Chapter 109: Abdominal Pain and Infections Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. An adult patient reports intermittent, crampy abdominal pain with vomiting. The provider notes marked abdominal distention and hyperactive bowel sounds. What will the provider do initially?

a. Admit the patient to the hospital for consultation with a surgeon b. Obtain upright and supine radiologic views of the abdomen c. Prescribe an antiemetic and recommend a clear liquid diet for 24 hours d. Schedule the patient for a barium swallow and enema

ANS: B a. Order a CBC, type and crossmatch, electrolytes, and renal function tests. b. Perform an ultrasound examination to evaluate the cause. c. Schedule the patient for an aortic angiogram. d. Transfer the patient to the emergency department for a surgical consult.

If available, the primary care provider can order radiographic studies of the abdomen and chest. Once small bowel obstruction is confirmed or suspected, immediate hospitalization with surgeon referral is necessary. Because small bowel obstruction can have potentially serious or life-threatening consequences, waiting 24 hours is not recommended.

2. A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. What is the initial action?

ANS: D

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This patient has symptoms and physical findings consistent with a ruptured aortic aneurysm and should have an immediate surgical consult. Ordering other tests is not necessary by the primary provider.

Multiple Response

1. Which symptoms noted in a patient reporting abdominal pain are suggestive of appendicitis? (Select all that apply.)

a. Abdominal rigidity along with pain b. Pain accompanied by low-grade fever c. Pain occurring prior to nausea and vomiting d. Pain that begins in the left lower quadrant e. Prolonged duration of right lower quadrant pain

ANS: A, B, C

Patients with appendicitis typically have pain that begins in the epigastric or periumbilical area and migrates to the left lower quadrant. Abdominal rigidity is common, as is low-grade fever. Pain precedes other symptoms and when the symptoms occur in any other order, the diagnosis of appendicitis should be questioned. Pain is usually of short duration.