Abdominal pain Flashcards Preview

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Flashcards in Abdominal pain Deck (18):
1

Key history in abdominal pain

Location, quality, intensity, duration, radiation, timing (relation to meals)
Other symptoms (constitutional, GI, cardiac, pulmonary, renal, pelvic)
Exacerbating and alleviating factors
Hx of similar symptoms
Hx of abdominal surgeries, trauma, gallstones, kidney stones, atherosclerosis
Medications (e.g. NSAIDs, corticosteroids)
Alcohol and drug use
Domestic violence
Stress/anxiety
Sexual history
Pregnancy history

2

Key physical exam in abdominal pain

Vital signs
Heart and lung exams
Abdominal exam, including tenderness, guarding and rebound, Murphy's sign (tenderness to palpation of RUQ with deep inspiration), psoas (lift R leg with resistance) and obturator (flex knee and internally rotate hip) signs
CVA percussion
Bowel sounds
Aortic bruits
Rectal exam
Pelvic exam

3

45 yo M with sudden onset colicky R sided flank pain radiating to testicles
+ N/V
+ Hematuria
+ CVA tenderness

Nephrolithiasis
Renal cell carcinoma
Pyelonephritis

UA, urine culture and sensitivity, urine cytology, BUN/Cr, CT - abdomen, US - renal, KUB, IVP, blood culture

4

60 yo M with dull epigastric pain radiating to back
+ weight loss, dark urine and clay-colored stool
+ heavy drinker and smoker
+ appears jaundiced on exam today

Pancreatic cancer
Cholangiocarcinoma
Acute viral hepatitis
Acute alcoholic hepatitis
Chronic pancreatitis
Abdominal aortic aneurysm
Cholecystitis/choledocholithiasis

CBC, electrolytes, amylase, lipase, AST/ALT/bilirubin/alkaline phosphatase, CT - abdomen, US - abdomen

5

56 yo M with severe mid-epigastric abdominal pain radiating to back that improves when leaning forward
+ anorexia, N/V
+ spent last three days binge drinking

Acute pancreatitis
Peptic ulcer disease
Cholecystitis/choledocholithiasis
Gastritis
Abdominal aortic aneurysm

CBC, electrolytes, BUN/Cr, amylase, lipase, AST/ALT/bilirubin/alkaline phosphatase, US - abdomen, CT - abdomen, upper endoscopy, ECG

6

41 yo obese F with RUQ abdominal pain radiating to R scapula
+ N/V
+ fever
+ pain started after eating fatty food
+ prior episodes
+ positive Murphy's sign

Acute cholecystitis
Choledocholithiasis
Hepatitis
Peptic ulcer disease

CBC, AST/ALT/bilirubin/alkaline phosphatase, US - abdomen, CT - abdomen, blood culture

7

43 yo obese F with RUQ abdominal pain, fever and jaundice
+ diagnosed with asymptomatic gallstones one year ago
+ hypotensive on exam today

Ascending cholangitis
Acute gallstone cholangitis
Acute cholecystitis
Hepatitis

CBC, AST/ALT/bilirubin/alkaline phosphatase, blood culture, viral hepatitis serologies, US - abdomen, MRCP, ERCP

8

25 yo M with RUQ pain, fever, anorexia, nausea and vomiting
+ dark urine and clay-colored stool

Acute hepatitis
Acute cholecystitis
Ascending cholangitis

CBC, amylase, lipase, AST/ALT/bilirubin/alkaline phosphatase, viral hepatitis serologies, UA, US - abdomen

9

35 yo M with burning epigastric pain 2-3 hours after meals
+ pain relieved by food and antacids

Peptic ulcer disease
Gastritis
GERD

Rectal exam, stool for occult blood, amylase, lipase, AST/ALT/bilirubin/alkaline phosphatase, upper endoscopy (including H. pylori testing), upper GI series

10

37 yo M with severe epigastric pain, nausea, vomiting and mild fever
+ appears toxic
+ Hx of intermittent epigastric pain relieved by food and antacids
+ smokes heavily
+ takes aspirin on daily basis

Perforated peptic ulcer
Acute pancreatitis
Hepatitis

Rectal exam, CBC, electrolytes, amylase, lipase, lactate, AST/ALT/bilirubin/alkaline phosphatase, CXR, KUB, CT - abdomen, upper endoscopy (including H. pylori testing), blood culture

11

18 yo M boxer with severe LUQ abdominal pain radiating to left scapula
+ had infectious mononucleosis three weeks ago

Splenic rupture
Kidney stone
Rib fracture

CBC, electrolytes, CXR, CT - abdomen, US - abdomen (if hemodynamically unstable)

12

40 yo M with cramping abdominal pain and vomiting
+ abdominal distention
+ inability to pass flatus or stool
+ Hx of multiple abdominal surgeries

Intestinal obstruction
Small bowel or colon cancer
Volvulus
Gastroenteritis

Rectal exam, CBC, electrolytes, AXR, CT - abdomen/pelvis with contrast, colonoscopy

13

70 yo F with acute onset severe, cramping abdominal pain
+ massive dark bowel movement
+ Hx of CHF and atrial fibrillation, receiving digitalis
+ pain out of proportion to exam

Mesenteric ischemia/infarction
Diverticulitis
Peptic ulcer disease

Rectal exam, CBC, amylase, lipase, lactate, ECG, AXR, CT - abdomen, mesenteric angiography, barium enema

14

21 yo F with acute onset severe RLQ pain, nausea and vomiting
+ no fever, urinary symptoms or vaginal bleeding
+ never taken OCPs
+ cyst on R ovary

Ovarian torsion
Appendicitis
Nephrolithiasis
Ectopic pregnancy

Pelvic exam, urine hCG, Doppler US - pelvis, rectal exam, UA, CBC, CT - abdomen, laparoscopy, chlamydia and gonorrhea testing, VDRL/RPR

15

68 yo M with LLQ abdominal pain, fever and chills over last three days
+ recent onset of alternating diarrhea and constipation
+ consumes a low-fiber, high-fat diet

Diverticulitis
Crohn's disease
Ulcerative colitis

Rectal exam, CBC, electrolytes, CXR, AXR, CT - abdomen, blood culture

16

20 yo M with severe RLQ abdominal pain, nausea and vomiting
+ started as vague pain around umbilicus yesterday
+ now pain is sharp and at RLQ
+ MacBurney's and psoas signs are positive

Acute appendicitis
Gastroenteritis
Diverticulitis

CBC, electrolytes, CT - abdomen, AXR, US - abdomen, blood culture

17

30 yo F with periumbilical pain over six months
+ pain never awakens her from sleep
+ pain is relieved by defecation and worsens when upset
+ alternating constipation and diarrhea
+ no N/V/D, weight loss or anorexia

Irritable bowel syndrome
Crohn's disease
Celiac disease

Rectal exam, stool for occult blood, pelvic exam, urine hCG, CBC, electrolytes, colonoscopy, CT - abdomen/pelvis, stool for ova and parasitology, Entamoeba histolytica antigen

18

24 yo F with bilateral lower abdominal pain starting at first day of menstrual period
+ fever
+ thick, greenish-yellow vaginal discharge
+ unprotected sex with multiple partners

Pelvic inflammatory disease
Endometriosis
Dysmenorrhea

Pelvic exam, urine hCG, cervical cultures, CBC, ESR, UA, urine culture, US - pelvis