Abdominal pain and pancreatitis

Question 1

What is the definition of acute pancreatitis?

Answer 1

An acute inflammatory process that leads to necrosis of the pancreatic parenchyma.

Question 2

What is the definition of chronic pancreatitis?

Answer 2

Chronic pancreatitis is a progressive fibroinflammatory process of the pancreas that results in permanent structural damage, which leads to impairment of exocrine and endocrine function

Question 3

What are the characteristics of GI pain?

Answer 3

• Initially, poorly located.
• Onset over hours (can be quick).
• Usually more of a dull ache.
• May have associated GI symptoms.

Question 4

What are the 8 important things when assessing abdominal pain?

Answer 4

Site - Where is the pain?

Onset - How sit it come on?

Character - What does the pain feel like?

Radiation - Where does the pain move to/extend to?

Associated symptoms - Any other symptoms?

Timing - How quickly did the pain come on/go?

Exacerbating/relieving factors- What makes the pain better/worse?

Severity - How much does the pin hurt on a scale of 1-10?

Question 5

Which 3 systems can present with abdominal pain?

Answer 5

foregut
midgut
hindgut

Question 6

What is peritonitis? (e.g. in appendicitis)

Answer 6

• Sharp pain that is very severe.
• Localised initially but becomes more generalised.
• Pain is much worse on movement.
• Patients with peritonitis display tendencies to:
  Guard – involuntary contractions of abdominal muscles to protect the area.
  Rebound tenderness – the application of pressure gives no pain but release and rebound gives pain

Question 7

What is colicky pain?

Answer 7

• Pain that comes and goes due to contractions of a hollow tube in an attempt to relieve obstructions.
• Examples of hollow tubes include: ureter, urethra, colon, bile ducts, pancreatic ducts.
• e.g. kidney stones

Question 8

Where does pancreatitis pain occur?

Answer 8

localised to the epigastrium and radiates towards the back

Question 9

What does pancreatitis present with?

Answer 9

• jaundice
• RUQ pain
• low BP
• nausea
• vomiting

Question 10

What tests can be carries out for pancreatitis investigation?

Answer 10

Simple examinations – BP, pulse, urine dipstick.

Blood tests - Full blood count, urea/electrolytes, inflammation markers, liver function tests, clotting, calcium, glucose.

Complex blood tests – Amylase, Lipase, Triglycerides.
(Elevated in pancreatitis)

Simple imaging – X-rays, ultrasound

Cross-sectional imaging – CT scan, MRCP scans

Invasive tests – ERCP

Question 11

What would be seen in a blood test if the person had pancreatitis?

Answer 11

• Hyperglycaemia, hypocalcaemia.
• CRP measures time since pancreatic attack.
• Elevated white count, bilirubin and liver enzymes.

Question 12

What are the causes of pancreatitis (get smashed)?

Answer 12

gallstone
ethanol
trauma
steroids
mumps
autoimmune
scorpion venom
hyperlipidaemia/hypercalcaemia
ERCP
Drugs (NSAID, furosemidee, sulphonamides)

Question 13

Systemic complications of pancreatitis

Answer 13

• Hypovolaemia.
• Hypoxia.
• Hypocalcaemia.
• Hyperglycaemia.
• DIC.
• Multiple organ failure.

Question 14

Local complications of pancreatitis

Answer 14

• Pancreatic necrosis.
• Fluid collections.
• Splenic vein thromboses.
• Chronic pancreatitis.

Question 15

What is the cause of pain in the umbilical area?

Answer 15

large and small bowel

stomach ulcer, constipation, crohn’s, trapped wind, food poisoning

Question 16

What is the cause of pain in the epigastric area?

Answer 16

pancreatitis, oesophagus, stomach

acid reflux, heart burn, gastritis, pancreatitis, stomach ulcer

Question 17

What is the cause of pain in the right hypochondriac?

Answer 17

biliary, hepatic

biliary colic, pulled muscle, kidney stone, hepatitis

Question 18

What is the cause of pain in the suprapubic region?

Answer 18

large intestine

trapped wind, constipation, menstrual, endometriosis, pelvic infection, fibroids, miscarriage

Question 19

What is the cause of pain in the right inguinal region?

Answer 19

appendix

appendicitis, mid cycle pain, constipation, ectoptic pregnancy, ovarian cyst, hernia

Question 20

What is the cause of pain in the left inguinal region?

Answer 20

IBS, crohn’s, constipation, ulcerative colitis, pelvic infection, mid cycle pain etc.

Question 21

What is the cause of pain in the right lumbar region?

Answer 21

kidney stone, kidney infection, trapped wind, pulled muscle, constipation

Question 22

What is the cause of pain in the left lumbar region?

Answer 22

constipation, trapped wind, crohn’s, ulcerative colitis, IBS, kidney stones

Question 23

What is the cause of pain in the left hypochondriac region?

Answer 23

pneumonia, hepatitis, kidney stone, enlarged spleen, spleen infection, trapped wind