Dunphy. Primary care IIB
Chief complaint abd pain ANS: Careful history
HPI (especially)
Pain assessment
Onset, timing
Location
Duration
Characteristics/Associated factors
Visceral pain is dull and poorly localized
Parietal pain is sharp and localized
Colicky pain comes and goes
Burning pain is caused by irritation from gastric contents
Aggravating factors, what makes it worse?
Relieving factors, what makes it better?
Treatment, what med./tx has been tried?
Visceral pain is ANS: dull and poorly localized
Burning pain is caused by ANS: irritation from gastric contents
Parietal pain is ANS: sharp and localized
Colicky pain ANS: comes and goes
Aggravating factors, ANS: what makes it worse?
,Relieving factors, ANS: what makes it better?
Physical Exam GI ANS: Heart and Lungs
Abdominal exam—inspection, auscultation, percussion, palpation
Digital rectal exam
Vaginal exam
Tests
CBC
Liver function tests (LFTs)
Serum chemistries/CMP
Urinalysis
Stool for occult blood
Pregnancy test
what would you think about with sudden severe pain ANS: Appendicitis
Intestinal perforation
Mesenteric infarction
Dissection or rupture of aortic aneurysm
Ectopic pregnancy
Burning pain- thoughts on what it would be? ANS: Gastroesophageal reflux disease (GERD)
Gastritis
Diverticulitis
,What would you think about with constant mild to severe pain ANS: Pancreatitis
Cholecystitis-Cholelithiasis
What would you think about with crampy or colicky pain? ANS: Intestinal obstruction
Inflammatory bowel dz.
Irritable bowel
Salpingitis
Urinary stones
Cholelithiasis
Constipation
Appendicitis is? ANS: the inflammation of the variform appendix caused by an obstruction and/or
infection
Appendicitis is the most common cause of ________ ______ pain requiring surgical intervention? ANS:
acute right lower quadrant abdominal
How many appendectomies are done annually? ANS: 200,000
Appendicitis occurs at any age but is most common between ages ____ and _____ ANS: 10 and 30
Men are ______ as likely to be diagnosed with appendicitis between 10 and 30 years than women, but
this equalizes over the life span. ANS: twice
_________ will affect 10 in 100,000 people in the United States, with a lifetime risk for individuals
projected at 7%-10%. ANS: Appendicitis
, Appendicitis is more common in ________countries. ANS: Western
Appendicitis is more common in diets that are_____ ? ANS: low in fiber, high in fat, and high in refined
sugars and other carbohydrates
__________ of the appendix by a variety of pathological processes is the cause of the majority of
appendicitis ANS: Obstruction
Appendicitis is ______ of the appendix, followed by obstruction and subsequent bacterial infection
ANS: Dilation
In appendicitis ______, is obstructed by hardened feces (fecalith), inflammatory processes (including
parasites, viruses, or bacteria), strictures, neoplasms, or foreign bodies (including vegetable or fruit
seeds or barium) ANS: lumen
In appendicitisn ______ continues to secrete fluid, which further distends the lumen, impairing the
venous blood flow and leading to tissue necrosis ANS: Mucosa
Left untreated, in appendicitis _____ ______is impeded
Bacteria continue to proliferate and, in the absence of treatment, perforation of the appendix occurs
ANS: arterial inflow
Subjective complaints of appendicitis ANS: Acute onset of mild to severe colicky, epigastric, or
periumbilical pain
Vague at first, but within 24 hours it localizes over the right lower quadrant
Exacerbated by walking or coughing
In male patients the pain may radiate into the testicles
May be associated with abdominal muscle spasm in male or female patients
Chief complaint abd pain ANS: Careful history
HPI (especially)
Pain assessment
Onset, timing
Location
Duration
Characteristics/Associated factors
Visceral pain is dull and poorly localized
Parietal pain is sharp and localized
Colicky pain comes and goes
Burning pain is caused by irritation from gastric contents
Aggravating factors, what makes it worse?
Relieving factors, what makes it better?
Treatment, what med./tx has been tried?
Visceral pain is ANS: dull and poorly localized
Burning pain is caused by ANS: irritation from gastric contents
Parietal pain is ANS: sharp and localized
Colicky pain ANS: comes and goes
Aggravating factors, ANS: what makes it worse?
,Relieving factors, ANS: what makes it better?
Physical Exam GI ANS: Heart and Lungs
Abdominal exam—inspection, auscultation, percussion, palpation
Digital rectal exam
Vaginal exam
Tests
CBC
Liver function tests (LFTs)
Serum chemistries/CMP
Urinalysis
Stool for occult blood
Pregnancy test
what would you think about with sudden severe pain ANS: Appendicitis
Intestinal perforation
Mesenteric infarction
Dissection or rupture of aortic aneurysm
Ectopic pregnancy
Burning pain- thoughts on what it would be? ANS: Gastroesophageal reflux disease (GERD)
Gastritis
Diverticulitis
,What would you think about with constant mild to severe pain ANS: Pancreatitis
Cholecystitis-Cholelithiasis
What would you think about with crampy or colicky pain? ANS: Intestinal obstruction
Inflammatory bowel dz.
Irritable bowel
Salpingitis
Urinary stones
Cholelithiasis
Constipation
Appendicitis is? ANS: the inflammation of the variform appendix caused by an obstruction and/or
infection
Appendicitis is the most common cause of ________ ______ pain requiring surgical intervention? ANS:
acute right lower quadrant abdominal
How many appendectomies are done annually? ANS: 200,000
Appendicitis occurs at any age but is most common between ages ____ and _____ ANS: 10 and 30
Men are ______ as likely to be diagnosed with appendicitis between 10 and 30 years than women, but
this equalizes over the life span. ANS: twice
_________ will affect 10 in 100,000 people in the United States, with a lifetime risk for individuals
projected at 7%-10%. ANS: Appendicitis
, Appendicitis is more common in ________countries. ANS: Western
Appendicitis is more common in diets that are_____ ? ANS: low in fiber, high in fat, and high in refined
sugars and other carbohydrates
__________ of the appendix by a variety of pathological processes is the cause of the majority of
appendicitis ANS: Obstruction
Appendicitis is ______ of the appendix, followed by obstruction and subsequent bacterial infection
ANS: Dilation
In appendicitis ______, is obstructed by hardened feces (fecalith), inflammatory processes (including
parasites, viruses, or bacteria), strictures, neoplasms, or foreign bodies (including vegetable or fruit
seeds or barium) ANS: lumen
In appendicitisn ______ continues to secrete fluid, which further distends the lumen, impairing the
venous blood flow and leading to tissue necrosis ANS: Mucosa
Left untreated, in appendicitis _____ ______is impeded
Bacteria continue to proliferate and, in the absence of treatment, perforation of the appendix occurs
ANS: arterial inflow
Subjective complaints of appendicitis ANS: Acute onset of mild to severe colicky, epigastric, or
periumbilical pain
Vague at first, but within 24 hours it localizes over the right lower quadrant
Exacerbated by walking or coughing
In male patients the pain may radiate into the testicles
May be associated with abdominal muscle spasm in male or female patients
