General

Question 1

what are the imaging modalities of choice in abdominal pain

Answer 1

Rt. Upper quadrant, suprapubic → u/s
Diffuse → ct abdomen
Rlq→ ct with iv contrast
Llq → ct with oral and iv contrast
X ray abdomen
Xray chest

Question 2

What might an xray show in abdo pain?/

Answer 2

Cxr upright- Free air under diaphragm- perforation
Calcifications - gallstones 10%. Urinary 90%, appendicoliths 5%
Air fluid levels - obstruction / paralytic ileus
Multiple dilated loops of bowel → paralytic ileum, obstruction

Question 3

What should the hx for abdo pain include?

Answer 3

Site
Onset, duration
Constant vs intermittent
Night time pain
Radiation
Characteristic
Exacerbating and relieving factors - meds and alternative therapies
Severity
Associated factors - anorexia, nausea, reflux , vomiting ( colour, amount), diarrhea, constipation, blood in stools, mouth ulcers, skin changes, bruises, jaundice, vaginal bleeding, discharge, dyseria, frequency, urgency, hematuria
B symptoms → fever, weight loss, night sweats
Previous me of similar symptoms
Past hx → surgery, malignancy, Ibd, hepatic disease, gallstones
Sexual and gyne hx - LMP, pregnancy STD
Meds and drugs → NSAIDs, Acetaminophen, aspirin, phenytoin, valproate, steroids, laxatives, ABx, alcohol
Preventative → last endoscopy, colonoscopy, fit, pap
Social → abuse
FIFE (patient’s experience of pain, thoughts, expectations, limitations on daily activities)

Question 4

First imaging modality used in children and for gyn

Answer 4

Ultrasound

Question 5

Management of abdo pain

Answer 5

NPO
NG (in SBO)
ANALGESIA
IV FLUIDS
Specific treatment
CONSULT AS NECESSARY

Question 6

DDx of abdominal pain with nausea/vomiting

Answer 6

Relieved by vomiting → gastric outlet obstruction, SBO, GERD
Not relieved by vomiting → pancreatitis, gallstones, mi, hepatitis, infectious Gastroenteritis