ABDO PAIN

Question 1

What is visceral pain?

Answer 1

Non specific pain that is poorly localised and not affected by movement

Question 2

What is parietal pain?

Answer 2

Localised pain
Peritonitic
Worse by movement

Question 3

Whats the most common initial and later pain course for gall bladder problems?

Answer 3

Initially epigastrium
Later RUQ

Question 4

Whats the most common initial and later pain course for pancreas problems?

Answer 4

Initially epigastrium
Later back

Question 5

Whats the most common initial and later pain course for appendix problems?

Answer 5

Initialy periumbilical
Later RIF

Question 6

Whats the most common initial and later pain course for meckels diverticulitis?

Answer 6

Initially periumbilical
Later lower

Question 7

Whats the most common initial and later pain course for diverticulitis?

Answer 7

Initially lower
Later LIF

Question 8

Whats the most common initial and later pain course for a perforated duodenal ulcer?

Answer 8

Initially epigastrium
Later upper and RIF

Question 9

What are examples of true acute causes of abdominal pain?

Answer 9

Perforation
Bleeding - ruptured AAA
Obstruction
Ischaemia
Volvulus

Question 10

Whats the difference between colic and ‘itis’?

Answer 10

Colic is pain that comes and goes. This suggests an obstruction
‘Itis’ is persistent pain that suggests inflammation

Question 11

What are examples of colicky abdo pain?

Answer 11

Bowel colic
Biliary colic
Ureteric colic
In labour

Question 12

What are examples of colicky pain that becomes consistent?

Answer 12

Biliary colic
Later cholecystitis
Later pancreatitis

Question 13

What associated factors should you ask about with abdominal pain?

Answer 13

GI - Vomiting, bowel changes, bleeding, weight loss, fever
Urology - frequency, UTI, bleeding
Gynae- PV bleeding, dysmenorrhea
Vascular - dizziness esp on standing, sweaty, palpitations

Question 14

Where does cholecystitis pain refer to?

Answer 14

The right shoulder

Question 15

What are causes of abdominal pain?

Answer 15

Intraperitoneal - GI, gynae, urinary tract, vascular
Extraperitoneal - abdominal wall, referred pain, spine
Medical - cardiac, resp, functional, renal, endocrine, neurology

Question 16

What are the 4 symptoms and 4 signs of bowel obstruction

Answer 16

Colicky pain
Vomiting
Distension
No bowel movements
(4 signs - Abdo distension, tympanic percussion, bowel sounds active, visible peristalsis if pt is very thin)

Question 17

What is constipation?

Answer 17

Rome IV criteria defines it as having two or more of the following for at least 3 months:

infrequent passage of stools (<3/week),
• straining >25% of time,
• passage of hard stools (Bristol stool chart form 1–2) in >25% defecations
• incomplete evacuation and sensation of anorectal blockage in >25% defecations
• manual manoeuvres to facilitate >25% defecations (digital evacuation, support of the pelvic floor).

Question 18

What are the causes of constipation?

Answer 18

Inadequate fibre intake
Immobility
Diabetes mellitus
Hypercalcaemia
Hypothyroidism
Porphyria
IBS
Idiopathic slow transit
Opiate use
Antimuscarinic use
Calcium channel blockers
Antidepressant use
Iron use
Depression
Anorexia nervosa
Repressed urge to defecate - psych
Obstruction and pseudo-obstruction
Colonic disease
Aganglionosis
Painful anal conditions
Rectal prolapse, muscosal prolapse intususseceptuion and solitary rectal ulcer syndrome
Large recto eel
Pelvic floor dyssynergia or anismus
Megarectum

Question 19

What is slow transit constipation?

Answer 19

the reduced motility of the large intestine, caused by abnormalities of the enteric nerves. The unusually slow passage of waste through the large intestine leads to chronic problems, such as constipation and uncontrollable soiling.