Acute abdominal pain so severe that the patient seeks medical attention (Note: Not the same as a “surgical abdomen,” because most cases of acute abdominal pain do not require surgical treatment)

• Rebound tenderness
• Motion pain
• Voluntary guarding
• Involuntary guarding
• Colic
• What conditions can mask abdominal pain?
• What is the most common cause of acute abdominal surgery in the United States?
• What should the acute abdomen physical exam include?
• What should go first, auscultation or palpation?
• What is the best way to have a patient localize abdominal pain?
• What is the classic position of a patient with peritonitis?
• What is the classic position of a patient with a kidney stone?
• What is the best way to examine a scared child or histrionic adult's abdomen?
• What lab tests are used to evaluate the patient with an acute abdomen?

What is a “left shift” on CBC differential?

Sign of inflammatory response:

• Immature neutrophils (bands)
• Note: Many call >80% of WBCs as neutrophils a “left shift”
• What lab test should every woman of childbearing age with an acute abdomen receive?
• Which x-rays are used to evaluate the patient with an acute abdomen?
• How is free air ruled out if the patient cannot stand?
• What diagnosis must be considered in every patient with an acute abdomen?

• What are the differential diagnoses by quadrant?

• RUQ
• LUQ
• LLQ
• RLQ
• What is the differential diagnosis of epigastric pain?
• What are nonsurgical causes of abdominal pain?
• What is the unique differential diagnosis for the patient with AIDS and abdominal pain?
• What causes pain limited to specific dermatomes?
• What is referred pain?

• Name the classic locations of referred pain:

• Cholecystitis
• Appendicitis
• Diaphragmatic irritation (from spleen, perforated ulcer, or abscess)
• Pancreatitis/cancer
• Rectal disease
• Nephrolithiasis
• Rectal pain
• Small bowel
• Uterine pain

• Give the classic diagnosis for the following cases:

• Hypotension and pulsatile abdominal mass
• Fever, LLQ pain, and change in bowel habits

• “Abdominal pain out of proportion to exam”

  Rule out mesenteric ischemia

• Classically, what two endocrine problems can cause abdominal pain?
Rapid-Fire Review

• Name the most likely diagnosis:

• 22-year-old female with acute onset of lower abdominal pain, hypotension, tachycardia, adnexal mass, and free fluid on vaginal ultrasound
• 21-year-old female with fever, leukocytosis, lower abdominal pain, + chandelier sign
• 54-year-old male smoker with c/o right-sided abdominal pain, hematuria, and a mass in the right side of his abdomen
• 67-year-old male with hypotension, abdominal pain, and an abdominal mass that pulsates
• 67-year-old female smoker with a history of 25-lb weight loss over 3 months due to abdominal pain after eating; nontender abdomen on exam

• Abdominal pain “out of proportion to exam”

  Mesenteric ischemia