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TCA 3 - Liver, Biliary and Pancreatic disease > Differentials of acute abdominal pain > Flashcards

Differentials of acute abdominal pain Flashcards

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1
Q

Which areas do you need to consider with abdominal pain?

A

Structures above and below the diaphragm

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2
Q

What is peritonitis?

A

Inflammation of the peritoneum

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3
Q

What causes peritonitis?

A
  • Peptic ulcer
  • Tumour
  • Gallbladder
  • Appendix
  • Spleen
  • AAA
  • Ectopic
  • Spontaneous Bacterial Peritonitis
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4
Q

What is the classical Hx of peritonitis?

A

Severe generalised abdominal pain

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5
Q

What are the classical examination findings of peritonitis?

A
  • Rebound and percussion tenderness
  • Later on, distention of abdomen
  • Guarding
  • No abdominal movement with respiration
  • Severe pain to light palpation
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6
Q

What investigations would you order for peritonitis and what would they show?

A
  • Erect CXR: air under diaphragm

* CT abdo/pelvic: reveals cause

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7
Q

What is the management for peritonitis?

A

Urgent laparotomy and repair

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8
Q

What is the classical Hx of ruptured AAA?

A
  • Elderly
  • Severe generalised abdominal pain
  • Back pain
  • Reduced GCS/collapse
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9
Q

What are the classical examination findings of ruptured AAA?

A
  • Shock
  • Peritonitis
  • Expansile mass
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10
Q

What investigations would you order for ruptured AAA and what would they show?

A
  • USS abdomen if freely available
  • CT only if stable
  • Don’t delay theatre
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11
Q

What is the management for ruptured AAA?

A
  • Aim for permissive hypotension (SBP–100)
  • Activate ‘massive haemorrhage protocol
  • Urgent open repair
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12
Q

What is appendicitis?

A

Inflammation of the appendix

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13
Q

What is the classical Hx of appendicitis?

A
  • Young patient
  • Periumbilical pain initially
  • Moves to RIF
  • Anorexia, nausea
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14
Q

What are the classical examination findings of appendicitis?

A
  • Tender RIF
  • Worse at McBurney’s point
  • Guarding/local peritonitis
  • Rovsing’s +ve
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15
Q

What investigations would you order for appendicitis and what would they show?

A
  • Clinical diagnosis
  • USS abdo/pelvis if gynae differentials
  • Inflammatory markers: raised
  • Urine: beta-HCG: rule out ectopic
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16
Q

What is the management for appendicitis?

A
  • Appendicectomy
  • Antibiotics
  • Nil by mouth
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17
Q

What are gallstones?

A

Presence of solid concretions in the gallbladder.

Symptoms are caused if a stone obstructs the cystic, bile or pancreatic duct.

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18
Q

What is biliary colic?

A

Blockage of bile duct

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19
Q

What is cholecystitis?

A

Inflammation of gallbladder

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20
Q

What is cholangitis?

A

Inflammation of bile duct system

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21
Q

What is acute pancreatitis?

A

A disorder of the exocrine pancreas. It is associated with acinar cell injury with local and systemic inflammatory responses.

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22
Q

What is cholelithiasis?

A

Formation of gallstones

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23
Q

What is the classical Hx of biliary colic?

A
  • Intermittent RUQ pain
  • Radiation of pain to right scapula
  • Exacerbated by fatty food
  • Cannot sit still
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24
Q

What is the classical examination signs of cholecystitis?

A
  • Continuous RUQ pain
  • Murphy’s +ve
  • Tender and guarding RUQ
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25
What is the classical Hx of common bile duct (CBD) stones?
* Jaundice | * RUQ pain
26
What is the classical Hx of cholangitis?
* Jaundice | * RUQ pain
27
What is the classical Hx of acute pancreatitis?
* Severe epigastric/ central pain * Radiating to back * Relieved by sitting forwards * Vomiting * Hx of possible cause: gallstones, alcohol, trauma, surgery, medications
28
What are the classical examination findings of acute pancreatitis?
* Epigastric tenderness * Tachycardia * Fever * Shock * Guarding * Grey-Turner’s and Cullen’s signs * Reduced or absent bowel sounds
29
What investigations would you order for gallstones and what would they show?
• LFTs: obstructive picture if CBD stones/cholangitis Rise in ALT, AST << rise in alk phos • Inflammatory markers: raised in cholecystitis/cholangitis • Abdominal USS
30
What investigations would you order for acute pancreatitis and what would they show?
* Amylase or lipase: raised * LFTs: deranged * CT abdo if diagnostic uncertaincy * Apache II / Glasgow score * ABG required * Calcium * Confirm cause * USS abdo (exclude gallstones) * Triglycerides * Immunoglobulins
31
What is the management for acute pancreatitis?
* Supportive management * IV crystalloids * Stop causative meds * No antibiotics unless proven infection * Treat cause * ITU may be required * Analgesia * Consider - antiemetic
32
What is the management for biliary colic?
* Analgesia | * OPT cholecystectomy
33
What is the management for cholecystitis?
* Antibiotics (ciproflocacin or cephalosporin) | * Cholecystectomy
34
What is the management for CBD stone?
* Continuous IVI (prevent hepato-renal syndrome) | * ERCP
35
What is the management for cholangitis?
* IV antibiotics (sipro/tazocin) | * Treat cause
36
What is diverticulitis?
Inflammation of the diverticulum or diverticula and may be caused by an infection.
37
What is the classical Hx of diverticulitis?
* Elderly * Epigastric pain that migrated to the LIF * Change in bowel habits * Rectal bleeding * Dysuria, urinary frequency
38
What are the classical examination findings of diverticulitis?
* Tender LIF * Guarding/local peritonism * PR (confirm no CA/abscess)
39
What investigations would you order for diverticulitis and what would they show?
* Inflammatory marker: raised * CXR: pneumoperitoneum (perforation) * AXR: dilated bowel loops, obstruction or abscesses * CT abdo/pelvis
40
What is the management for diverticulitis?
* NBM (nil by mouth) and IV fluids | * Bowel antibiotics (cef + Met)
41
What is renal colic?
Urinary stones block part of the urinary tract (kidneys, ureter or bladder)
42
What is the classical Hx of renal colic?
* Spasm of loin to groin pain (excruciating) * Nausea and vomiting * Cannot lie still
43
What are the classical examination findings of renal colic?
• Soft abdomen may be renal angle tendernes
44
What investigations would you order for renal colic and what would they show?
• Urine dip: microscopic haematuria • KUB X-ray Kidney, ureter and bladder • CT KUB
45
What is the management for renal colic?
* Diclofenac analgesia * Smooth muscle relaxants * Antibiotics (cefuroxime) if infection * Pelvic stone treatment * Ureteric stone treatment
46
What is bowel obstruction?
Mechanical or functional obstruction of the small or large intestines which prevents the normal movement of the products of digestion
47
What is the classical Hx of bowel obstruction?
• Colicky abdominal pain Small bowel: • Vomiting (may be faeculent) Large bowel: • No bowel motions or flatus
48
What are the classical examination findings of bowel obstruction?
* Distended, tender abdomen * Then later on, tender and rigid abdomen * Tinkling bowel sounds
49
What investigations would you order for bowel obstruction and what would they show?
* AXR: distended bowel loops | * CT abdo/pelvic: confim and determine cause
50
What is the management for bowel obstruction?
* NBM and Iv fluids * Wie-bore NG tube * Laparoscopy/laparotomy depending on cause
51
What is acute mesenteric ischaemia?
Inadequate blood flow through mesenteric arteries, resulting in ischaemia and eventual gangrene of the bowel wall.
52
What is the classical Hx of acute mesenteric ischaemia?
* Age >50 yrs * Severe abdominal pain * Bloody darrhoea * Nausea, vomiting * Risk factors: AF, CVS risk factors
53
What are the classical examination findings of acute mesenteric ischaemia?
* Hypovolaemia -> shock * Variable tenderness and guarding * Absent bowel sounds * Asymmetrical peripheral pulses
54
What investigations would you order for acute mesenteric ischaemia and what would they show?
* VBG: Increase lactate * CT abdo/pelvic: ischaemic bowel * Mesenteric angiography: if required
55
What is the management for acute mesenteric ischaemia?
* Aggressive IV fluids * Antibiotics (gentamicin + metronidazole) * Surgical bowel resection * Heparin may be used
56
What is a perforated viscus?
A perforation that can occur at any anatomical location from the upper oesophagus to the anorectal junction
57
What is the classical Hx of a perforated viscus?
* Rapid onset and sharp pain * Malaise, vomiting, lethargy * Features of sepsis
58
What are the classical examination findings of a perforated viscus?
* Localised or generalised peritonism * Thoracic perforation (e.g. oesophageal rupture) * Pain: chest or neck pain, radiating to the back, worsens on inspiration
59
What investigations would you order for a perforated viscus and what would they show?
* FBC: raised WCC and CP * CXR: free air under diaphragm * CT scan: shows free air presence and shows location of perforation
60
What is the management for a perforated viscus?
* Broad spectrum antibiotics | * Urgent theatre
61
What is a gastric/ peptic ulcer?
Break in the mucosal lining of the stomach or duodenum >5mm in diameter, with depth to the submucosa.
62
What is the classical Hx of a peptic ulcer?
* Epigastric pain * Related to meals (peptic ulcer = during meals; duodenal ulcer = before meals/at night) * Risk factors; NSAIDs, alcohol, spicy food
63
What are the classical examination findings of a gastric/ peptic ulcer?
* Tender epigastrium | * Soft abdomen
64
What investigations would you order for a peptic ulcer and what would they show?
* FBC: may be microcytic anaemia * Erect CXR: exclude perforation * OGD: if severe
65
What is the management for a gastric/ peptic ulcer?
* PPI | * H-pylori eradication
66
What is pyelonephritis?
Severe infectious disease of the renal parenchyma, calices and pelvis that can be acute, recurrent or chronic.
67
What is the classical Hx of pyelonephritis?
* Fever, chills rigors * Loin pain * Urinary frequency and dysuria
68
What are the classical examination findings of pyelonephritis?
* Loin tenderness | * Renal angle tenderness
69
What investigations would you order for pyelonephritis and what would they show?
* Urine dip and culture: positive leukocytes and nitrites | * Inflammatory markers: raised
70
What is the management for pyelonephritis?
• Antibiotics (ciprofloxacin or cephalosporin)
71
What is an ectopic pregnancy?
A fertilised ovum implanting and maturing outside of the uterine endometrial cavity.
72
What is the classical Hx of an ectopic pregnancy?
* Severe unilateral pelvic pain * 6-8 weeks pregnant, not using contraception, missed period * Shoulder tip pain * May have spotting * 'Prune-juice' vaginal discharge
73
What are the classical examination findings of an ectopic pregnancy?
* Tenderness RIF/ LIF * Guarding * Adnexal tenderness with or without mass * Cervical excitation
74
What investigations would you order for an ectopic pregnancy and what would they show?
* Urinary beta-HCG: +ve * Serum beta-HCG: + trend * Transvaginal USS
75
What is the management for an ectopic pregnancy?
* Laparoscopy/laparotomy | * Anti-D prophylaxis
76
What is an ovarian cyst rupture/ torsion/ haemorrhage?
Cyst - Enlarged, fluid-filled ovary or portion of ovarian tissue. Torsion – twisting or torsion or the ovary around its ligamentous supports
77
What is the classical Hx of an ovarian cyst rupture/ torsion/ haemorrhage?
* Sudden unilateral pelvic pain * May be light vaginal bleeding * May be fever/vomiting
78
What are the classical examination findings of an ovarian cyst rupture/ torsion/ haemorrhage?
* Tenderness RIF/LIF * Guarding * Adnexal tenderness with or without mass
79
What investigations would you order for an ovarian cyst rupture/ torsion/ haemorrhage and what would they show?
* Transvaginal/abdo USS | * Urinary beta-HCG: r/o ectopic
80
What is the management for an ovarian cyst rupture/ torsion/ haemorrhage?
• Laparoscopy/laparotomy
81
What is pelvic inflammatory disease?
``` Spectrum of inflammatory disorders of the upper female genital tract, including any combination of; • Endometritis • Salpingitis • Tubo-ovarian abscess • Pelvic peritonitis ```
82
What is the classical Hx of pelvic inflammatory disease?
* Bilateral pelvic pain * Vaginal discharge * Dyspareunia and dysmenorrhoea * May be post-coital and inter-menstrual bleeding
83
What are the classical examination findings of pelvic inflammatory disease?
* Suprapubic tenderness * Vaginal discharge, cervicitis * Bilateral adnexal tenderness * Cervical excitation * May be fever
84
What investigations would you order for pelvic inflammatory disease and what would they show?
* Inflammatory markers: raised | * Triple vaginal swabs
85
What is the management for pelvic inflammatory disease?
• Broad spectrum antibiotics (metronidazole + doxycycline + quinolone)

TCA 3 - Liver, Biliary and Pancreatic disease (6 decks)

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