Manny, a 32-year-old medical student comes to your office, complaining of severe abdominal pain

radiating to his back. He states it began last night after hours of heavy drinking. He has had

abdominal pain and vomiting in the past after drinking but never as bad as this. He cannot keep

any food or water down, and these symptoms have been going on for almost 12 hours. He has

had no recent illnesses or injuries. His past medical history is unremarkable. He denies smoking

or using illegal drugs but admits to drinking 6 to 10 beers per weekend night. He admits that last

night he drank something like 14 drinks. On examination you find a young male appearing his

stated age in some distress. He is leaning over on the examination table and holding his abdomen

with his arms. His blood pressure is 90/60 and his pulse is 120. He is afebrile. His abdominal

examination reveals normal bowel sounds, but he is very tender in the left upper quadrant and

epigastric area. He has no Murphy's sign or tenderness in the right lower quadrant. The

remainder of his abdominal examination is normal. His rectal, prostate, penile, and testicular

examinations are normal. He has no inguinal hernias or tenderness with that examination. Blood

work is pending. What etiology of abdominal pain is most likely causing his symptoms?

Bong-bong, a 73-year-old retired lawyer comes to your office complaining of abdominal pain,

constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or

diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with

his grandson, 3 days before his symptoms began. He denies any other recent illnesses. His past

medical history is significant for coronary artery disease and high blood pressure. He has been

married for over 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon

cancer and his father had a stroke. On examination he appears his stated age and is in no acute

distress. His temperature is 38.2 degrees C and his other vital signs are unremarkable. His head,

cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over

the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable

and his fecal occult blood test is negative. His prostate is slightly enlarged but his testicular,

penile, and inguinal examinations are all normal. Blood work is pending.

What diagnosis for abdominal pain best describes his symptoms and signs?

Leody, a 80-year-old retired mechanic comes to your clinic for a physical examination at his wife's

request. He has recently been losing weight and has felt very fatigued. He has had no chest pain,

shortness of breath, nausea, vomiting, or fever. His past medical history includes colon cancer,

for which he had surgery, and arthritis. He has been married for over 45 years. He denies any

tobacco or drug use and has not drunk alcohol in over 40 years. His parents both died of cancer

in their 70s. On examination his vital signs are normal. His head, cardiac, and pulmonary

examinations are unremarkable. On abdominal examination you hear normal bowel sounds, but

when you palpate his liver it is abnormal. His rectal examination is positive for occult blood.

What further abnormality of the liver was likely found on examination?

Norberto, a 28-year-old manager of Jollibee comes to your clinic, complaining of severe right-sided

abdominal pain for 12 hours. He began having a stomachache yesterday, with a decreased

appetite, but today the pain seems to be just on the lower right side. He has had some nausea and

vomiting but no constipation or diarrhea. His last bowel movement was last night and was

normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical

history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six

beers per week. His mother has breast cancer and his father has coronary artery disease. On

examination he appears ill and is lying on his right side. His temperature is 38C and his heart

rate is 115. His bowel sounds are decreased and he has rebound and involuntary guarding, one

third of the way between the anterior superior iliac spine and the umbilicus in the right lower

quadrant. His rectal, inguinal, prostate, penile, and testicular examinations are normal.

What is the most likely cause of his pain?

Isko, a 50-year-old man, presents with pain in his epigastrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered?

Panfilo is a 62-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?

Jose, a daycare worker presents to your office with jaundice. He denies IV drug use, blood transfusion, and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely?

Faisal is a 64-year-old man who was told by another care provider that his liver is enlarged. Although he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease. Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the following would you do next?

Which is the proper sequence of examination for the abdomen?