Abdominal Pain Ch. 7 Paauw

Front 1

How do you categorize abdominal pain?

Back 1

by acuity, duration (acute vs. chronic) and location (focal vs. diffuse)

Front 2

What are 7 abdominal catatrophes that should not be missed?

Back 2

1. cholangitis
2. ischemic bowel
3. appendicitis
4. splenic rupture
5. ruptured AAA
6. ectopic pregancy
7. bowel perforation

Front 3

What are causes of diffuse abdominal pain?

Back 3

1. pancreatitis
2. bowel obstruction
3. early appendicitis
4. ischemic bowel
5. constipation
6. peritonitis

Front 4

What can bowel perforation and ischemic bowel cause?

Back 4

gram-negative sepsis

Front 5

What can AAA and etopic pregnancy cause?

Back 5

rapid volume depletion and shock

Front 6

What are important extra-abdominal problems that can masquerade as abdominal pain?

Back 6

1. angina
2. lower lobe pneumonia
3. PE
4. abdominal wall pain

Front 7

How can angina present as abdominal pain?

Back 7

Angina can present atypically as epigastric pain. You would still see characteristics of angina such as pain worsened by exercise, relieved by resting, associated with dyspnea, diaphoresis or nausea

Front 8

How can lower lobe pneumonia or PE present as abdominal pain?

Back 8

These conditions can irritate the diaphragm and cause upper quadrant abdominal pain, usually worsened by breathing

Front 9

What causes RUQ abdominal pain?

Back 9

Duodenal ulcer
Gallstone disease
Hepatitis
Right kidney obstruction or inflammation

Front 10

What is the key information to gather about abdominal pain from the patient history?

Back 10

1. onset and duration
2. character and severity of pain
3. location and radiation
4. progression of symptoms over time
5. associated symptoms
6. relation to meals, exercise, defecation
7. changes in stool or flatus
8. exacerbating and relieving factors
9. history of recent travel, infectious exposure, alcohol use
10. medications

Front 11

What causes should you think of in elderly patients who have abdominal pain?

Back 11

1. cholecystitis (inflammation of the gallbladder
2. ischemic bowel
3. obstipation
4. diverticulitis
5. aortic aneurysm
6. abdominal presentations of coronary artery disease

Front 12

What is obstipation?

Back 12

severe constipation, intestinal obstruction

Front 13

What are common causes of chronic abdominal pain?

Back 13

1. Gastroesophageal reflux
2. Peptic ulcer
3. Bilary colic
4. Irritable bowel syndrome
5. Inflammatory bowel disease
6. Obstipation
7. Chronic mesenteric ischemia (ischemic bowel)
8. Atypical angina

Front 14

What are the risk factors for gastroesophageal reflux?
Key features?

Back 14

1. obesity
2. CCB use

Key features: acid or food regurgitation, symptoms worse when supine

Front 15

What are the risk factors for peptic ulcer?

Back 15

1. NSAIDS
2. prednisone
3. alcohol
4. caffeine

Front 16

What are the risk factors for irritable bowel syndrome

Back 16

1. anxiousness
2. female
3. young to middle-aged

Front 17

What are the risk factors for inflammatory bowel disease?

Back 17

none known

Front 18

What are the risk factors for obstipation?

Back 18

1. elderly
2. narcotics
3. calcium channel blockers

Front 19

What are the risk factors for chronic mesenteric ischemia (ischemic bowel)?

Back 19

1. atherosclerotic risk factors

Front 20

What are the risk factors for atypical angina leading to abdominal pain?

Back 20

1. hypertension
2. family hx of early MI
3. hyperlipidemia
4. smoking

Front 21

What are the key features of gastroesophageal reflux?

Back 21

1. acid or food regurgitation
2. symptoms worse when supine

Front 22

What are the key features of peptic ulcer?

Back 22

1. improved with antacids
2. worse with acidic or spicy food and NSAIDS
3. melena

Front 23

What are risk factors for biliary colic?

Back 23

fat, female, forty

Front 24

What are the key features of biliary colic?

Back 24

1. intermittent episodes of RUQ pain
2. pain may radiate to right shoulder
3. postprandial pain, especially after fatty food

Front 25

What are the key features of inflammatory bowel disease?

Back 25

1. nocturnal pain
2. intermittent bloody stool
3. extraintestinal manifestations (arthritis, gallstones, erythema nodosum, pyoderma gangrenosum, episcleritis, uveitis, thromboembolism, sclerosing cholangitis

Front 26

What are the key features of irritable bowel syndrome?

Back 26

1. no nocturnal symptoms
2. improves with defecation
3. alternating constipation and diarrhea
4. mucus in stool

Front 27

What are the key features of obstipation?

Back 27

1. inability to pass stool
2. hard stool

Front 28

What are the key features of chronic mesenteric ischemia (ischemic bowel)?

Back 28

1. postprandial, diffuse abdominal pain (also called intestinal angina)
2. anorexia
3. weight loss

Front 29

What are the key features of atypical angina (causing chronic abdominal pain)?

Back 29

1. worse with exercise and eating
2. associated dyspnea, diaphoresis and nausea

Front 30

To assess for the likelihood of pancreatitis, ask about risk factors:

Back 30

gallstone disease, excessive alcohol use, hypertriglyceridemia and certain medications such as antiretrovirals, predisone and hydrochlorothiazide. Also, ask about worsening of symptoms with eating and radiation of pain to back or flank.

Front 31

To assess for the likelihood of bowel obstruction, ask about:

Back 31

inability to pass stool or flatus.