Abdominal pain Flashcards Preview

Presentations > Abdominal pain > Flashcards

Flashcards in Abdominal pain Deck (11):
1

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

2

Recall the causes of epigastric pain

GORD
peptic ulcer (perforated)
pancreatitis, gastritis/duodenitis, gallbladder disease, aortic aneurysm
MI
acute cholecystitis
Perforated oesophagus

3

Recall the causes of left upper quadrant pain

peptic ulcer
gastric/colonic (splenic flexure) cancer, splenic rupture, subphrenic/perinephric abscess, renal (colic, pyelonephritis)
ruptured spleen
L pneumonia
Perforated colon

4

Recall the causes of right upper quadrant pain

acute cholecystitis
duodenal ulcer
hepatitis
congestive hepatomegaly
pyelonephritis
appendicitis
R pneumonia
biliary colic
colonic cancer (hepatic flexure), subphrenic abscess

5

Recall the causes of left lower quadrant pain

Diverticulitis
volvulus
colon cancer
UTI
Cancer in undescended testis
Gynae: torsion of ovarian cyst, salpingitis, ectopic pregnancy
Strangulated hernia
Peforated colon
Crohn's disease
Ulcerative colitis
Renal/ureteric stones

6

Recall the causes of right lower quadrant pain

Appendicitis
Salpingitis
Ruptured ectopic pregnancy
renal/ureteric stone
strangulated hernia
mesenteric adenitis
meckel's diverticulitis
crohn's disease
perforated caecum
psoas abscess

7

Recall causes of generalised abdominal pain

gastroenteritis
IBS
Peritonitis
Constipation

8

Recall causes of central abdominal pain

Mesenteric ischaemia
Pancreatitis
Abdominal aneurysm

9

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

Masses

Respiratory examination - lung bases may masquerade as abdo pain - check for consolidation signs e.g. decreased expansion, breathsounds, increased vocal resonence, dull percussion

10

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

11

What investigations would you carry out for abdominal pain

Bloods: FBC for signs of infection/inflammation, blood loss (low Hb), neutrophilia (pancreatitis), CRP, Pancreatic amylase/lipase (amylase if 3-5 days, lipase longer half life), liver enzymes (AST+ ALT raised- pathology IN the liver, raised ALP, bilirubin + GGT- pathology in the biliary tree/extrinsic compression of it. Rise in ALP without GGT- source other than liver e.g. bone, placenta. Just GGT- alcohol), albumin-pancreatitis, U&Es + creatinine (esp if vomiting), calcium (pancreatitis), glucose, ABG(ARDS), troponin (MI)

ECG

Imaging: AXR - small bowel obstruction if dilated loops, calcification- gall stones, pancreatitis, outline of psoas muscle obscured with ruptured AAA or severe pancreatitis. CXR- perforated ulcer, lower lobe consolidation, pleural effusion can occur with pancreatitis and boerhaave's perforation. Abdo USS: exclude gallstones, biliary dilation, AAA