PANCE - Abdominal Pain

Here are key facts for PANCE 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 Ulcers: Caused by H. pylori infection, drugs, stress, and, in the case of gastritis, autoimmune dysfunction. 3. GI 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. Irritable Bowel Syndrome: The most common functional bowel disorder, characterized by disordered brain-gut interactions. 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 – anything that causes inflammation and swelling of the uterus or ovaries.

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1. Esophagitis: Treatments include proton pump inhibitors to reduce acid production by the stomach. 2. Gastritis and Ulcers: Treatments include proton pump inhibitors, antacids, H2 blockers, and prostaglandins. Inflammation can travel up and down the esophagus to and from the stomach. 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. In ulcerative colitis, the diarrhea is frequently bloody. Anti-inflammatories and immune suppressors are often prescribed. 5. Functional Bowel Disorders: Etiologies are uncertain, but are thought to include infection and/or psychosocial causes. 1. 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. 2. Abdominal Quadrants: Understanding quadrant-based diagnosis is essential for correctly identifying the source of abdominal pain. 3. Small Bowel Obstruction: Adhesions bind and restrict the intestinal tract, which obscures movement of materials, especially after abdominal surgery. 4. Diverticulitis: Characterized by purulent inflammation in the diverticula. 5. Crohn's Disease: Histopathology often shows granulomas, distinguishing it from other inflammatory conditions.

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1. History Taking: Key questions to differentiate emergent from non-emergent abdominal pain. 2. Physical Examination: Special maneuvers and techniques specific to abdominal assessment. 3. Diagnostic Algorithms: Evidence-based approaches to workup by predominant symptom. 4. Procedural Considerations: Indications for diagnostic and therapeutic procedures. 5. Imaging Selection: Cost-effective and appropriate use of imaging modalities. 1. Medication Selection: First-line treatments based on diagnosis and severity. 2. Pain Management: Appropriate analgesic selection without masking physical findings. 3. Antimicrobial Therapy: Empiric coverage for common intra-abdominal infections. 4. Preventive Medications: Prophylactic approaches for recurrent conditions. 5. Chronic Management: Long-term medication strategies for inflammatory conditions. 1. Follow-up Protocols: Appropriate timing and testing for post-acute monitoring. 2. Specialist Referral: When to refer to gastroenterology, surgery, or other specialties. 3. Patient Education: Lifestyle modifications and dietary recommendations. 4. Red Flags: Critical findings requiring immediate escalation of care. 5. Special Populations: Modifications for pediatric, geriatric, and pregnant patients.