12. Epigastric Pain

Question 1

Answer 1

Question 2

History taking for epigastric pain (SOCRATES)?

Answer 2

Question 3

Once you have characterised the epigastric pain, which additional symptoms should you ask about? (5)

Answer 3

Question 4

What is of particular relevance in past medical history for a patient presenting with epigastric pain? (4)

Answer 4

Question 5

Answer 5

Question 6

Does family history have any relevance to the presentation of acute epigastric pain?

Answer 6

Question 7

Why is Mr Simpson’s social history of particular relevance in his presentation of epigastric pain?

Answer 7

While you should always ask about smoking and alcohol intake, it is particularly important that you spend some time establishing alcohol intake when faced with a patient complaining of epigastric pain.

Question 8

Answer 8

Question 9

What clinical sign is this?

Answer 9

= Grey Turner’s sign (flank discolouration due to severe pancreatitis)

Question 10

Looking at Mr Simpson you notice that he is sitting forwards in bed - a position he says he finds more comfortable. On palpation there is mild epigastric tenderness, but no rebound tenderness or guarding. There are no palpable masses, obvious abdominal distention, or discolouration. A DRE is unremarkable. The lung bases are clear. His observations are as follows: T38.6C, HR111bpm, BP 106/79, RR 17, O2 sats 97%RA.
What investigations should you order for Mr Simpsons (BLOODS = 10)?

Answer 10

Question 11

Other than bloods, which 3 investigations should you order for a patient presenting with acute epigastric pain?

Answer 11

Question 12

Answer 12

Question 13

Should patients presenting with epigastric pain have a CT scan?

Answer 13

Question 14

Answer 14

Question 15

What are the causes of acute pancreatitis? How will you start investigating the pathology?

Answer 15

Question 16

Answer 16

Question 17

How should Mr Simpson’s acute pancreatitis be managed?

Answer 17

Question 18

How will you prevent a recurrence of this condition (acute pancreatitis) in Mr Simpson?

Answer 18

Question 19

Answer 19

Question 20

Answer 20

Question 21

Answer 21

Question 22

Answer 22

Question 23

What are the 7 indications for endoscopic investigation of dyspepsia?

Answer 23

Question 24

How does the breath test for H.pylori work?

Answer 24

Question 25

What are the complications of peptic ulcers? (5)

Answer 25

Question 26

What are the complications of Pancreatitis?
- 7 Local?
- 7 Systemic?

Answer 26

Question 27

What is the role of stool elastase in chronic pancreatitis management? Why?

Answer 27

Question 28

What are Cushing’s and Curling’s ulcers?

Answer 28

Question 29

What are the differentials for a raised serum amylase level? (10)

Answer 29

Question 30

Answer 30

Question 31

Answer 31