12. Epigastric Pain Flashcards
What are some of the differential diagnoses for epigastric pain?
Acute pancreatitis Perforated peptic ulcer Gastritis/ duodenitis Peptic ulcer disease Biliary colic Acute cholecystitis Ascending cholangitis Myocardial infarction Ruptured AAA Mesenteric ischaemia
Whereabouts is the pain from peritonitis?
Whole abdomen
Whereabouts is the pain from any biliary diseases?
Right upper quadrant
What does epigastric pain of sudden onset suggest?
Perforation of a viscus
How quickly does pain from acute pancreatitis and biliary colic develop?
Usually reaches maximal intensity over 10-20 min
What does ‘burning’ epigastric pain suggest?
Peptic ulcers, gastritis and duodenitis
What does ‘deep’/ ‘boring’ epigastric pain suggest?
Pancreatitis
What does shoulder tip pain suggest?
Irritation of the phrenic nerve due to diaphragmatic involvement. This may be due to basal pneumonia/ subphrenic abscess
What kind of pain is relieved by sitting forwards?
Acute pancreatitis
What other symptoms should should you ask about once you have characterised epigastric pain?
Nausea/ vomiting Fever Dyspepsia Changes in stool Cough (basal pneumonia, GORD)
What drugs may contribute to peptic ulcer disease?
NSAIDs, steroids, bisphosphonates, salicylates
What drugs may contribute to acute pancreatitis?
Sodium valproate, steroids, thiazides, azathioprine
What score is used to assess the severiy and prognosis of pancreatitis?
Glasgow score
What are the causes of acute pancreatitis?
I GET SMASHED Idiopathic Gallstones Ethanol Trauma Steroids Mumps/ HIV/ Coxsackie infection Autoimmune Scorpion bites
What is an easy way to remember the order of an abdo exam?
LSB, Shifting D, LSK, Triple A
For Percussion and palpation-
Percussion- Liver, Spleen, Bladder (LSB) then percuss for shifting dullness
Palpation- Liver, spleen, kidneys, abdominal aorta
