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Flashcards in Abdominal pain Deck (22)
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1
Q

Structures located in the RUQ

A
Liver
Gall bladder
Duodenum
Head of the pancreas
Right adrenal gland
Portion of the right kidney
Portions of the ascending
and transverse colon
2
Q

Conditions arising from the RUQ

A
Biliary colic
Hepatitis
Peptic ulcer
Pancreatitis
Renal colic
Herpes zoster
Myocardial ischaemia
3
Q

Structures located in the LUQ

A
Left lobe of liver
Stomach
Spleen
Body of the pancreas
Left adrenal gland
Portion of the left kidney
Portions of the transverse and
descending colon
4
Q

Conditions arising from the LUQ

A
Gastritis
Splenic enlargement or rupture
Pancreatitis
Renal colic
Herpes zoster
Myocardial ischaemia
5
Q

Structures located in the RLQ

A
Lower portion of the right kidney
Caecum and appendix
Portion of the ascending colon
Ovary and salpinx
Uterus if enlarged
Right ureter
6
Q

Conditions arising from the RLQ

A
Appendicitis
Diverticulitis
Intestinal obstruction
Renal colic
Ectopic pregnancy
Ovarian cyst
Salpingitis
Endometriosis
7
Q

Structures located in the LLQ

A
Lower portion of the left kidney
Sigmoid colon
Portion of the descending colon
Ovary and salpinx
Uterus if enlarged
Left ureter
8
Q

Conditions arising from the LLQ

A
Diverticulitis
Intestinal obstruction
Renal colic
Irritable bowel syndrome
Ectopic pregnancy
Ovarian cyst
Salpingitis
Endometriosis
9
Q

Dyspepsia/gastritis -

A

LUQ

  • Patients with dyspepsia present with a range of symptoms that commonly involve vague abdominal discomfort (aching) above the umbilicus associated with belching, bloating, flatulence, feeling of fullness and heartburn. It is normally relieved by antacids and aggravated by spicy foods or excessive caffeine. Vomiting is unusual.
10
Q

Splenic enlargement or rupture

A

LUQ

  • If the spleen is enlarged, generalised left upper quadrant pain associated with abdom-
    inal fullness and early feeding satiety is observed (Fig. 7.17). Referred pain to the left

shoulder is sometimes seen. The condition is rare and is nearly always secondary to

another primary cause, which might be an infection, a result of inflammation or hae-
matological in origin.

11
Q

Acute cholecystitis and cholelithiasis

A

RUQ

  • Cholelithiasis (presence of gall stones in the bile ducts, also called biliary colic) is
    the more common presentation. (Fig. 7.18) Typically, the pain lasts for more than
    30 minutes, but less than 8 hours, is colicky in nature and often severe. Nausea
    and vomiting are often present. Classically, the onset is sudden, starts a few hours
    after a meal and frequently awakens the patient in the early hours of the morning.
    In acute cholecystitis (inflammation of the gall bladder) symptoms are similar but
    also associated with fever and abdominal tenderness. The pain may radiate to
    the tip of the right scapula. The incidence of both increases with increasing age
    and is most common in people aged over 50. It is also more prevalent in women
    than in men.
12
Q

Hepatitis

A

RUQ

  • Liver enlargement from any type of hepatitis will cause discomfort or dull pain
    around the right rib cage (Fig. 7.19). Associated early symptoms are general malaise,
    tiredness, skin rash (pruritus) and nausea. On examination there is normally hepatic
    tenderness.
13
Q

Ulcers

A

RUQ

-Ulcers are classed as either gastric or duodenal. They occur most commonly in
patients aged 30 to 50 years old and are more common in men than in women.
Symptoms are variable but typically the patient will have localised mid-epigastric
pain (Fig. 7.20) described as ‘constant’, ‘annoying’ or ‘gnawing/boring’.
With gastric ulcers, symptoms are inconsistent but the pain usually comes on

whenever the stomach is empty – usually 15 to 30 minutes after eating – and is gen-
erally relieved by antacids or food and aggravated by alcohol and caffeine. NSAID

use is associated with a three- to fourfold increase in gastric ulcers.
Duodenal ulcers tend to be more consistent in symptom presentation. Pain occurs

2 to 3 hours after eating, and pain that awakens a person at night is highly sugges-
tive of duodenal ulcer.

14
Q

Acute pancreatitis

A

Pain affecting both right and left upper quadrants

  • Pain of pancreatitis develops suddenly and is described as agonising and constant
    with the pain being centrally located (epigastric) that often radiates into the back
    (Fig. 7.21). Pain reaches its maximum intensity within minutes and can last hours or
    days. Vomiting is common but does not relieve the pain. Early in the attack patients
    might get relief from the pain by sitting forwards. It is commonly seen in those that
    misuse alcohol (25% of cases) or suffer from gallstones (50% of cases). Patients are
    very unlikely to present in a community pharmacy due to the severity of the pain
    but a mild attack could present with steady epigastric pain that is sometimes centred
    close to the umbilicus and can be difficult to distinguish between other causes of
    upper quadrant pain.
15
Q

Renal colic

A

Pain affecting both right and left upper quadrants

Urinary calculi (stones) can occur anywhere in the urinary tract, although most fre-
quently stones get lodged in the ureter. Pain begins in the loin, radiating around the

flank into the groin and sometimes down the inner side of the thigh (Fig. 7.22). Pain
is very severe and colicky in nature. Attacks are spasmodic and tend to last minutes
to hours and often leave the person prostrate with pain. The person is restless and
cannot lie still. Symptoms of nausea and vomiting might also be present. It is twice
as common in men than in women and usually occurs between the ages of 40 and
60 years old.

16
Q

MI

A

Pain affecting both right and left upper quadrants

  • Angina and myocardial infarction (MI) cause chest pain that can be difficult to dis-
    tinguish initially from epigastric/retrosternal pain caused by dyspepsia (Fig. 7.23).

However, pain of cardiovascular origin often radiates to the neck, jaw and inner aspect
of the left arm. Typically, angina pain is precipitated by exertion and subsides after
a few minutes once at rest. Pain associated with MI will present with characteristic
deep crushing pain. The patient will appear pale, display weakness and be tachycardic.
Cardiovascular pain should respond to sublingual glyceryl trinitrate therapy.

17
Q

Appendicitis

A

LRQ

Classically, the pain starts in the mid-abdomen region, around the umbilicus, be-
fore migrating to the right lower quadrant after a few hours (Fig. 7.27), although

right-sided pain is experienced from the outset in about 50% of patients. The pain
of appendicitis is described as colicky or cramp-like but after a few hours becomes
constant. Movement tends to aggravate the pain and vomiting might also be present.
Appendicitis is most common in young adults, especially in young men.

18
Q

Conditions affecting women (other than period pain)

A

Generalised lower abdominal pain (Fig. 7.28) can be experienced in a number of
gynaecological conditions:
• Ectopic pregnancy: these are usually experienced between weeks 5 and 14 of the
pregnancy. Patients suffer from persistent moderate to severe pain that is sudden
in onset. Referred pain to the tip of the scapula is possible. Most patients (80%)
experience bleeding that ranges from spotting to the equivalent of a menstrual
period. Diarrhoea and vomiting is often also present.
• Salpingitis (inflammation of the fallopian tubes): occurs predominantly in young,

sexually active women, especially those fitted with an IUD. Pain is usually bi-
lateral, low and cramping. Pain starts shortly after menstruation and can worsen

with movement. Malaise and fever are common.
• Endometriosis: patients experience lower abdominal aching pain that usually starts
5 to 7 days before menstruation begins and can be constant and severe. The pain
often worsens at the onset of menstruation. Referred pain into the back and down
the thighs is also possible.

19
Q

Gastroenteritis

A

Diffuse abdominal pain

  • Other symptoms of nausea, vomiting and diarrhoea will
    be more prominent in gastroenteritis than abdominal pain.

The patient might also have a fever and suffer from gen-
eral malaise.

20
Q

Peritonitis

A

Severe pain in the upper abdomen is present. This is ac-
companied by intense rigidity of the abdominal wall

producing a ‘board like’ appearance; fever and vomiting
might also be present. Urgent referral is required due to
associated complications.

21
Q

TRIGGER POINTS indicative of referral:

Abdominal pain

A
  • Abdominal pain
    with fever: Suggests potential diverticulitis,
    peritonitis, biliary colic or
    salpingitis
- Pregnancy or
suspected
pregnancy: Eliminate pain relating to
pregnancy or ectopic
pregnancy
  • Abdominal pain
    associated
    with trauma: May indicate damage to organs
- Severe pain or
pain that
radiates: Suggests more sinister causes
such as potential myocardial
infarction or significant
inflammation of the GI tract
  • Elderly: Diverticulitis and obstruction more common
  • Vomiting: Suggests conditions such as
    peritonitis, pancreatitis,
    appendicitis or renal or biliary
    colic
22
Q

Refer age

A

> 50 years