Abdominal Pain

Question 1

What is shifting pain?

Answer 1

Sore in one spot, then jumps into another: no longer sore in original place

Question 2

What is spreading pain?

Answer 2

Starts in one place and gradually spreads into another

Question 3

What is somatic pain?

Answer 3

Sore to touch

Localised

Question 4

What is visceral pain?

Answer 4

Sore whether you press or not

Regional

Question 5

Which organs are most likely to be affected in epigastric pain?

Answer 5

Stomach
Duodenum
Pancreas
Oesophagus

Question 6

Where is stomach pain usually felt?

Answer 6

In the front

Epigastric

Question 7

Where is pain form the pancreas and duodenum commonly felt?

Answer 7

Epigastric pain

In the front, but radiating to then back

Question 8

What is the epigastrium the site of referred pain for?

Answer 8

MI
Pneumonia
Indigestion

Question 9

Which organs are most likely to be affected by RUQ pain?

Answer 9

Liver

Gall bladder

Question 10

Which organs are most likely to be affected by LUQ?

Answer 10

Spleen

Tail of pancreas

Question 11

What is the RUQ the site of referred pain for?

Answer 11

Right basal pneumonia

Right renal angle

Question 12

Which organs are most likely to be affected by central pain?

Answer 12

Small bowel
Large bowel up to transverse colon
Starting point of acute appendicitis

Question 13

Which organs are most likely to be affected by RIF pain?

Answer 13

Appendicitis
Ruptured ovarian cyst
Pelvic inflammatory disease

Question 14

Which organs are most likely to be affected by LIF pain?

Answer 14

Diverticular disease
Acute diverticulitis
Ruptured ovarian cyst
Pelvic inflammatory disease

Question 15

Which organs are most likely to be affected by suprapubic pain?

Answer 15

Bladder

Pelvic organs in females

Question 16

What is the LUQ the site of referred pain for?

Answer 16

Left basal pneumonia

Left renal angle

Question 17

How do you differentiate between gastric and duodenal ulcer pain?

Answer 17

Gastric = worse on eating 
Duodenal = improves on eating

Question 18

Where does liver pain commonly refer and why?

Answer 18

Left shoulder

Causes diaphragmatic irritation

Question 19

What is the differential for pain which is specifically related to movement?

Answer 19

MSK causes

Question 20

What is the cause of throbbing pain?

Answer 20

Inflammation

Question 21

What is the cause of colicky pain?

Answer 21

Obstruction

Question 22

What are the main categories for causes of pain?

Answer 22

Inflammation 
Underlying malignancy 
Related to drugs 
Related to infection 
Iatrogenic (self or medical profession)

Question 23

How might a colicky pain present in a patient?

Answer 23

Patient moving around

Question 24

How might an inflammatory pain present in a patient?

Answer 24

Patient lying still (worse on movement)

Question 25

How might general peritonitis present in a patient?

Answer 25

Abdomen not moving with respiration

Question 26

What are you looking for when asking the patient to "take a deep breath in"?

Answer 26

Murphy's sign | Gallbladder pain

Question 27

How do you check for peritonitis in a patient?

Answer 27

``` “Puff up your tummy” “Suck your tummy in” “Give me a gentle cough” “Give me a big cough” Pain on percussion ```

Question 28

What is dull percussion a sign of?

Answer 28

Normal | Fluid

Question 29

What is tympanic percussion a sign of?

Answer 29

Gas

Question 30

When might listening to bowel sounds be important?

Answer 30

After bowel surgery

Question 31

What are bruits and what causes them?

Answer 31

Noise caused by turbulence | Heard well in abdominal aortic aneurysms

Question 32

What is the classic presentation of appendicitis?

Answer 32

1 - Pain, usually epigastric or umbilical and generalised 2 - Anorexia, nausea, or vomiting 3 - Tenderness somewhere in the abdomen or pelvis. Commonly localised at RIF. 4 - Fever 5 - Leucocytosis

Question 33

What is the classic presentation of a perforated appendix?

Answer 33

Generalised pain and guarding with peritonism

Question 34

What is the classic presentation of biliary colic?

Answer 34

``` Gradual onset Colicky pain, comes and goes Worse on eating: dairy, spicy, fatty Nausea and anorexia Pain radiates to right back Some pain and irritation in right shoulder Tender in deep palpation Murphy's negative No temperature and normal bloods ```

Question 35

What is the classic presentation of acute cholecystitis?

Answer 35

``` Same as biliary colic + Murphy's positive High temperature Leukocytosis Localised peritonitis in RUQ ```

Question 36

What is the common presentation of diverticulitis?

Answer 36

``` Sluggish bowels Pain relieved by moving bowels/passing wind Localised severe pain in LIF on exam Temperature High pulse rate ```

Question 37

What are the three presentations of abdominal pain that you must differentiate very quickly?

Answer 37

Ischaemic gut Ruptured AAA Acute pancreatitis