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Flashcards in 12. Epigastric Pain Deck (30)
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1

What are 10 of the differential diagnoses for epigastric pain?

Acute pancreatitis
Perforated peptic ulcer
Gastritis/ duodenitis
Peptic ulcer disease
Biliary colic
Acute cholecystitis
Ascending cholangitis
MI
Ruptured AAA
Mesenteric ischaemia

2

Where is the pain in peritonitis?

Epigastrum spreading to whole abdomen

3

Where is the pain in biliary diseases?

RUQ or epigastric

4

What does sudden onset epigastric pain suggest?

Perforation of a viscus
MI

5

How quickly does pain from acute pancreatitis and biliary colic develop?

Maximal intensity over 10-20 min

6

What does 'sharp, burning' epigastric pain suggest?

Peptic ulcers
Gastritis
Duodenitis

7

What does 'deep'/ 'boring' epigastric pain suggest?

Pancreatitis

8

What does pain radiation to shoulder tip suggest?

Irritation of the phrenic nerve due to diaphragmatic involvement e.g. basal pneumonia/ subphrenic abscess

9

What kind of pain is relieved by sitting forwards?

Acute pancreatitis

10

What other symptoms should should you ask about once you have characterised epigastric pain?

Nausea/ vomiting
Fever: infection/ widespread inflammation
Dyspepsia
Changes in stool
Cough (basal pneumonia, GORD)

11

What 4 drugs may contribute to peptic ulcer disease?

NSAIDs
Steroids
Bisphosphonates (alendronate)
Salicylates (aspirin)

12

What 4 drugs may contribute to acute pancreatitis?

Sodium valproate
Steroids
Thiazides
Azathioprine

13

What score is used to assess the severity and prognosis of pancreatitis?

Glasgow score

14

What are the causes of acute pancreatitis?

I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps/ HIV/ Coxsackie infection
AI
Scorpion bites
Hyperlipidaemia/ hypercalcaemia/ hypothermia
Endoscopic retrograde cholangiopancreatography
Drugs

15

What is an easy way to remember the order of an abdo exam?

LSB, Shifting D, LSK, Triple A

For Percussion + palpation-
Percussion: Liver, Spleen, Bladder (LSB) then percuss for shifting dullness
Palpation: Liver, spleen, kidneys, abdominal aorta

16

What does pain radiation to the back suggest?

Pancreatitis
Leaking AAA
Peptic ulcers

17

Describe the nature of the pain in biliary colic

Relatively constant (not colicky)

18

What does worsening of pain with movement suggest?

Intraabdominal origin
Peritonitis

19

What does worsening of pain with deep breathing suggest?

Basal pneumonia
PE
Pneumothorax
Pericarditis

20

What does the triggering of pain by fatty meals suggest?

Biliary colic

21

What is indicated by pale stool? What is indicated by foul smelling, floating stools?

Pale: Bile not reaching bowel
Foul: Poor digestion of fat- due to pancreatic exocrine insufficiency/ chronic biliary obstruction

22

What are patients with a history of gallstone disease prone to?

Recurrence of gallstones
Complications: Acute pancreatitis, acute cholecystitis, ascending cholangitis

23

What are patients with a history of peptic ulcer disease prone to?

Perforated peptic ulcer

24

What are patients with a history of GORD prone to?

Recurrence

25

What are patients with a history of arterial disease prone to?

MI
Mesenteric ischaemia

26

List 4 causes of jaundice presenting with epigastric pain

Ascending cholangitis
Gall-stone + non gallstone induced acute pancreatitis
Acute hepatitis

27

What causes Cullens or Grey Turners sign?

Acute haemorrhagic pancreatitis

28

Which diseases cause localised tenderness of the epigastrium?

Acute cholecystitis
Mild pancreatitis

29

What causes severe, generalised tenderness, guarding and board like rigidity?

Peritonitis

30

What are the components of the Glasgow scale?

PANCREAS
Pa O2 <8 kPa
Age >55y
Neutrophilia >15 x 10^9
Calcium < 2 mM
Renal function: urea > 16mM
Enzymes: LDH >600 or AST > 200
Albumin < 32
Sugar >10 mM