ABDO PAIN Flashcards
What is visceral pain?
Non specific pain that is poorly localised and not affected by movement
What is parietal pain?
Localised pain
Peritonitic
Worse by movement
Whats the most common initial and later pain course for gall bladder problems?
Initially epigastrium
Later RUQ
Whats the most common initial and later pain course for pancreas problems?
Initially epigastrium
Later back
Whats the most common initial and later pain course for appendix problems?
Initialy periumbilical
Later RIF
Whats the most common initial and later pain course for meckels diverticulitis?
Initially periumbilical
Later lower
Whats the most common initial and later pain course for diverticulitis?
Initially lower
Later LIF
Whats the most common initial and later pain course for a perforated duodenal ulcer?
Initially epigastrium
Later upper and RIF
What are examples of true acute causes of abdominal pain?
Perforation
Bleeding - ruptured AAA
Obstruction
Ischaemia
Volvulus
Whats the difference between colic and ‘itis’?
Colic is pain that comes and goes. This suggests an obstruction
‘Itis’ is persistent pain that suggests inflammation
What are examples of colicky abdo pain?
Bowel colic
Biliary colic
Ureteric colic
In labour
What are examples of colicky pain that becomes consistent?
Biliary colic
Later cholecystitis
Later pancreatitis
What associated factors should you ask about with abdominal pain?
GI - Vomiting, bowel changes, bleeding, weight loss, fever
Urology - frequency, UTI, bleeding
Gynae- PV bleeding, dysmenorrhea
Vascular - dizziness esp on standing, sweaty, palpitations
Where does cholecystitis pain refer to?
The right shoulder
What are causes of abdominal pain?
Intraperitoneal - GI, gynae, urinary tract, vascular
Extraperitoneal - abdominal wall, referred pain, spine
Medical - cardiac, resp, functional, renal, endocrine, neurology
What are the 4 symptoms and 4 signs of bowel obstruction
Colicky pain
Vomiting
Distension
No bowel movements
(4 signs - Abdo distension, tympanic percussion, bowel sounds active, visible peristalsis if pt is very thin)
What is constipation?
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).
What are the causes of constipation?
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
What is slow transit constipation?
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.
