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Questions and Answers
Which of the following conditions is NOT associated with pain arising from spinal nerves or roots?
Which factor may relieve severe muscle spasms associated with spinal nerve or root pain?
What type of pain varies considerably in type and location according to the text?
Which symptom is rare in the context of irritable bowel syndrome (IBS) according to the text?
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What brings on episodes of abdominal pain related to irritable bowel syndrome (IBS) according to the text?
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What is NOT clearly established regarding the mechanisms of disease in abdominal pain arising from spinal nerves or roots?
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What is a characteristic of referred pain from the spine?
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What is a characteristic of pain referred to the abdomen from the testes or seminal vesicles?
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Which of the following mechanisms can contribute to abdominal pain of metabolic origin?
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What is a feature that porphyria and lead poisoning share?
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Which condition is often associated with episodes of severe abdominal pain?
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What is the hallmark of familial Mediterranean fever?
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What is the most important consideration in determining the differential diagnosis of abdominal pain?
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Why should narcotics or analgesics not be withheld until a definitive diagnosis or plan has been formulated?
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What is the importance of obtaining an accurate menstrual history in a female patient?
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How can the normal anatomic relationships be altered during pregnancy?
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What is the importance of a gentle and thorough physical examination in a patient with suspected peritoneal inflammation?
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Study Notes
Abdominal Pain Originating from Spinal Nerves or Roots
- Pain is sudden, lancinating, and may be caused by herpes zoster, impingement by arthritis, tumors, a herniated nucleus pulposus, diabetes, or syphilis
- Pain is not related to food intake, abdominal distention, or changes in respiration
- Severe muscle spasms may be relieved by, but are not accentuated by, abdominal palpation
- Pain is worsened by movement of the spine and is usually confined to a few dermatomes
- Hyperesthesia is very common
Irritable Bowel Syndrome (IBS)
- A functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits
- Diagnosis is made on the basis of clinical criteria and after exclusion of demonstrable structural abnormalities
- Episodes of abdominal pain may be brought on by stress, and the pain varies considerably in type and location
- Nausea and vomiting are rare, localized tenderness and muscle spasm are inconsistent or absent
Approach to Abdominal Pain
- Few abdominal conditions require urgent operative intervention
- Referred pain from the spine is characteristically intensified by certain motions and is associated with hyperesthesia over the involved dermatomes
- Pain referred to the abdomen from the testes or seminal vesicles is generally accentuated by the slightest pressure on either of these organs
Mechanisms of Abdominal Pain
- Affecting the vascular system (advance atherosclerosis)
- Affecting autonomic nerves (intestinal motility)
- Hyper viscosity (hyperglycemia - impedes splanchnic circulation)
Metabolic Abdominal Crises
- Pain of metabolic origin may simulate almost any other type of intraabdominal disease
- Several mechanisms may be at work, such as hyperlipidemia, C1 esterase deficiency, and familial Mediterranean fever
- Abdominal pain is the hallmark of familial Mediterranean fever
Diagnostic Approach
- The location of the pain can assist in narrowing the differential diagnosis
- The chronological sequence of events in the patient's history is often more important than the pain's location
- Careful attention should be paid to the extraabdominal regions
- Narcotics or analgesics should not be withheld until a definitive diagnosis or a definitive plan has been formulated
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Description
This quiz focuses on the importance of considering the chronological sequence of events in a patient's history over the actual location of abdominal pain for differential diagnosis. It emphasizes not withholding narcotics or analgesics until a definitive plan is formulated to provide adequate pain relief.
