Classic Symptom of Ischemic Colitis

[MudPhud20XX]

FA says it's "pain out of proportion to exam." Can anyone explain what this means? Also, what is the significance of this symptom?
Thank you.

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[bulldogmed]

It sounds pretty self-explanatory to me. If someone comes in with fevers, chills, n/v, and they complain of RLQ pain with guarding and rebound tenderness, then they probably have appendicitis. They pain would be in proportion to the exam. If someone comes in without all those symptoms and just complains of guarding and rebound tenderness (I don't know if ischemic colitis presents this way, but just for purposes of explanation) then that would be "pain out of proportion to exam." Basically, if they have abdominal pain, but no other causes can be found on PE, IC should be on your DDx.

 

[Apoplexy__]

Most importantly, the pain comes after eating, and is so bad that it makes them not want to eat. In fact, they're so afraid to eat that they can present with weight loss.

Recent weight loss + unbearable localized pain to LLQ after meals + bloody stools = Ischemic colitis.

 

[bulldogmed]

Duodenal ulcers can present w/ pain after meals leading to weight loss, so you can't jump immediately to IC from that symptom alone.

 

[HatWobble]

Gastric ulcers can present w/ pain after meals leading to weight loss, so you can't jump immediately to IC from that symptom alone.

FTFY

 

[bulldogmed]

FTFY

Is that right? Thanks. I get stuff like that mixed up sometimes. Like bacitracin-sensitive vs. bacitracin-resistant.