Lower Abdo Pain

Question 1

Causes of right lumbar pain

Answer 1

Appendicitis
Bowel obstruction in caecum 
Crohn’s disease
Ruptured ectopic pregnancy
Renal/ureteric stones 
Coeval volvulus 
Meckel’s Diverticulitis
Perforated viscous 
Inguinal hernia

Question 2

What is Meckel’s diverticulitis?

Answer 2

Congenital form of diverticulitis

Question 3

What might cause left iliac pain?

Answer 3

UC and Crohn’s
Sigmoid diverticulitis 
Testicular torsion 
constipation 
Leaking AAA
Ruptured ectopic 
Ischaemic colitis
Colon cancer (rarely)

Question 4

What is a volvulus?

Answer 4

Looped bit of bowel

Question 5

Key conditions that cause flank pain?

Answer 5

Pyelonephritis 
Nephrolithiasis (kidney stones)
Ureteric colic (kidney stones in ureter 
Testicular torsion 
Perforated peptic ulcer 
Leaking AAA

Question 6

OTher causes of flank pain

Answer 6

Renal cancer
Abscess
Basal pneumonia

Question 7

Spinal causes of flank pain?

Answer 7

Fractures
metastasises
Disc prolapse

Question 8

Gynaecological reasons for flank pain?

Answer 8

Ectopic pregnancy

OVarian torsion

Question 9

Other abdo pathology causing flank pain?

Answer 9

Pancreatitis

Diverticulitis

Question 10

Differentials for SUDDEN onset left/right iliac pain

Answer 10

Perforated viscous
Ureteric stones
Testicular torsion
Volvulus

Question 11

SLow onset

Answer 11

UC/Crohn’s

Question 12

Colicky right/left iliac pain?

Answer 12

Ureteric stones

Volvulus

Question 13

Constant pain at right or left iliac pain?

Answer 13

Appendicitis - deep pain
Testicular torsion
Diverticulits is colicky then constant

Question 14

What type of pain is UC or Crohn’s?

Answer 14

Crampy

Question 15

Appendicitis radiation

Answer 15

Central to RIF

Question 16

Ureteric stones radiation

Answer 16

Loin to groin

Question 17

What exacerbates appendicitis?

Answer 17

Movement

Question 18

Why must you ask about timing of last excretion?

Answer 18

Could indicated bowel obstruction

Question 19

What might N& V suggest?

Answer 19

Appendicitis
Bowel obstruction
Testicular torsion
Ureteric stones

Question 20

Fever might suggest

Answer 20

Appendicitis
DIverticulitis
UC
Crohn’s

Question 21

Tinkling bowel sounds might suggest

Answer 21

Intestinal obstruction (e.g. volvulus)

Question 22

Aphthous ulcers might suggest

Answer 22

Crohn’s

Question 23

Weight loss might suggest

Answer 23

Crohn’s

UC

Question 24

Lower urinary tract symptoms would suggest

Answer 24

Ureteric stones

Question 25

Volvulus signs on X-RAY?

Answer 25

Coffe bean sign and fetus sign

Question 26

Kidney stones - uni lateral or bi lateral

Answer 26

Uni lateral

Question 27

Describe the type of pain in kidney stones

Answer 27

Gradual that becomes severe

Question 28

Differentiate kidney stones and ureteric stone pain

Answer 28

COnstant pain - kidney stones | Colicky pain - ureteric stones because the ureters are trying to contract and end up spasming

Question 29

Sharp pain would suggest

Answer 29

Ruptured AAA

Question 30

Shooting pain would suggest

Answer 30

Nerve impingement

Question 31

If the pain radiates down the leg, what would it suggest?

Answer 31

Pain down the leg from flank

Question 32

Peritonitis might be caused by

Answer 32

Ruptured AAA | Perforated peptic ulcer

Question 33

What makes ureteric colic better?

Answer 33

Nothing

Question 34

If the pain is worse on activity, what might it suggest?

Answer 34

MSK

Question 35

If the pain lasts may weeks?

Answer 35

MSK pain

Question 36

Fevers associated with flank pain can be due to

Answer 36

Inflammation: pyelonephritis, appendicitis Other form of sepsis: Psoas abscess Malignancy

Question 37

Dehydration as an associated symptom will be seen in

Answer 37

Kidney stones

Question 38

Nausea and vomiting will be associated with

Answer 38

``` Visceral organs E.g. ureteric colic Biliary colic Appendicitis Testicular torsion ```

Question 39

Ureteric obstruction is associated with

Answer 39

Hesitancy Reduced flow Dribbling and incomplete urination

Question 40

UTI Is associated with

Answer 40

Urinary frequency increase URgency Dysuria

Question 41

What preexisting conditions may be relevant to flank pain

Answer 41

``` Previous kidney stones Recurrent cystitis (UTI) Atherosclerotic disease Longstanding back pain Kidney disease e.g. polycystic kidney disease Having 1 kidney ``` IBD Recurrent surgery

Question 42

Recurrent stones predispose to what type of kidney stone?

Answer 42

Struvite stones produced by bacteria?

Question 43

What drug hx is important ?

Answer 43

Acyclovir Indinavir Acetazolamide

Question 44

Why are Acyclovir and Indinavir important

Answer 44

These antivirals may cause kidney stone formation

Question 45

How can acetazolamide cause kidney stones

Answer 45

Pee more Dehydration Kidney stones

Question 46

FH

Answer 46

IBD COlon cancer Kidney stones

Question 47

Social hx - what do you ask?

Answer 47

``` Diet Exercise Occupation Stress Travel - sexual history esp if there’s a chance of pregnancy ```