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Gastrointestinal (LECTURE NOTES) > Approach to the patient with abdominal pain > Flashcards

Flashcards in Approach to the patient with abdominal pain Deck (36):
1

Pain of acute onset may result from what

An acute vascular event
obstruction of a viscus
Infection

2

Pain of gradual onset may result from what

Chronic inflammatory processes
functional causes

3

If the pain is colick what does this usually realte to

A viscus - intestinal renal and biliary colic

4

If the pain is constant, what might the pain related to?

Solid organs

5

If the pain is poorly localised, what is it usually related to

A viscus (intestinal, renal and biliary colic)

6

If the pain is in the epigastrium where does this relate to?

The liver
pancreas
stomach
proximal small bowel

7

If the pain is located centrally, where does this relate to?

The small intestine and proximal colon

8

What are 4 alarm symptoms in the history

Weight loss
older age
nocturnal wakening
family history of cancer or IBD

9

What are 2 alarm symptoms on examination

Abnormal examination
fever

10

What are 5 alarm symptoms in the investigations

Positive faecal occult bloood
anaemia
leucocytosis
elevated ESR or CRP
Abnormal biochemistry

11

If the pain is located to the suprapubic area, what does this relate to?

Disorders in the colon, renal tract and female reproductive organs

12

If the pain radiates, why might this be useful

In localising the origin of the pain

13

Why does referred pain occur

As a result of visceral afferent neurons converging with the somatic afferent neurons in the spinal cord and sharing second-order neurons

14

Describe visceral pain

Dull, crampy, burning or gnawing
Related to internal organs and the visceral peritoneum

15

Describe somatic pain

Sharp, pricking
Originates from the abdominal wall or parietal peritoneum

16

What might pain developing soon after a meal with upper abdominal bloating, nausea or vomiting indicate

Gastric or small intestinal pathology or sensitivity

17

if the pain is associated with twisting or bending, where is the likely problem

Abdominal wall

18

If haematuria is present, what does this indicate

renal colic

19

what does vomiting or upper abdominal distension suggest

small bowel obstruction or ileus

20

what should be asked when speaking about bowel habit

Frequency
consistency
urgency
blood
mucus
ALWAYS ASK WHAT IS NORMAL FOR THE PATIENT!!

21

If a patient is lying completely still not walnting to move and in severe pain what might they have

Peritonitis

22

What type of pain would a patient have if they were constantly moving around and unable to get comfortable

Visceral pain (obstruction of a viscus)

23

What might leg swelling be an indicator of

decreased blood albumin related to liver disease or malnutrition

24

When might a GI patient have clubbing

Chronic liver disease
IBD

25

What are some other features found on general examination that are indicative of chronic liver disease

Palmar erythema
asterixis
Dupytren's contractures
spider naevi

26

What are some other features found on general examination that are indicative of chronic liver disease

Palmar erythema
asterixis
Dupytren's contractures
spider naevi

27

What might be seen in the mouth with vitamin B12 deficiency

Glossitis

28

How does referred pain occur

Due to convergence of visceral afferent and somatic afferent neurons in the spinal cord

29

Where does gall bladder referred pain occur

The right scapula

30

Where does referred pain occur from a ruptured spleen or pancreatitis

Left shoulder region

31

Where does referred pain occur from a ruptured spleen or pancreatitis

Left shoulder region

32

Patients with previous abdominal surgeries are at risk for what

Intestinal obstruction

33

What is occasionally seen in acute haemorrhagic pancreatitis

Brusing at the flanks (grey Turner's sign) and periumbilically (Cullen's sign)

34

If there are no bowel sounds, what does this indicate

Ileus and in the presence of severe pain suggests peritonitis

35

If there are high pitched or tinkling bowel sounds, what does this indicate

Intestinal obstruction

36

What blood tests should be done for most patients with abdominal pain

FBC
U&E
Creatinie
Urinalysis