USMLE/COMLEX 3 - Abdominal Pain

Here are key facts for USMLE Step 3 & COMLEX-USA Level 3 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: Esophagitis can cause upper abdominal pain; inflammation of the esophagus is most often caused by acid reflux, medications, and eosinophilic esophagitis. 2. Gastritis and Peptic Ulcer Disease: Gastritis and stomach ulcers are caused by H. pylori infection, drugs, stress, and, in the case of gastritis, autoimmune dysfunction. 3. Intestinal Obstruction: GI strictures and obstruction are caused by hernias, adhesions, volvulus, tumors, inflammatory narrowing, foreign bodies, and fecal impaction. 4. Diverticulitis: Diverticulitis occurs when there is inflammation (often with bacterial infection) in diverticula, which are pouch-like outcroppings of the intestinal wall. 5. Intestinal Ischemia: Intestinal ischemia can be the result of systemic hypotension, atherosclerosis, blood clots, and constricting fibrosis or strictures that inhibit blood flow. 6. Inflammatory Bowel Disease: Inflammatory bowel disease comprises the chronic/remitting autoimmune disorders Crohn's disease and ulcerative colitis. 1. Esophagitis Treatment: Treatments include proton pump inhibitors to reduce acid production by the stomach. 2. Gastritis Management: Treatments include proton pump inhibitors, antacids, H2 blockers, and prostaglandins. 3. Ischemia Intervention: Surgery and/or medications to restore blood flow are prescribed. 4. IBD Therapy: Anti-inflammatories and immune suppressors are often prescribed. 1. Pancreatitis: Pancreatitis causes epigastric pain that radiates towards the back. 2. Gallstone Disease: Gallstone disease causes pain in the right upper abdominal quadrant; we can remember this, because the gallstones get stuck in the biliary system, which is towards the right side of the abdomen. 3. Appendicitis: Appendicitis often presents early on with pain in the peri-navel area that later moves to the right lower abdominal quadrant (where we find the appendix). 4. Kidney Stones: Kidney stones cause "flank" pain – pain in the side of the torso; pain can travel to the groin area, too. 5. Gynecological Causes: Gynecological causes include: ruptured ovarian cysts, pelvic inflammatory disease, ectopic pregnancy, and endometriosis – essentially, anything that causes inflammation and swelling of the uterus or ovaries can cause lower abdominal and back pain.

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1. Pancreatitis Markers: 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, etc.). 2. Inflammatory Bowel Disease Symptoms: Patients often experience diarrhea in addition to abdominal cramping and other symptoms. In ulcerative colitis, the diarrhea is frequently bloody. 3. Appendicitis Clinical Course: Appendicitis often presents early on with pain in the peri-navel area that later moves to the right lower abdominal quadrant (where we find the appendix). 4. Functional Bowel Disorders: Functional bowel disorders (FBDs) are characterized by disordered brain-gut interactions. The most common FBD is Irritable bowel syndrome, and patients experience constipation and diarrhea with abdominal pain. 1. Obstruction Management: GI strictures and obstruction are caused by hernias, adhesions, volvulus, tumors, inflammatory narrowing, foreign bodies, and fecal impaction. 2. Diverticulitis Treatment: Diverticulitis occurs when there is inflammation (often with bacterial infection) in diverticula, which are pouch-like outcroppings of the intestinal wall. 3. Ischemia Approach: Intestinal ischemia can be the result of systemic hypotension, atherosclerosis, blood clots, and constricting fibrosis or strictures that inhibit blood flow. Surgery and/or medications to restore blood flow are prescribed. 4. Abdominal Assessment: Abdominal quadrants - Understanding the anatomical locations helps in differential diagnosis and treatment planning.

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1. Acute Management Algorithms: Evidence-based protocols for common acute abdominal emergencies. 2. Antibiotic Selection: Specific regimens based on suspected source of infection and local resistance patterns. 3. Procedural Competencies: Paracentesis technique, nasogastric tube placement, and interpretation of findings. 4. Risk Stratification Tools: Validated scoring systems for severity assessment of pancreatitis, appendicitis, and diverticulitis. 5. Fluid Resuscitation Strategies: Type, rate, and monitoring parameters for patients with acute abdominal pain. 1. Abdominal Compartment Syndrome: Recognition, monitoring, and management. 2. Sepsis Secondary to Abdominal Source: Early identification and goal-directed therapy. 3. Post-operative Complications: Managing ileus, anastomotic leak, and wound infections. 4. Nutritional Support: Timing and route of nutrition in acute abdominal conditions. 5. Multidisciplinary Approach: Coordination between emergency medicine, surgery, gastroenterology, and critical care. 1. Follow-up Protocols: Evidence-based schedules for monitoring recovery. 2. Chronic Pain Management: Multimodal approaches for functional disorders and chronic pancreatitis. 3. Prevention Strategies: Dietary modifications, lifestyle changes, and prophylactic medications. 4. Patient Education: Self-management tools and recognition of warning signs requiring urgent attention. 5. Quality Measures: Performance indicators for care of patients with common abdominal conditions.