Gastro Medicicne - Acute abdominal pain: a very basic introduction

Question 1

What is one of the most common ways to think about the potential causes of abdominal pain pain?

Answer 1

Question 2

Another way of classifying the causes of an acute abdomen, or any condition, is by using a surgical sieve?

Infective:

Answer 2

Infective:

• gastroenteritis
• appendicitis
• diverticulitis
• pyelonephritis
• cholecystitis
• cholangitis
• pelvic inflammatory disease
• hepatitis
• pneumonia

Question 3

Another way of classifying the causes of an acute abdomen, or any condition, is by using a surgical sieve?

Inflammatory:

Answer 3

Inflammatory:

• pancreatitis
• peptic ulcer disease

Question 4

Another way of classifying the causes of an acute abdomen, or any condition, is by using a surgical sieve?

Vascular:

Answer 4

Vascular:

• ruptured abdominal aortic aneurysm
• mesenteric ischaemia
• myocardial infarction

Question 5

Another way of classifying the causes of an acute abdomen, or any condition, is by using a surgical sieve?

Traumatic:

Metabolic:

Answer 5

Traumatic:

• ruptured spleen
• perforated viscus (e.g. oesophagus, stomach, bowel)

Metabolic:

• renal/ureteric stone
• diabetic ketoacidosis

Question 6

Common causes of organic abdominal pain?

Answer 6

Question 7

Common causes ofHepatobiliary problems?

Answer 7

Question 8

Digestive emergencies?

Answer 8

Question 9

Lower gastrointestinal tract problems?

Answer 9

Question 10

Lower gastrointestinal tract problems?

Answer 10

Appendicitis:

• Right iliac fossa
• Pain initial in the central abdomen before localising to the right iliac fossa (RIF).
• Anorexia is common. Tachycardia, low-grade pyrexia, tenderness in RIF
• Rovsing’s sign: more pain in RIF than LIF when palpating LIF

Acute diverticulitis:

• Left lower quadrant
• Colicky pain typically in the LLQ
• Diarrhoea, sometimes bloody.
• Fever, raised inflammatory markers and white cells

Intestinal obstruction:

• Central
• History of malignancy (intraluminal obstruction)/previous operations (adhesions)
• Vomiting. Not opened bowels recently
• ‘Tinkling’ bowel sounds

Question 11

Urological causes of pain?

Answer 11

Renal Colic:

• Loin pain radiating to the groin
• Pain is often severe but intermittent. Patient’s are characteristically restless.
• Visible or non-visible haematuria may be present

Question 12

Urological causes of pain?

Answer 12

Acute pyelonephritis

• Loin pain
• Fever and rigors are common as is vomiting

Question 13

Urological causes of pain?

Answer 13

Urinary retention

• Suprapubic
• Caused by obstruction to the bladder outflow.
• Much more common in men, who often have a history of benign prostatic hyperplasia

Question 14

Urological causes of pain?

Answer 14

Question 15

Gynaecological causes of pain?

Remember, all women of a reproductive age who present with abdominal pain should be considered pregnant until proven otherwise

Answer 15

Ectopic pregnancy

• Right or left iliac fossa
• Typically presents with pain and a history of amenorrhoea for the past 6-9 weeks. Vaginal bleeding may be present

Question 16

Vascular causes of pain?

Answer 16

Ruptured abdominal aortic aneurysm:

• Central abdominal pain radiating to the back
• Presentation may be catastrophic (e.g. Sudden collapse) or sub-acute (persistent severe central abdominal pain with developing shock)
• Patients may be shocked (hypotension, tachycardic)
• Patients may have a history of cardiovascular disease

Question 17

Vascular causes of pain?

Answer 17

Mesenteric ischaemia:

• Central abdominal pain
• Patients often have a history of atrial fibrillation or other cardiovascular disease
• Diarrhoea, rectal bleeding may be seen
• A metabolic acidosis is often seen (due to ‘dying’ tissue)