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31 Cards in this Set

  • Front
  • Back
How do you categorize abdominal pain?
by acuity, duration (acute vs. chronic) and location (focal vs. diffuse)
What are 7 abdominal catatrophes that should not be missed?
1. cholangitis
2. ischemic bowel
3. appendicitis
4. splenic rupture
5. ruptured AAA
6. ectopic pregancy
7. bowel perforation
What are causes of diffuse abdominal pain?
1. pancreatitis
2. bowel obstruction
3. early appendicitis
4. ischemic bowel
5. constipation
6. peritonitis
What can bowel perforation and ischemic bowel cause?
gram-negative sepsis
What can AAA and etopic pregnancy cause?
rapid volume depletion and shock
What are important extra-abdominal problems that can masquerade as abdominal pain?
1. angina
2. lower lobe pneumonia
3. PE
4. abdominal wall pain
How can angina present as abdominal pain?
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
How can lower lobe pneumonia or PE present as abdominal pain?
These conditions can irritate the diaphragm and cause upper quadrant abdominal pain, usually worsened by breathing
What causes RUQ abdominal pain?
Duodenal ulcer
Gallstone disease
Right kidney obstruction or inflammation
What is the key information to gather about abdominal pain from the patient history?
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
What causes should you think of in elderly patients who have abdominal pain?
1. cholecystitis (inflammation of the gallbladder
2. ischemic bowel
3. obstipation
4. diverticulitis
5. aortic aneurysm
6. abdominal presentations of coronary artery disease
What is obstipation?
severe constipation, intestinal obstruction
What are common causes of chronic abdominal pain?
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
What are the risk factors for gastroesophageal reflux?
Key features?
1. obesity
2. CCB use

Key features: acid or food regurgitation, symptoms worse when supine
What are the risk factors for peptic ulcer?
2. prednisone
3. alcohol
4. caffeine
What are the risk factors for irritable bowel syndrome
1. anxiousness
2. female
3. young to middle-aged
What are the risk factors for inflammatory bowel disease?
none known
What are the risk factors for obstipation?
1. elderly
2. narcotics
3. calcium channel blockers
What are the risk factors for chronic mesenteric ischemia (ischemic bowel)?
1. atherosclerotic risk factors
What are the risk factors for atypical angina leading to abdominal pain?
1. hypertension
2. family hx of early MI
3. hyperlipidemia
4. smoking
What are the key features of gastroesophageal reflux?
1. acid or food regurgitation
2. symptoms worse when supine
What are the key features of peptic ulcer?
1. improved with antacids
2. worse with acidic or spicy food and NSAIDS
3. melena
What are risk factors for biliary colic?
fat, female, forty
What are the key features of biliary colic?
1. intermittent episodes of RUQ pain
2. pain may radiate to right shoulder
3. postprandial pain, especially after fatty food
What are the key features of inflammatory bowel disease?
1. nocturnal pain
2. intermittent bloody stool
3. extraintestinal manifestations (arthritis, gallstones, erythema nodosum, pyoderma gangrenosum, episcleritis, uveitis, thromboembolism, sclerosing cholangitis
What are the key features of irritable bowel syndrome?
1. no nocturnal symptoms
2. improves with defecation
3. alternating constipation and diarrhea
4. mucus in stool
What are the key features of obstipation?
1. inability to pass stool
2. hard stool
What are the key features of chronic mesenteric ischemia (ischemic bowel)?
1. postprandial, diffuse abdominal pain (also called intestinal angina)
2. anorexia
3. weight loss
What are the key features of atypical angina (causing chronic abdominal pain)?
1. worse with exercise and eating
2. associated dyspnea, diaphoresis and nausea
To assess for the likelihood of pancreatitis, ask about risk factors:
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.
To assess for the likelihood of bowel obstruction, ask about:
inability to pass stool or flatus.