Abdominal pain Flashcards

Question

What physical exam and lab findings are seen in acute pancreatitis?

Answer 1

Physical: Acutely ill, abdominal distention, decreased bowel sounds, diffuse rebound tenderness Labs: Elevated amylase (rises 2–12 hours, normalizes in 2–3 days), elevated lipase (elevated for days) ## Footnote Lipase is more specific than amylase.

Answer 2

Hospital admission NPO IV fluids Analgesics ## Footnote Severe cases may require ICU; complications include pancreatic necrosis, pseudocyst.

Answer 3

Helicobacter pylori infection NSAID use Hypersecretory states (e.g., Zollinger-Ellison syndrome) ## Footnote Perforation is a surgical emergency with high mortality if untreated.

Answer 4

Symptoms: Sudden, severe, steady epigastric pain radiating to sides/back/right shoulder Physical: Epigastric tenderness, rebound tenderness, abdominal muscle rigidity ## Footnote Pain worsens with movement; patients may lie still (peritoneal sign).

Answer 5

Diagnosis: Upright X-ray showing free air under diaphragm Management: Surgical emergency (refer immediately) ## Footnote Free air is seen in 70–80% of cases; CT is more sensitive if X-ray is negative.

Answer 6

Causes: Adhesions, internal hernia Symptoms: Sudden crampy umbilical/epigastric pain, early vomiting (small bowel), late vomiting (large bowel) ## Footnote Adhesions are the most common cause in developed countries.

Answer 7

Physical: Hyperactive high-pitched bowel sounds, abdominal distention, palpable fecal mass, empty rectum Diagnosis: CBC, serum amylase, stool occult blood, abdominal X-ray (air-fluid levels) ## Footnote X-ray shows dilated loops and air-fluid levels; CT confirms diagnosis.

Answer 8

Hospitalization NPO IV fluids Nasogastric tube decompression ## Footnote Surgical intervention needed for complete obstruction or strangulation.

Answer 9

Functional GI disorder with no structural/biochemical abnormalities Affects 14–24% of females, 5–19% of males Onset: Late adolescence to early adulthood, rare >50 years ## Footnote IBS is a diagnosis of exclusion; rule out organic disease first.

Answer 10

3+ months of continuous/recurrent symptoms: Abdominal pain/discomfort relieved by bowel movement Associated with change in stool frequency and/or consistency ## Footnote Rome IV criteria are commonly tested; symptoms must be chronic.

Answer 11

Occurring on ≥25% of occasions: Altered stool frequency (>3 BMs/day or <3 BMs/week) Altered stool form (lumpy/hard or loose/watery) Altered stool passage (straining, urgency, incomplete evacuation) Mucus passage Bloating/abdominal distention ## Footnote Mucus and bloating are classic; blood in stool is a red flag for organic disease.

Answer 12

CBC with differential ESR Electrolytes BUN, creatinine TSH Stool for occult blood and ova/parasites Flexible sigmoidoscopy ## Footnote Normal tests support IBS; abnormal findings prompt further investigation.

Answer 13

Exclude organic disease Provide support/reassurance Dietary modification (e.g., high fiber, avoid triggers) Pharmacotherapy (e.g., antispasmodics, loperamide) Alternative therapies (e.g., CBT, probiotics) ## Footnote Patient education is key; stress management improves outcomes.

Answer 14

Uncomplicated disease (asymptomatic or symptomatic) due to low-fiber Western diets Rare in first 4 decades, incidence 50–65% by age 80 ## Footnote Diverticulosis is often incidental; complications include diverticulitis/bleeding.

Answer 15

Irregular defecation Intermittent abdominal pain Bloating Excessive flatulence Flattened/ribbon-like stools Recurrent steady/crampy pain ## Footnote Symptoms mimic IBS but occur in older patients.

Answer 16

Diagnosis: CBC, stool for occult blood, barium enema Management: Increase fiber intake to 35 g/day (gradually), avoid popcorn, corn, nuts, seeds ## Footnote High-fiber diet prevents complications; CT is preferred for diverticulitis.

Answer 17

Movement of gastric contents into esophagus Symptoms: Heartburn (burning midepigastric pain, worsens with recumbency), water brash, postprandial pain relieved by antacids ## Footnote Affects 15% of adults; severe cases may cause dysphagia or chest pain mimicking angina.

Answer 18

High-fat/sugar foods, chocolate, coffee, onions, citrus, tomato-based, spicy foods Cigarette smoking, alcohol Aspirin, NSAIDs, potassium supplements ## Footnote Lifestyle modification is first-line management.

Answer 19

Diagnosis: History of heartburn, empiric PPI trial, CBC, H. pylori antibody, barium swallow, endoscopy (for severe/atypical symptoms) Management: Lifestyle changes (smoking cessation, reduce ETOH, elevate head of bed), antacids, sucralfate, PPIs ## Footnote PPIs are most effective; maintenance therapy often required.

Answer 20

Ulcerative colitis (UC): Continuous inflammation of colonic mucosa, starting in rectum Crohn’s disease: Patchy inflammation of any GI tract segment, often ileum/colon ## Footnote UC is mucosa-limited; Crohn’s is transmural, increasing fistula risk.

Answer 21

Loose/watery stools (may be bloody) Rectal bleeding (common in colitis) Tenesmus, fecal incontinence Fatigue, weight loss, anorexia Fever, chills, nausea, vomiting Joint pains, mouth sores ## Footnote Extraintestinal manifestations (e.g., uveitis, arthritis) are high-yield.

Answer 22

CBC, stool for culture/ova/parasites/C. difficile, occult blood. Flexible sigmoidoscopy (for rectal bleeding). Colonoscopy with biopsy (shows skip lesions in Crohn’s). ## Footnote Endoscopy differentiates UC (continuous) from Crohn’s (patchy).

Answer 23

Co-managed with GI specialist. 5-aminosalicylic acid (5-ASA) products. Corticosteroids. Immunosuppressives. Surgery (e.g., colectomy for UC, resection for Crohn’s). ## Footnote Biologics (e.g., anti-TNF) are used for refractory cases.

Answer 24

H. pylori infection (>90% of cases). NSAID use. Stress, smoking, alcohol, COPD. Genetic factors (e.g., Zollinger-Ellison syndrome, blood group O). ## Footnote H. pylori eradication prevents recurrence.

Answer 25

Symptoms: Epigastric burning/gnawing pain 1–3 hours after meals, relieved by food/antacids. Management: 2-week antiulcer trial, treat H. pylori, PPIs (superior to H2RAs), misoprostol if NSAIDs continued. ## Footnote Recurrence rate is 75–80% without maintenance.

Answer 26

Gastric: H. pylori in 65–75%, pain worsened by food, associated with malignancy, weight loss common. Duodenal: H. pylori in >90%, pain relieved by food, weight gain common, malignancy rare. ## Footnote Endoscopy is required for gastric ulcers to rule out cancer.

Answer 27

Rovsing’s sign: Palpation of LLQ causes pain in RLQ. ## Footnote Other signs include psoas (hip flexion pain) and obturator (internal rotation pain); highly tested on USMLE.

Answer 28

Periumbilical bruising indicating hemorrhagic pancreatitis or ruptured ectopic pregnancy. ## Footnote Grey Turner’s sign (flank bruising) is also associated; both are rare but high-yield.

Answer 29

Gallstones (40–50% of cases). ## Footnote Alcohol is the second most common cause; hypertriglyceridemia is a key differential.

Answer 30

Rectal bleeding or unintentional weight loss. ## Footnote These suggest organic disease (e.g., IBD, cancer); urgent work-up needed.

Answer 31

Fever, jaundice, RUQ pain. ## Footnote Reynolds’ pentad adds hypotension and altered mental status; indicates severe infection.

Abdominal pain Flashcards

(55 cards)