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GI > 3- abdominal pain & acute abdomen > Flashcards

3- abdominal pain & acute abdomen Flashcards

1
Q

what region is pain felt in from
a) foregut
b) midgut
c) hindgut

A

a) epigastric pain
b) umbilical
c) hypogastric pain

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2
Q

what is pain assessment acronym? (first one you use when taking history?)

A

SOCRATES

site, onset, character, radiation, associated symptoms, timing, exacerbating/relieving factors, severity

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3
Q

what is pain areas for appendicitis etc?

A

starts vague when visceral peritoneum but when parietal peritoneum starts to become irritated, more specific area of pain

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4
Q

what are associated symptoms of abdominal pain to ask about?

A
  • ANS activated - nausea, sweating
  • cytokine effects - malaise, fever
  • oral - appetite, diet, vomit (volume, frequency, colour, blood)
  • anus - diarrhoea, PR blood
  • urinary - colour, blood, frequency
  • vagina - abnormal discharge, periods, pregnant
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5
Q

what is acute abdominal pain usually like?

A

generally 7 days or less

  • usually sharp (parietal peritoneum)
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6
Q

what is chronic abdominal pain usually like?

A

= weeks, months,years

  • social, psychological issues
  • often varying intensity
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7
Q

what acronym can you ask about after SOCRATES - for further questions?

A

RED M&S SOFA

R = radiology history →scans
E = endoscopy history
D = drugs→blood thinners? (bad for surgery)
M = medical history
&
S = surgical history
S = social history (smoking, drinking)
O = last oral intake
F = family history
A = allergies

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8
Q

what can cause pain felt in right hypochondriac region?

A
  • gallstones
  • stomach ulcer
  • pancreatitis
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9
Q

what can cause pain felt in left hypochondriac region?

A
  • stomach
  • ulcer
  • duodenal
  • biliary colic
    -pancreatitis
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10
Q

what can cause pain felt in epigastric region?

A
  • stomach ulcer
  • heartburn/indigestion
  • pancreatitis, gallstones
  • epigastric hernia
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11
Q

what can cause pain felt in right lumbar region?

A
  • kidney stones
  • urine infection
  • constipation
  • lumbar hernia
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12
Q

what can cause pain felt in left lumbar region?

A
  • kidney stones
  • diverticular disease
  • constipation
  • inflammatory bowel disease
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13
Q

what can cause pain felt in umbilical region?

A
  • pancreatitis
  • early appendicitis
  • stomach ulcer
  • inflammatory bowel
  • small bowel
  • umbilical hernia
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14
Q

what can cause pain felt in right iliac region?

A
  • appendicitis
  • constipation
  • pelvic pain
  • groin pain
  • inguinal hernia
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15
Q

what can cause pain felt in left iliac region?

A
  • diverticular disease
  • pelvic pain
  • groin pain
  • inguinal hernia
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16
Q

what can cause pain felt in pubic region?

A
  • urine infection
  • appendicitis
  • diverticular disease
  • inflammatory bowel
  • pelvic pain (gynae)
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17
Q

what are initial management priorities of abdominal pain?

A
  • pain relief
  • simple quick tests = urinalysis, bloods, x-ray
  • consider oxygen
  • IV fluids
  • consider blood transfusion if bleeding
  • consider early IV antibiotics if strong suspicion of sepsis
  • consider CT or other scans
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18
Q

what inflammations of things can lead to peritonitis (inflammation of peritoneum)?

A
  • Appendicitis
  • Cholecystitis
  • Pancreatitis
  • Peptic ulcer
  • Diverticulitis
  • GI tract perforation
  • Acute mesenteric ischaemia
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19
Q

what are serious medical things that cause acute abdomen pain (like conditions - not organ stuff in abdomen)?

A
  • Diabetic ketoacidosis
  • Pyelonephritis
  • Inferior MI
  • PE or Lower lobe pneumonia
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20
Q

what obstructions can cause acute abdominal pain?

A
  • Bowel obstructions
  • Strangulated hernia
  • Renal colic
21
Q

what are causes of shock causing acute abdomen pain?

A
  • Leaking AAA / dissection
  • Ectopic pregnancy
22
Q

what is felt on physical exam for peritonitis?

A

guarding & tender (bumps in road sore), look different to obstructive

23
Q

what are symptoms of obstructive causes for abdominal pain?

A

distended, vomiting, no wind (blocked pipe)

24
Q

what is seen on end of bed test for peritonitis?

A
  • Flushed face
  • Motionless
  • Foetal position
  • Shallow rapid respiration
25
Q

what is seen on end of bed test for obstruction abdominal pain?

A
  • Distended abdomen
  • Sick bowls
  • Vomiting
26
Q

what is seen on end of bed test if less concerning abdominal pain?

A
  • Crying / sobbing
  • Sunglasses
  • Away for a smoke
27
Q

what are causes of shock?

A
  • inadequate fluid absorption(insufficient intake or vomiting)
  • blood loss (AAA, ectopic pregnancy, trauma)
  • pump failure (MI)
  • loss of systemic vascular resistance (sepsis)
  • leaky capillaries from inflammatory response (sepsis, peritonitis, pancreatitis)
28
Q

what should you look for on inspection of abdomen in clinical exam?

A
  • Surgical scars
  • Distended abdomen
  • Obvious masses… and is it pulsatile
  • External hernia
  • Discolored skin changes
  • Visible organomegaly (unusual)
  • Stigmata of liver failure e.g. ascites, jaundice
29
Q

what blood tests should be done for abdominal pain?

A
  • full blood count = white cell count + neutrophil
  • U&E’s = urea & electrolytes (renal function)
  • amylase (marker for pancreatitis)
  • LFTs (liver function tests)
  • glucose
30
Q

what radiography scans can be done for abdominal pain?

A
  • x-rays →not massively helpful but quick and sometimes do
  • CT scan →good for when people very ill
  • abdominal ultrasound →use a lot, good for gallbladder disease good for gallstones and urinary tract stones, good for ectopic pregnancy, used in trauma
  • erect chest x-ray →essential for upper abdominal pain, especially if sudden pain (done when sitting upright)
31
Q

what requires immediate surgical intervention?

A

ruptured AAA(abdominal aortic aneurysm), ruptured ectopic pregnancy, bleeding spleen, liver, mesentery

32
Q

what is common presentation for ruptured AAA? how treat?

A

abdominal aortic aneurysm -present with shock, pulsatile mass in abdomen, elderly male w hypertension +PVD

  • treat by fix with graft in open surgery or radiologically
33
Q

what are causes of urgent surgical intervention?

A
  • Appendicitis
  • Perforation (peptic ulcer, diverticular perforation)
  • Bowel obstruction with tender abdomen ?ischaemic bowel
  • Mesenteric ischaemia
  • sigmoid volvulus = twist in bowel
  • Sepsis
  • Persistent, significant bleeding
34
Q

what timeframe is
a) immediate surgical intervention
b) urgent surgical intervention
c) non-urgent surgical intervention

A

a) immediately
b) with 4-6 hours
c) within 48 hours

35
Q

what is common presentation of acute appendicitis?

A
  • Migratory pain (umbilicus to Right Iliac Fossa)
  • Nausea / vomiting
  • Loss of appetite
  • Mild fever
  • Looks flushed
  • Guarding RIF – McBurney’s point = 1/3 from ASIS to umbilicus (where base of appendix lies →most tender point)
36
Q

what is perforation look like on xray?

A

pneumoperitoneum = free air under diaphragm

37
Q

what is mesenteric ischaemia?

A

cause for urgent surgical intervention = blood supply blocked off to gut - difficult to diagnose as vague symptoms and can be tricky on CT scan

can be very devastating

38
Q

what is common presentation of incarcerated hernia?

A

cause for urgent surgical intervention
- sudden onset of pain →usually femoral or inguinal
- Forceful brown liquid vomiting
- Clinical exam usually reveals diagnosis (except in obturator hernia)

39
Q

when can toxic megacolon occur? what urgency of surgery is required?

A

large colon becomes distended and loses blood uppy →happens in IBD or c.difficile colitis
= required urgent surgical intervention

40
Q

what are most common causes of non-surgical intervention?

A
  • Cholecystitis
  • Simple Small Bowel Obstruction (ie. Without suspicion of dead bowel)
  • Diverticulitis
  • Simple incarcerated hernia (ie. Not strangulated hernia with bowel inside)
41
Q

what is acute cholecystitis?

A

= very common, often some sort of blockage problem (usually gallstone) - inflammation of gallbladder

42
Q

what is common presentation of acute cholecystitis?

A
  • get epigastric pain and can move to right upper quadrant pain
  • vomiting, fever
  • murphy’s sign →deep breaths as move to right upper quadrant, can feel very inflamed gallbladder and patient gets pain as it hits our hand
43
Q

what test for acute cholcystitis?

A

ultrasound

44
Q

what is small bowel obstruction?

A

= cause for non-urgent surgical intervention
= most caused by adhesions or hernias (others: incarcerated hernia, cancer deposits, Crohn’s, gallstone ileus)

45
Q

what is treatment and scan to confirm diagnosis of small bowel obstruction?

A

→CT scan to confirm (can do x-ray)

treatment = compress gut, treat with fluids and keep eye on nutrition →if fails the surgery

46
Q

how can you identify small bowel obstruction on
a) abdominal x-ray
b) CT

A

a) laddering of small bowel - fluid filled loops
b) dilated then collapsed bowel (transition point)

47
Q

what is acute pancreatitis? what are 2 most common causes?

A

common = infection of pancreatitis
= gall stones & alcohol

48
Q

what is mnemonic for remembering causes of pancreatitis?

A

I – Idiopathic

G – Gallstones (esp calculi <5 mm) & Genetic mutations

E – Ethanol/ alcohol (especially spirits)

T – Trauma & obstructing Tumors of the pancreas

S – Surgery & Steroids

M – Mumps & other infectious triggers

A – Autoimmune

S – Scorpion stings (Tityus trinitatis)

H – Hypercalcaemia / Hyperlipidaemia

E – ERCP-induced pancreatitis

D – Drug side-effect

&

S – Smoke (duration associated with non-Gallstone AP)

49
Q

what do you need to diagnose pancreatitis?

A

to diagnose need 2 out of 3

  1. epigastric pain
  2. elevated enzyme (amylase 3x normal)
  3. imaging confirmation with CT or other

GI (56 decks)

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