Flashcards in 12. Epigastric Pain Deck (30)
What are 10 of the differential diagnoses for epigastric pain?
Perforated peptic ulcer
Peptic ulcer disease
Where is the pain in peritonitis?
Epigastrum spreading to whole abdomen
Where is the pain in biliary diseases?
RUQ or epigastric
What does sudden onset epigastric pain suggest?
Perforation of a viscus
How quickly does pain from acute pancreatitis and biliary colic develop?
Maximal intensity over 10-20 min
What does 'sharp, burning' epigastric pain suggest?
What does 'deep'/ 'boring' epigastric pain suggest?
What does pain radiation to shoulder tip suggest?
Irritation of the phrenic nerve due to diaphragmatic involvement e.g. basal pneumonia/ subphrenic abscess
What kind of pain is relieved by sitting forwards?
What other symptoms should should you ask about once you have characterised epigastric pain?
Fever: infection/ widespread inflammation
Changes in stool
Cough (basal pneumonia, GORD)
What 4 drugs may contribute to peptic ulcer disease?
What 4 drugs may contribute to acute pancreatitis?
What score is used to assess the severity and prognosis of pancreatitis?
What are the causes of acute pancreatitis?
I GET SMASHED
Mumps/ HIV/ Coxsackie infection
Hyperlipidaemia/ hypercalcaemia/ hypothermia
Endoscopic retrograde cholangiopancreatography
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
What does pain radiation to the back suggest?
Describe the nature of the pain in biliary colic
Relatively constant (not colicky)
What does worsening of pain with movement suggest?
What does worsening of pain with deep breathing suggest?
What does the triggering of pain by fatty meals suggest?
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
What are patients with a history of gallstone disease prone to?
Recurrence of gallstones
Complications: Acute pancreatitis, acute cholecystitis, ascending cholangitis
What are patients with a history of peptic ulcer disease prone to?
Perforated peptic ulcer
What are patients with a history of GORD prone to?
What are patients with a history of arterial disease prone to?
List 4 causes of jaundice presenting with epigastric pain
Gall-stone + non gallstone induced acute pancreatitis
What causes Cullens or Grey Turners sign?
Acute haemorrhagic pancreatitis
Which diseases cause localised tenderness of the epigastrium?
What causes severe, generalised tenderness, guarding and board like rigidity?