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Self-Assessment Questions


Chronic Abdominal Pain: Review Questions

Douglas G. Adler, MD

Dr. Adler is an assistant professor of medicine and Director of Gastrointestinal Endoscopy, University of Texas-Houston Medical School, Houston, TX.

Choose the single best answer for each question.

1. A 56-year-old man presents for evaluation of long-standing abdominal pain. He reports a 2-year history of epigastric pain with radiation to the back made worse by eating and improved with fasting. His stools are occasionally loose. The patient is a recovered alcoholic who has been abstinent for 7 years. He has lost 10 lb in the last year. Another physician diagnosed him with irritable bowel syndrome (IBS) and recommended a high-fiber diet, which did not help. His examination reveals a thin but otherwise normal-appearing man without focal abnormalities. Which of the following tests would be the most helpful in evaluating this patient?
  1. Computed tomography (CT) scan of the abdomen and pelvis
  2. Colonoscopy
  3. Crohn’s disease
  4. Esophagogastroduodenoscopy (EGD)
  5. 72-Hour fecal fat collection
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Questions 2 and 3 refer to the following case.

A 26-year-old woman presents for a second opinion regarding her abdominal pain. She has a lifelong history of constipation (2 bowel movements per week) and bloating, and she often feels that her bowel movements are incomplete. Her pain is diffuse, typically worsens after eating fatty foods or eating in restaurants, and improves after defecation. Her weight, appetite, and energy level are all stable, and she has a normal sleep pattern. She has never had blood or mucous in her stools. A prior physician performed an EGD, colonoscopy, and small bowel radiography, all of which were normal. Her physical examination is unremarkable.

2. What is this patient’s most likely diagnosis?

  1. Chronic gastritis
  2. Chronic mesenteric ischemia
  3. IBS
  4. Major depression
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3. Which of the following is the best first-line therapy for this patient?

  1. Amitriptyline
  2. Combination acetaminophen/codeine tablets
  3. Hyoscyamine
  4. Psyllium fiber supplementation
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4. A 45-year-old woman with scleroderma presents for evaluation of chronic nausea, vomiting, and abdominal pain. She describes dull, achy midabdominal pain after eating that typically lasts for hours. Symptoms are often relieved by vomiting. She also describes intermittent substernal pain, which is made worse by vomiting, and chronic diarrhea for the past several months of unclear cause. Her physical examination reveals a thin woman with typical scleroderma facies and extremity findings but is otherwise unremarkable. Blood tests reveal a decreased serum albumin level and a macrocytic anemia. Which of the following is the most likely cause of this patient’s mid-abdominal pain?
  1. Bacterial overgrowth
  2. Biliary colic
  3. Gastroesophageal reflux disease (GERD)
  4. Gastroparesis
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5. A 28-year-old woman presents with a 3-month history of chronic right lower abdominal pain. The pain occurs daily without clear precipitants and is associated with bloating that spontaneously resolves. The patient occasionally has fevers that she cannot explain, but they typically resolve without treatment. She has 3 to 4 loose stools per day that contain mucus but not blood. She has lost 10 lb in the last 3 months despite a good oral intake. She also reports occasional eye pain with light sensitivity. On examination, her abdomen is focally tender in the right lower quadrant without peritoneal signs or palpable masses; the remaining examination is unremarkable. What is the most likely underlying diagnosis in this patient?

  1. Chronic appendicitis
  2. Crohn’s disease
  3. IBS
  4. Systemic lupus erythematosus (SLE)
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