Lecture 7: Abdominal Pain I

Question 1

What are the types of abdominal pain?

Answer 1

Visceral Pain
Parietal Pain
Referred Pain

Question 2

Describe visceral pain.

Answer 2

Stimulation of visceral pain fibers

• distension or stretching of hollow organs
• not localized, usually midline

Question 3

Describe parietal pain.

Answer 3

Stimulation of somatic pain fibers

• inflammation in parietal peritoneum
• localized, sharp, usually worse with movement of coughing

Question 4

Describe referred pain.

Answer 4

Pain that originates within abdomen but felt other places

-example: duodenal and pancreatic pain felt in back

Question 5

What are the more important OLDCAAARTS to focus on for patients presenting with abdominal pain?

Answer 5

Location: what quadrant

Aggravating/Alleviating Factors: food

Question 6

What GI ROS questions should you ask a patient with abdominal pain?

Answer 6

Nausea
Vomiting 
Diarrhea
Black stools
Blood in stools
Blood in vomit

Question 7

What GU ROS questions should you ask a patient with abdominal pain?

Answer 7

Dysuria
Polyuria
Hematuria
Flank or CVA pain

Question 8

What GYN ROS questions should you ask a patient with abdominal pain?

Answer 8

Vaginal Bleeding
Vaginal Discharge
Last Menstrual Period
Possibility of pregnancy

Question 9

What are some specific GI cases to pay attention to in a patient’s history?

Answer 9

Hepatitis
GERD
IBD
Chronic abdominal pain
Constipation 
Liver issues

Question 10

What are some specific GI surgical cases to pay attention to in a patient’s history?

Answer 10

Abdominal: cholecystectomy, appendectomy
GYN: hysterectomy, tubal ligation, c-section, ovarian cyst

Question 11

In what order should the physical exam be performed?

Answer 11

Inspection
Auscultation
Percussion
Palpation

Question 12

What are some important landmarks to inspect for?

Answer 12

Xiphoid process
Costal margins
Umbilicus
ASIS

Question 13

What main organs are found in the RUQ?

Answer 13

Liver

Gallbladder

Question 14

What main organs are found in the RLQ?

Answer 14

Appendix

Ovary

Question 15

What main organs are found in the LUQ?

Answer 15

Stomach

Spleen

Question 16

What main organs are found in the LLQ?

Answer 16

Colon

Ovary

Question 17

What main organs are found in the epigastric area?

Answer 17

Pancreas

Question 18

What are some things to inspect for on the abdominal surface?

Answer 18

Surface and contour of abdomen

Skin color
Surgical scars
Striae (stretch marks)
Dilated veins
Rash
Ecchymoses 
Hernias

Question 19

To listen for bruits, what do you use?

Answer 19

Bell of stethoscope

Question 20

What can absent bowel sounds indicate?

Answer 20

Long-lasting intestinal obstruction
Intestinal perforation
Mesenteric ischemia

Question 21

What can decreased bowel sounds indicate?

Answer 21

Post-surgical ileus

Peritonitis

Question 22

What can increased bowel sounds indicate?

Answer 22

Diarrhea

Early Bowel Obstruction

Question 23

What can high pitched bowel sounds indicate?

Answer 23

Early intestinal obstruction

Question 24

What can bruits indicate?

Answer 24

Vascular obstruction

Question 25

What can friction rub indicate?

Answer 25

Inflammation of peritoneal surface of an organ, heard best at liver and spleen

Question 26

What can venus hum indicate?

Answer 26

Increased collateral circulation b/t portal and systemic venous systems, heard best at epigastric and umbilical regions

Question 27

When percussing the abdomen, what type of sound predominates?

Answer 27

Tympany: high-pitched and air filled

Question 28

If the spleen is enlarged, what does it do?

Answer 28

Expands anteriorly, downward, and medially

Question 29

If the vertical span of the liver is increased, what can that indicate?

Answer 29

``` Cirrhosis Lymphoma Hepatitis Right-sided heart failure Amyloidosis Hemochromatosis RIght pleural effusion ```

Question 30

If the vertical span of the liver is decreased, what can that indicate?

Answer 30

Cirrhosis

Question 31

If irregular edges or nodules are palpated on the liver, what can that indicate?

Answer 31

Hepatocellular carcinoma

Question 32

If firmness or hardness are palpated on the liver, what can that indicate?

Answer 32

Cirrhosis Hemochromatosis Amyloidosis Lymphoma

Question 33

If dullness is percussed at the midaxillary line, what can that indicate?

Answer 33

Splenomegaly

Question 34

What is a systematic approach to developing a broad differential diagnosis for GI issues?

Answer 34

VINDICATE - Vascular - Infection/Inflammatory - Neoplasm - Drugs/Degenerative - Iatrogenic/Idiopathic - Congenital - Autoimmune/allergic/anatomic - Trauma - Endocrine/environment

Question 35

What are some symptoms of bilary colic secondary to choelithiasis?

Answer 35

RUQ Pain - Pain can feel sharp, crampy, or like a constant dull ache. --Colic after eating a heavy meal - Bilious vomiting - Positive Murphy's sign

Question 36

What are some symptoms of pancreatitis?

Answer 36

Epigastric abdominal pain - bilious vomiting - abdominal pain that radiates to your back. - abdominal pain that feels worse after eating. - tenderness when touching the abdomen.

Question 37

What are some symptoms of ureterolithiasis?

Answer 37

Severe pain in the side and back, below the ribs. - pain that radiates to the lower abdomen and groin. - pain that comes in waves and fluctuates in intensity. - pain on urination. - pink, red or brown urine. - Cloudy or foul-smelling urine. - nausea and vomiting - persistent need to urinate.

Question 38

What are some symptoms of appendicitis?

Answer 38

RLQ Abdominal Pain - pain starts in belly button move to RLQ - low grade fever and chills - nausea and vomiting - loss of appetite. - constipation or diarrhea - inability to pass gas - stomach swelling