Abdominal pain: Clinical

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Abdominal pain: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 27-year-old man presents to his primary care doctor’s office after he felt a right testicular mass a week ago. He notes he has had a dull, intermittent ache in his groin for the past 2 months, which has had attributed to strenuous exercises as a personal trainer. His past medical history is significant for surgical correction of right-sided cryptorchidism at the age of 1. On physical examination, the patient’s right testicle is non-tender, but a firm and fixed mass is palpated. Transillumination is negative. An ultrasound of the right testicle demonstrates a heterogenous mass. Which of the following is the most appropriate next step?


Abdominal pain is a very common complaint, and the differential diagnosis is wide, ranging from benign to life-threatening conditions. Life-threatening conditions include a ruptured abdominal aortic aneurysm, mesenteric ischemia, perforation anywhere along the gastrointestinal tract, acute bowel obstruction, acute pancreatitis, peritonitis, ectopic pregnancy, ovarian torsion, and myocardial infarction.

There are three main types of abdominal pain: visceral, parietal, and referred pain. Visceral pain happens when the nerves that run through the walls of an organ get stretched. The pain isn't usually well localized and feels like a dull ache or cramp. Hollow organs cause an intermittent colicky type of pain, whereas solid organs cause a more constant pain.

Sometimes, as a disease evolves, visceral pain can become parietal pain, which is also called somatic pain. That’s the pain that results from irritation to the parietal peritoneal wall. Parietal pain is sharp and can be localized by pointing to a specific spot. Finally, there’s referred pain which is when the brain mistakenly identifies pain as coming from one region like the shoulder when it’s actually coming from a different region like the diaphragm.

Abdominal pain can often be separated into the abdominal area that’s involved. Foregut organs - so the stomach, duodenum, pancreas, and biliary tract - cause epigastric pain. Epigastric pain that’s associated with bloating, abdominal fullness, heartburn, or nausea is called dyspepsia, and it’s generally due to gastroesophageal reflux disease, gastritis, pancreatitis, or peptic ulcer disease - meaning an ulcer of the stomach or duodenum.


Abdominal pain is any pain or discomfort that occurs in the abdomen. There are many possible causes of abdominal pain, and it can be difficult to pinpoint the exact cause without a thorough evaluation. Common causes of abdominal pain include constipation, gas, heartburn, food poisoning, gastritis, and viral gastroenteritis. More serious causes of abdominal pain include appendicitis, pancreatitis, cholecystitis and cholelithiasis, renal stones, and pelvic inflammatory disease.


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