12. Epigastric Pain Flashcards
What are 10 of the differential diagnoses for epigastric pain?
Acute pancreatitis Perforated peptic ulcer Gastritis/ duodenitis Peptic ulcer disease Biliary colic Acute cholecystitis Ascending cholangitis MI Ruptured AAA Mesenteric ischaemia
Where is the pain in peritonitis?
Epigastrum spreading to whole abdomen
Where is the pain in biliary diseases?
RUQ or epigastric
What does sudden onset epigastric pain suggest?
Perforation of a viscus
MI
How quickly does pain from acute pancreatitis and biliary colic develop?
Maximal intensity over 10-20 min
What does ‘sharp, burning’ epigastric pain suggest?
Peptic ulcers
Gastritis
Duodenitis
What does ‘deep’/ ‘boring’ epigastric pain suggest?
Pancreatitis
What does pain radiation to shoulder tip suggest?
Irritation of the phrenic nerve due to diaphragmatic involvement e.g. 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: infection/ widespread inflammation Dyspepsia Changes in stool Cough (basal pneumonia, GORD)
What 4 drugs may contribute to peptic ulcer disease?
NSAIDs
Steroids
Bisphosphonates (alendronate)
Salicylates (aspirin)
What 4 drugs may contribute to acute pancreatitis?
Sodium valproate
Steroids
Thiazides
Azathioprine
What score is used to assess the severity 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 AI Scorpion bites Hyperlipidaemia/ hypercalcaemia/ hypothermia Endoscopic retrograde cholangiopancreatography Drugs
What is an easy way to remember the order of an abdo exam?
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
What does pain radiation to the back suggest?
Pancreatitis
Leaking AAA
Peptic ulcers
Describe the nature of the pain in biliary colic
Relatively constant (not colicky)
What does worsening of pain with movement suggest?
Intraabdominal origin
Peritonitis
What does worsening of pain with deep breathing suggest?
Basal pneumonia
PE
Pneumothorax
Pericarditis
What does the triggering of pain by fatty meals suggest?
Biliary colic
What is indicated by pale stool? What is indicated by foul smelling, floating stools?
Pale: Bile not reaching bowel
Foul: Poor digestion of fat- due to pancreatic exocrine insufficiency/ chronic biliary obstruction
What are patients with a history of gallstone disease prone to?
Recurrence of gallstones
Complications: Acute pancreatitis, acute cholecystitis, ascending cholangitis
What are patients with a history of peptic ulcer disease prone to?
Perforated peptic ulcer
What are patients with a history of GORD prone to?
Recurrence
What are patients with a history of arterial disease prone to?
MI
Mesenteric ischaemia
List 4 causes of jaundice presenting with epigastric pain
Ascending cholangitis
Gall-stone + non gallstone induced acute pancreatitis
Acute hepatitis
What causes Cullens or Grey Turners sign?
Acute haemorrhagic pancreatitis
Which diseases cause localised tenderness of the epigastrium?
Acute cholecystitis
Mild pancreatitis
What causes severe, generalised tenderness, guarding and board like rigidity?
Peritonitis
What are the components of the Glasgow scale?
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
