Flashcards in Abdominal pain Deck (11):
What questions are key to ask about the abdominal pain in the history?
Site- pain spread from epigastrium to whole abdo - peritonitis, pain spread upwards to chest - cardiac?
Onset- sudden suggests perforation of a viscus e.g. boerhaave's/duodenal ulcer/MI
acute pancreatitis/biliary colic - 10-20mins max intensity
inflammatory processes e.g. hepatitis takes hours
Character - constant/colicky, sharp/dull/crushing/burning- depends on the underlying cause
Radiation e.g. pancreatitis to back, phrenic nerve involved?
Time of occurrence and aggravating or relieving factors e.g. meals, defecation, sleep
Recall the causes of epigastric pain
peptic ulcer (perforated)
pancreatitis, gastritis/duodenitis, gallbladder disease, aortic aneurysm
Recall the causes of left upper quadrant pain
gastric/colonic (splenic flexure) cancer, splenic rupture, subphrenic/perinephric abscess, renal (colic, pyelonephritis)
Recall the causes of right upper quadrant pain
colonic cancer (hepatic flexure), subphrenic abscess
Recall the causes of left lower quadrant pain
Cancer in undescended testis
Gynae: torsion of ovarian cyst, salpingitis, ectopic pregnancy
Recall the causes of right lower quadrant pain
Ruptured ectopic pregnancy
Recall causes of generalised abdominal pain
Recall causes of central abdominal pain
What would you look for on examination for someone with abdo pain?
Position - some pain can change with position
Jaundice- seen with acute hepatitis or post-hepatic causes of biliary obstruction, pancreatitis
Cullen's or Grey Turner's signs - extravasated blood in retroperitoneum, around the umbilicus and flank respectively. Seen in acute haemorrhagic pancretitis but are rare and non specific signs
Signs of small bowel obstruction: distended abdomen, absent/tinkling bowel sounds
Tenderness and guarding: localised e.g. acute cholecystitis (murphy's sign) or mild pancreatitis. Generalised sever tenderness with guarding and rigidity - peritonitis
Respiratory examination - lung bases may masquerade as abdo pain - check for consolidation signs e.g. decreased expansion, breathsounds, increased vocal resonence, dull percussion
What is murphys sign and how would you interpret the results?
Lie patient supine and ask to exhale. Place hand just below costal margin approx MCL then instruct patient to inhale.
Positive sign- patient stops inhalation due to pain - caused my move of diaphragm pushing inflamed gallbladder into palpating hand. This indicates cholecystitis
Negative sign- patient comfortable and breathes all the way in without any pain. This may suggest pyelonephritis and ascending cholangitis