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis (especially during pregnancy), thoracic causes (pleurisy/pneumonia), PE, pericarditis, MI (especially inferior MI)

Question 2

what is the differential diagnosis for LUQ?

Answer 2

PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurysm, thoracic causes, pyelonephritis, nephrolithiasis, hiatal hernia (strangulated paraesophageal hernia), Boerhaave’s syndrome, Mallory-Weiss tear, splenic artery aneurysm, colon disease

Question 3

what is the differential diagnosis for LLQ?

Answer 3

diverticulitis, sigmoid volvulus, perforated colon, colon cancer, URI, SBO, IBD, nephrolithiasis, pyelonephritis, fluid accumulation from aneurysm or perforation, referred hip pain, gynecologic causes, appendicitis (rare)

Question 4

what is the differential diagnosis for RLQ?

Answer 4

appendicitis! same as LLQ, plus mesenteric lymphadenitis, cecal diverticulitis, Meckel’s diverticulum, intussusception

Question 5

What is the differential diagnosis of epigastric pain?

Answer 5

PUD, gastritis, MI, pancreatitis, biliary colic, gastric volvulus, Mallory-Weiss tear

Question 6

what is the unique differential diagnosis for the patient with AIDS and abdominal pain?

Answer 6

• CMV (most common)
• Kaposi’s sarcoma
• Lymphoma
• TB
• mycobacterium avian intracellulare

Question 7

what is the classic referred pain location for cholecystitis?

Answer 7

right sub scapular pain (also epigastric)

Question 8

what is the classic referred pain location for appendicitis?

Answer 8

early: periumbilical
rarely: testicular

Question 9

what is the classic referred pain location for diaphragmatic irritation (from spleen, perforated ulcer, or abscess)?

Answer 9

shoulder pain (+ Kehr’s sign on the left)

Question 10

what is the classic referred pain location for pancreatitis/cancer?

Answer 10

back pain

Question 11

what is the classic referred pain location for rectal disease?

Answer 11

pain in the small of the back

Question 12

what is the classic referred pain location for nephrolithiasis?

Answer 12

testicular pain/flank pain

Question 13

what is the classic referred pain location for rectal pain?

Answer 13

midline small of back pain

Question 14

what is the classic referred pain location for small bowel?

Answer 14

periumbilical pain

Question 15

what is the classic referred pain location for uterine pain?

Answer 15

midline of small of back pain

Question 16

what is the classic diagnosis for: abdominal pain out of proportion to exam?

Answer 16

rule out mesenteric ischemia

Question 17

what is the classic diagnosis for: hypotension and pulsatile abdominal mass?

Answer 17

ruptured AAA; go to the OR

Question 18

what is the classic diagnosis for: fever, LLQ pain, and change in bowel habits?

Answer 18

diverticulitis

Question 19

classically, what endocrine problems can cause abdominal pain?

Answer 19

• Addisonian crisis

- Diabetic KetoAcidosis (DKA)

Question 20

what is the most likely diagnosis for: 22yo woman with acute onset lower abdominal pain, hypotension, tachycardia, adnexal mass, and free fluid on vaginal ultrasound?

Answer 20

ectopic pregnancy rupture

Question 21

what is the most likely diagnosis for: 21yo woman with fever, leukocytosis, lower abdominal pain, + chandelier sign?

Answer 21

pelvic inflammatory disease (PID)

Question 22

what is the most likely diagnosis for: 54yo male smoker with c/o right-sided abdominal pain, hematuria, and a mass in the right side of the abdomen?

Answer 22

renal cell carcinoma

Question 23

what is the most likely diagnosis for: abdominal pain ‘out of proportion to exam’?

Answer 23

mesenteric ischemia

Question 24

what is the most likely diagnosis for: 67yo man with hypotension, abdominal pain, and an abdominal mass that pulsates?

Answer 24

ruptured abdominal aortic aneurysm

Question 25

what is the most likely diagnosis for: 67yo female smoker with a history of 25-lb weight loss over 3mo due to abdominal pain after eating; contender abdomen on exam?

Answer 25

chronic mesenteric ischemia