ABIM - Abdominal Pain

Here are key facts for ABIM from the Abdominal Pain tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.

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1. Esophagitis: Inflammation of the esophagus is most often caused by acid reflux, medications, and eosinophilic esophagitis. 2. Gastritis and Peptic Ulcer Disease: Caused by H. pylori infection, drugs, stress, and, in the case of gastritis, autoimmune dysfunction. 3. Intestinal Obstruction: Caused by hernias, adhesions, volvulus, tumors, inflammatory narrowing, foreign bodies, and fecal impaction. 4. Diverticulitis: Inflammation (often with bacterial infection) in diverticula, which are pouch-like outcroppings of the intestinal wall. 5. Intestinal Ischemia: Result of systemic hypotension, atherosclerosis, blood clots, and constricting fibrosis or strictures that inhibit blood flow. 6. Inflammatory Bowel Disease: Comprises the chronic/remitting autoimmune disorders Crohn's disease and ulcerative colitis. 7. Functional Bowel Disorders: Characterized by disordered brain-gut interactions, most commonly Irritable bowel syndrome, with patients experiencing constipation and diarrhea with abdominal pain. 1. Pancreatitis: Result of bile duct stones, alcohol abuse, and/or cigarette smoking. Causes epigastric pain that radiates towards the back. 2. Gallstone Disease: Causes pain in the right upper abdominal quadrant as gallstones get stuck in the biliary system. 3. Appendicitis: Often presents early on with pain in the peri-navel area that later moves to the right lower abdominal quadrant. 4. Kidney Stones: Cause "flank" pain – pain in the side of the torso; pain can travel to the groin area. 5. Gynecological Causes: Include ruptured ovarian cysts, pelvic inflammatory disease, ectopic pregnancy, and endometriosis.

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1. Esophagitis: Treatments include proton pump inhibitors to reduce acid production by the stomach. 2. Gastritis and Peptic Ulcers: Inflammation can travel up and down the esophagus to and from the stomach. Treatments include proton pump inhibitors, antacids, H2 blockers, and prostaglandins. 3. Intestinal Ischemia: More common in the intestines than in the stomach or esophagus. Surgery and/or medications to restore blood flow are prescribed. 4. Inflammatory Bowel Disease: Patients often experience diarrhea in addition to abdominal cramping and other symptoms. In ulcerative colitis, the diarrhea is frequently bloody. Anti-inflammatories and immune suppressors are often prescribed. 5. Pancreatitis: Early/acute pancreatitis is characterized by elevated serum amylase and lipase levels. Late/chronic pancreatitis can result in loss of endocrine and exocrine functions (i.e., patients have diabetes mellitus). 1. Abdominal Quadrants: Understanding the relationship between pain location and underlying organ systems helps narrow the differential diagnosis. 2. Diverticulitis: Presents with purulent inflammation visible on pathology. 3. Crohn's Disease: Histopathology shows granulomas, a key diagnostic finding. 4. Small Bowel Obstruction: After abdominal surgery, adhesions bind and restrict the intestinal tract, which obscures movement of materials. 5. Functional Bowel Disorders: Etiologies are uncertain, but are thought to include infection and/or psychosocial causes.

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Below is information not explicitly contained within the tutorial but important for ABIM. 1. Algorithmic Workup: Systematic approach to abdominal pain based on location, quality, and associated symptoms. 2. Cost-Effective Testing: Appropriate use of laboratory tests and imaging studies. 3. Risk Stratification: Identifying high-risk features requiring urgent intervention. 4. Special Populations: Approach to elderly, immunocompromised, and post-surgical patients. 5. Emerging Biomarkers: New laboratory tests that may improve diagnostic accuracy. 1. Medical Therapy: Current guidelines for management of common conditions. 2. Antimicrobial Stewardship: Appropriate selection of antibiotics for intra-abdominal infections. 3. Endoscopic Interventions: Indications and limitations of therapeutic endoscopy. 4. Management of Complications: Strategies for addressing adverse outcomes. 5. Multidisciplinary Approach: Coordination between specialties for complex cases. 1. Prevention Strategies: Evidence-based approaches to reducing recurrence. 2. Chronic Disease Management: Long-term care for inflammatory bowel disease and functional disorders. 3. Quality Improvement: Metrics for assessing care delivery in abdominal conditions. 4. Patient-Centered Outcomes: Functional status and quality of life considerations. 5. Emerging Therapies: Novel approaches entering clinical practice.