Test 4-GI Part I (Abdominal Pain &
Appendicitis Exam Questions with
Correct Answers
Abdominal Pain:
( Definition, epidemiology and etiology)
(Buttaro, Chapter 126) - Answer--Abdominal pain is a most challenging condition to
diagnose in primary care.
-Patient's often present abdominal pain that is very vague.
Pathophysiology: - Answer--Several major mechanisms of abdominal pain, including
pain from obstruction of a hollow viscus, capsular distention, peritoneal irritation,
mucosal ulceration, vascular insufficiency, altered body motility, nerve injury, abdominal
wall injury, and pain referred from an extra abdominal site.
Visceral pain - Answer-usually arise from a hollow viscus result from distention or
spasm of a hollow organ due to intestinal obstruction. It is commonly described as a dull
and crampy and is poorly localized.
Parietal pain: - Answer-is a sharp and well localized pain arise from irritation of the
parietal peritoneum, such as the pain of acute appendicitis with inflammation spread to
the peritoneum.
Referred pain: - Answer-is an aching type of pain experienced away from the disease
process and is perceived to be near the surface of the body.
Location of Pain: - Answer-Right Upper Abdominal Quadrant pain: generally emanates
from the chest cavity, liver, gallbladder, stomach, bowel, or right kidney or ureter.
Diagnoses of pain in this area are cholecystitis and hepatitis.
Left upper Quadrant pain: heart or chest cavity, spleen, stomach, pancreas (especially
acute pancreatitis) or left kidney or ureter.
Left Lower Abdominal pain: bowel, left ureter, or pelvis and is most commonly
associated with diverticulitis.
Right lower Quadrant pain is associated with appendix, bowel, right ureter, or pelvis,
with the most common diagnosis being appendicitis. Cholecystitis or peptic ulcer
perforation also must be considered.
Centralized abdominal across several quadrants: typically associated with the bowel,
whereas abdominal wall pain from trauma or inflammation can occur in any quadrant.
, Diagnosis - Answer-Accurate diagnosis is highly dependent on history, physical
examination, and appropriate laboratory and radiologic procedures. Allergies,
medication history (including over-the counter drugs, vitamins, and supplements),
surgical history, social and sexual history, last menstrual period, dietary history, last
food or fluid ingested, and family history of abdominal pain are important considerations
that should be elicited.
Diseases that may cause acute abdominal pain include: - Answer-Appendicitis
• Cholecystitis
• Diverticulitis
• Small bowel obstruction
• Perforated peptic ulcer
• Peritonitis
• Ruptured ectopic pregnancy
• Ruptured abdominal aortic aneurysm
• Hypercalcemia
• Superior mesenteric artery syndrome
• Acute intermittent porphyria
• Pelvic inflammatory disease (especially in female patients)
Acute diseases of the chest, including myocardial infarction, congestive heart failure,
pulmonary infarction, and pneumonia, may mimic primary disease of the abdomen.
Appendicitis - Answer-An inflammatory disease of the wall of the appendix that may
result in perforation with subsequent peritonitis. Diagnosis is primarily based on the
history and physical examination.
Appendicitis -Patho - Answer-Thought to be caused by the blockage of the appendiceal
lumen, leading to distention of the appendix as a result of accumulated intramural fluid
with secondary bacterial infection.
Appendicitis-Clinical Presentation - Answer-The most reliable historical feature in the
diagnosis of acute appendicitis is the sequence of symptoms. Three s/s most predictive
of acute appendicitis include pain that starts in the epigastrium or periumbilical are,
migration of the pain to the RLQ and abdominal rigidity. The pain can be diffuse or
occur at other sites of the abdomen, including LLQ. Anorexia, N/V, constipation or rarely
diarrhea accompanied by low grade fever follows the onset of pain. Pain perception
may be decreased in the elderly, s/s may be vague in elderly which is why they have an
increase incidence of perforation.
Appendicitis-Physical Examination - Answer-DX requires a detail history and PE
including pelvic exam in females. Low grade fever is usually present. Localized
tenderness is a valuable physical finding, and the patient can often specify the painful
spot with one finger. Localized tenderness is usually in the RLQ between the umbilicus
and the anteriorsuperior iliac spine (McBurney's point). There may be signs of peritoneal
irritation, including guarding, rebound tenderness and obturator and psoas sign. The
Appendicitis Exam Questions with
Correct Answers
Abdominal Pain:
( Definition, epidemiology and etiology)
(Buttaro, Chapter 126) - Answer--Abdominal pain is a most challenging condition to
diagnose in primary care.
-Patient's often present abdominal pain that is very vague.
Pathophysiology: - Answer--Several major mechanisms of abdominal pain, including
pain from obstruction of a hollow viscus, capsular distention, peritoneal irritation,
mucosal ulceration, vascular insufficiency, altered body motility, nerve injury, abdominal
wall injury, and pain referred from an extra abdominal site.
Visceral pain - Answer-usually arise from a hollow viscus result from distention or
spasm of a hollow organ due to intestinal obstruction. It is commonly described as a dull
and crampy and is poorly localized.
Parietal pain: - Answer-is a sharp and well localized pain arise from irritation of the
parietal peritoneum, such as the pain of acute appendicitis with inflammation spread to
the peritoneum.
Referred pain: - Answer-is an aching type of pain experienced away from the disease
process and is perceived to be near the surface of the body.
Location of Pain: - Answer-Right Upper Abdominal Quadrant pain: generally emanates
from the chest cavity, liver, gallbladder, stomach, bowel, or right kidney or ureter.
Diagnoses of pain in this area are cholecystitis and hepatitis.
Left upper Quadrant pain: heart or chest cavity, spleen, stomach, pancreas (especially
acute pancreatitis) or left kidney or ureter.
Left Lower Abdominal pain: bowel, left ureter, or pelvis and is most commonly
associated with diverticulitis.
Right lower Quadrant pain is associated with appendix, bowel, right ureter, or pelvis,
with the most common diagnosis being appendicitis. Cholecystitis or peptic ulcer
perforation also must be considered.
Centralized abdominal across several quadrants: typically associated with the bowel,
whereas abdominal wall pain from trauma or inflammation can occur in any quadrant.
, Diagnosis - Answer-Accurate diagnosis is highly dependent on history, physical
examination, and appropriate laboratory and radiologic procedures. Allergies,
medication history (including over-the counter drugs, vitamins, and supplements),
surgical history, social and sexual history, last menstrual period, dietary history, last
food or fluid ingested, and family history of abdominal pain are important considerations
that should be elicited.
Diseases that may cause acute abdominal pain include: - Answer-Appendicitis
• Cholecystitis
• Diverticulitis
• Small bowel obstruction
• Perforated peptic ulcer
• Peritonitis
• Ruptured ectopic pregnancy
• Ruptured abdominal aortic aneurysm
• Hypercalcemia
• Superior mesenteric artery syndrome
• Acute intermittent porphyria
• Pelvic inflammatory disease (especially in female patients)
Acute diseases of the chest, including myocardial infarction, congestive heart failure,
pulmonary infarction, and pneumonia, may mimic primary disease of the abdomen.
Appendicitis - Answer-An inflammatory disease of the wall of the appendix that may
result in perforation with subsequent peritonitis. Diagnosis is primarily based on the
history and physical examination.
Appendicitis -Patho - Answer-Thought to be caused by the blockage of the appendiceal
lumen, leading to distention of the appendix as a result of accumulated intramural fluid
with secondary bacterial infection.
Appendicitis-Clinical Presentation - Answer-The most reliable historical feature in the
diagnosis of acute appendicitis is the sequence of symptoms. Three s/s most predictive
of acute appendicitis include pain that starts in the epigastrium or periumbilical are,
migration of the pain to the RLQ and abdominal rigidity. The pain can be diffuse or
occur at other sites of the abdomen, including LLQ. Anorexia, N/V, constipation or rarely
diarrhea accompanied by low grade fever follows the onset of pain. Pain perception
may be decreased in the elderly, s/s may be vague in elderly which is why they have an
increase incidence of perforation.
Appendicitis-Physical Examination - Answer-DX requires a detail history and PE
including pelvic exam in females. Low grade fever is usually present. Localized
tenderness is a valuable physical finding, and the patient can often specify the painful
spot with one finger. Localized tenderness is usually in the RLQ between the umbilicus
and the anteriorsuperior iliac spine (McBurney's point). There may be signs of peritoneal
irritation, including guarding, rebound tenderness and obturator and psoas sign. The
