What is Murphy's sign?
Place two fingers on the RUQ; pain on inspiration and cessation of inspiration
Where is pain from obstruction of paired structures referred to?
What is acute cholecystitis?
Inflammation of the gall bladder
What the types of abdominal hernia's?
What is choledocholithiasis?
Stone in the common bile duct
(Not causing inflammation)
How does acute appendicitis usually appear on examination?
Tenderness in R iliac fossa (McBurney's point)
+/- Rovsing's sign (palpation of L lower quadrant causes pain to be felt in RLQ)
What type of pain is typically relieved by leaning forward?
Epigastric that radiates to the back
High pitched bowel sounds are indicative of what usually?
What is ascending cholangitis?
Inflammation of the common bile duct
What is biliary colic?
Pain due to obstruction of the cystic duct by gall stones
(Not inflammatory pain)
Where is pain from obstruction of the gut felt?
What is McBurney's point?
The point, 1/3 third of the way between the ASIS and the umbilicus where pain from appendicitis is felt
How does peritonitis present?
Abdominal guarding and rebound tenderness
What are some non-abdominal causes of abdominal pain?
What is colicky pain?
What typically causes it?
Pain that waxes and wanes
Obstruction of a hollow viscus
How does inflammatory pain usually present?
What is the pain of gastroenteritis typically like?
How does pain progress in appendicitis?
Initially visceral and referred
Once inflammation becomes transmural and touches the peritoneum in the right iliac fossa the pain moves
- Patient can finger the spot
What is rebound tenderness?
Pain on removal of pressure applied during examination
What special physical signs are looked for in appendicitis?
Rovsing's sign - Pain > in RIF than LIF when the LIF is pressed
Psoas sign - Pain on extending R hip while the patient lies on left (if retrocaecal appendix)
Cope/Obturator sign - pain on flexion and internal rotation of R hip if appendix in close relation to obturator internus
How does pain from perforation present?
Sudden, can be on a background of pre-existing pain
What are the three types of hollow viscus obstructions?
Intraluminal eg stone
In the wall eg colon cancer
Extrinsic eg adhesion
What are the causes of pancreatitis?
I GET SMASHED
Drugs - particularly flucloxicilin
What is ERCP?
What risk is associated with it?
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems.
Why does diaphragmatic pathology often refer pain to the shoulder tip?
Because they share innervation from C3/4
What is Mittelschmerz pain?
Pain with ovulation
What is Grey Turner's sign? What causes it? In which conditions might it be found?
Brusing in the flanks
Bleeding in the retroperitonium
What is Cullen's sign? In which condition might it be seen?
Superficial oedema and bruising around the umbilicus
What is Meckel's diverticulum?
A congenital diverticulum present at birth and remenent of the omphalomesenteric duct