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YR3: MM FC Ed. > 12. Epigastric Pain > Flashcards

12. Epigastric Pain Flashcards

1
Q

What are 10 of the differential diagnoses for epigastric pain?

A 
Acute pancreatitis
Perforated peptic ulcer
Gastritis/ duodenitis
Peptic ulcer disease
Biliary colic
Acute cholecystitis
Ascending cholangitis
MI
Ruptured AAA
Mesenteric ischaemia
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2
Q

Where is the pain in peritonitis?

A

Epigastrum spreading to whole abdomen

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3
Q

Where is the pain in biliary diseases?

A

RUQ or epigastric

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4
Q

What does sudden onset epigastric pain suggest?

A

Perforation of a viscus

MI

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5
Q

How quickly does pain from acute pancreatitis and biliary colic develop?

A

Maximal intensity over 10-20 min

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6
Q

What does ‘sharp, burning’ epigastric pain suggest?

A

Peptic ulcers
Gastritis
Duodenitis

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7
Q

What does ‘deep’/ ‘boring’ epigastric pain suggest?

A

Pancreatitis

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8
Q

What does pain radiation to shoulder tip suggest?

A

Irritation of the phrenic nerve due to diaphragmatic involvement e.g. basal pneumonia/ subphrenic abscess

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9
Q

What kind of pain is relieved by sitting forwards?

A

Acute pancreatitis

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10
Q

What other symptoms should should you ask about once you have characterised epigastric pain?

A 
Nausea/ vomiting
Fever: infection/ widespread inflammation 
Dyspepsia
Changes in stool
Cough (basal pneumonia, GORD)
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11
Q

What 4 drugs may contribute to peptic ulcer disease?

A

NSAIDs
Steroids
Bisphosphonates (alendronate)
Salicylates (aspirin)

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12
Q

What 4 drugs may contribute to acute pancreatitis?

A

Sodium valproate
Steroids
Thiazides
Azathioprine

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13
Q

What score is used to assess the severity and prognosis of pancreatitis?

A

Glasgow score

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14
Q

What are the causes of acute pancreatitis?

A 
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps/ HIV/ Coxsackie infection
AI
Scorpion bites
Hyperlipidaemia/ hypercalcaemia/ hypothermia
Endoscopic retrograde cholangiopancreatography
Drugs
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15
Q

What is an easy way to remember the order of an abdo exam?

A

LSB, Shifting D, LSK, Triple A

For Percussion + palpation-
Percussion: Liver, Spleen, Bladder (LSB) then percuss for shifting dullness
Palpation: Liver, spleen, kidneys, abdominal aorta

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16
Q

What does pain radiation to the back suggest?

A

Pancreatitis
Leaking AAA
Peptic ulcers

17
Q

Describe the nature of the pain in biliary colic

A

Relatively constant (not colicky)

18
Q

What does worsening of pain with movement suggest?

A

Intraabdominal origin

Peritonitis

19
Q

What does worsening of pain with deep breathing suggest?

A

Basal pneumonia
PE
Pneumothorax
Pericarditis

20
Q

What does the triggering of pain by fatty meals suggest?

A

Biliary colic

21
Q

What is indicated by pale stool? What is indicated by foul smelling, floating stools?

A

Pale: Bile not reaching bowel
Foul: Poor digestion of fat- due to pancreatic exocrine insufficiency/ chronic biliary obstruction

22
Q

What are patients with a history of gallstone disease prone to?

A

Recurrence of gallstones

Complications: Acute pancreatitis, acute cholecystitis, ascending cholangitis

23
Q

What are patients with a history of peptic ulcer disease prone to?

A

Perforated peptic ulcer

24
Q

What are patients with a history of GORD prone to?

A

Recurrence

25
Q

What are patients with a history of arterial disease prone to?

A

MI

Mesenteric ischaemia

26
Q

List 4 causes of jaundice presenting with epigastric pain

A

Ascending cholangitis
Gall-stone + non gallstone induced acute pancreatitis
Acute hepatitis

27
Q

What causes Cullens or Grey Turners sign?

A

Acute haemorrhagic pancreatitis

28
Q

Which diseases cause localised tenderness of the epigastrium?

A

Acute cholecystitis

Mild pancreatitis

29
Q

What causes severe, generalised tenderness, guarding and board like rigidity?

A

Peritonitis

30
Q

What are the components of the Glasgow scale?

A 
PANCREAS
Pa O2 <8 kPa
Age >55y
Neutrophilia >15 x 10^9
Calcium < 2 mM
Renal function: urea > 16mM
Enzymes: LDH >600 or AST > 200
Albumin < 32
Sugar >10 mM

YR3: MM FC Ed. (46 decks)

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