Term
| Patient comes in with RUQ pain, accompanied by a fever. Work-up shows elevated WBCs, phosphatase and bilirubin. What's the most likely diagnosis? What procedure would you use to confirm? What would the diagnosis be if there was no fever/leukocytosis? |
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Definition
- Cholecystitis
- Ultrasound
- Biliary colic
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Term
| How do you assess for ascites? |
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Definition
General signs will be protuberant abdoman with bulging flanks. Since ascites is fluid filled sacs, there will be discrete areas of tympany and dullness
- Shifting dullness - map borders of tympany and dullness, then turn patient. In ascites, pattern will shift.
- Test for fluid wave - have patient place hand firmly in midline and tap one side, while feeling the other. If fluid-filled ascites is present, the tap will travel through the liquid to the other side.
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Term
[image]
Identify. What does this indicate? |
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Definition
- Caput medusae.
- Liver cirrhosis (portal hypertension)
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Term
[image]
Identify. What does it indicate? |
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Definition
- Palmar erythema
- Cirrhosis
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Term
| What are the physical signs of liver failure / cirrhosis? |
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Definition
- Increased Hepar
- Portal Hypertension-Ascites, Caput medusae, Splenomegaly, Varices
- Gynecomastia
- Spider angiomata
- Palmer erythema
- Jaundice
- Testicular atrophy
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Term
| Patient presents with midepigastrium pain. Upon admission, the pain begins migrating to the RLQ. As this happens, a fever develops, accompanied by leukocytosis. What is the most likely diagnosis? |
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Definition
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Term
| What are the major sites of referred pain? |
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Definition
- Diaphragm --> Neck
- Spleen --> Left shoulder
- Pancreas --> Back
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Term
| How do you distinguish colic/visceral pain from peritonitis/somatic pain? |
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Definition
| Colic pain is from distension; the patient will move around. Peritonitis is irritation; patient will attempt to lie down to ameliorate it. |
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Term
| Patient presents with RUQ fullness or discomfort. What's on your differential list? |
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Definition
| Early hepatitis, biliary tract disease, hepatomegaly. |
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Term
Patient comes in with mid-abdominal pain. What's on your differential?
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Definition
| Early appendicitis, ulcer, cancer |
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Term
| Patient comes in with lower abdominal pain. What do you put on your differential? |
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Definition
| Diverticular, cancer, uterine, ovarian complications |
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Term
| What are the major causes of acute diarrhea? What is the characteristic of their stool? Associated symtpoms? Timing? |
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Definition
- Secretory infections (i.e. viral, bacterial, etc.). Stool is watery without blood, pus or mucus. Commonly presents in travellers or those eating from common food source (e.g. restaurant), alongside nausea, vomiting, perumbilical cramping
- Inflammatory infections- (e.g. Salmonella, Shigella, Tersinia, Campylobacter). loos to water bowel, often with blood, pus or mucus. Seen in travelers, presents with rectal urgency, tenesmus, fever.
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Term
| What are the "diarrheal syndromes?" What are the characteristics of the stool? Associated symptoms? |
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Definition
- IBS: Loose stool, may show mucus, but no blood. Alternates with constipation, presents with crampy lower abdominal pain and distension, flatulence (worse in morning). Usually young women.
- Cancer of sigmoid colon- may be blood-streaked. Crampy lower abdominal pain. Typically seen in older adults (55+). May present with thin, pencil-like stool
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Term
| What are some of the causes of jaundice due to increased production of bilirubin? What are some of the causes due to decreased excretion of conjugated bilirubin? |
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Definition
- Hemolytic anemia, Gilbert's syndrome
- Viral hepatitis, cirrhosis, primary biliary cirrhosis, drug-induced cholestasis
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Term
| What are some of the symtpoms of jaundice? |
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Definition
- Sceral icterus
- Gray / light colored stool, sometimes alcholic
- Itching of skin
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Term
| Patient presents with acute abdominal pain. Upon inspection, their abdomen is rigid and the patient insists that you do not press down. You gently listen to the bowel with your stethoscope, slowly pushing down as you proceed. Upon removal of the stethoscope, the patient jumps up, in pain. What is the most likely diagnosis? What was most likely heard? |
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Definition
| Peritonitis; no bowel sounds (can be diffuse or localized) |
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Term
| Patient comes in with LLQ pain. They have mild fever and leukocytosis. What's the most likely diagnosis? What test would be the most definitive? What is a major concern? |
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Definition
- Diverticulitis
- CT
- Perforation/abcess or free perforation
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Term
| Patient comes in with boring epigastric pain that refers to the back. Social history is significant for alcholism. Labs come back with elevated amylase/lipase. What is the most likely diagnosis? |
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Definition
| Pancreatitis (evaluate with CT) |
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Term
| Patient comes in complaining of nausea and vomiting, with symptomatic relief after vomiting. KUB shows dilated loops with an air fluid level. Past medical history is significant for abdominal surgery. What is the most likely diagnosis? What might this disease progress into? What should you check for? |
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Definition
- Bowel obstruction (due to adhesion)
- Bowel ischemia
- Hernia
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Term
What can cause pain that...
- Awakens patient when they're asleep?
- Is acute?
- Moves from chest to abdomen?
- Is burning? Tear? Gripping? Dull/aching?
- Crampy/constricting?
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Definition
- Acute perforation, inflammation, torsion of organ, stone in biliary/renal stones
- Ectopic pregnancy, perforation of gastric ulcer, peritonitis, acute pancreatitis
- Aortic aneurysm
- Perforated gastric ulcer; dissecting aneurysm; intestinal obstruction; pyelonephritis
- Biliary or renal colic
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Term
What disease symptom is likely to be relieved by...
- Belching?
- Eating?
- Vomiting?
- Leaning forward?
- Flexing knees?
- Flexing right thigh?
- Flexing left thigh?
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Definition
- Gastric distension
- Peptic ulcer
- Pyloric obstruction
- Pancreatic cancer/pancreatitis
- Peritonitis
- Appendicitis
- Diverticulitis
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Term
| What does generalized itching suggest? Intense pruritis? Itching of anal skin? |
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Definition
- Diffuse skin disorder, renal/hepatic disease
- Malignancies of gastrointestinal tract
- Fistulas, fissure, psoriasis, parasites, poor hygeine, diabetes
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Term
| What are some of the characteristics of gastric peptic ulcers? How does it differ from duodenal? |
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Definition
- Pain occurs 1/2 hour to hour after eating.
- In duodenal ulcers, pain occurs 2-3 hours after eating, and food lessens pain. Also, nocturnal pain is present, with backache if perforation occurs.
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