Abdo pain Flashcards
Perforated viscus
Any GI organ can perforate.
e.g. IO, Peptic ulcer, appendix, diverticula, HCC
Ruptured AAA
Severe peritonitis and hypotension.
Ruptured ectopic pregnancy
Classic vaginal bleeding + abdo pain
Vaginal bleeding not always present
Spontaneous bacterial peritonitis + Peritoneal dialysis related peritonitis
Patients on PD can get bacterial infection of intra-peritoneal fluid.
Present with generalized peritonitis.
Testicular torsion
High-riding tender testes lying transversely with loss of cremasteric reflex.
Epididymo-orchitis
Positive Prehn’s sign
Gradual pain onset
A/w UTI symptoms
Cholecystitis
RUQ pain lasting hours. May radiate to right shoulder.
May have low-grade fever.
Murphy’s sign classic
No jaundice
Acute cholangitis
Charcot triad = RHC pain, Fever, Jaundice
Raynaud Pentad = Neurological symptoms, hypotension
Pt is sicker than in cholecystitis.
Cholecystic liver enzyme pattern = ALP GGT > AST ALT
Acute hepatitis
Fever, jaundice, tender hepatomegaly
Non-specific symptoms e.g. N/V.
ALT AST > ALP
Hepatic abscess
Fever
sometimes with jaundice or hepatomegaly
Acute pancreatitis
Steady epigastric and periumbilical pain, radiating to back.
Relieved on bending forward
Persistent nausea, frequent vomiting.
Look out for signs of haemorrhagic pancreatitis
Appendicitis
Classic dull periumbilical (referred) pain migrating to RIF.
Localized RIF guarding + rebound tenderness.
Anorexia -> abdo pain -> vomiting -> fever
Alvarado score for assessment.
Diverticulitis
Low-grade fever
Possible tender, palpable mass
Change in bowel habits
Sometimes urinary urgency and frequency + sterile pyuria
Rarely hematochezia.
Acute abdo suggests perforation and peritonitis
Meckel’s diverticulum
Indistinguishable from acute appendicitis
Intestinal obstruction
Abdo distension
Abdominal colic
No bowel output
N/V
Constipation colic
Diagnosis of exclusion. Common in elderlies.
Adhesion colic
Common with prior surgery
Intermittent colic pain
Diagnosis of exclusion
Adhesions are between bowel loops
Mesenteric ischemia
Severe generalized non-specific pain.
Classic scenario is someone with AF or other embolic RFs.
Abdo exam is normal. But with ischemia progression, **bowel sounds become sluggish, abdominal distension develops. **
Peritoneal signs develop and patient turns hypotensive.
Lactate will be raised.
Urolithiasis
Loin to groin colic. Often severe. Higher obstruction can cause flank pain.
Consider pyonephrosis if there are signs of infection.
Pyelonephritis
Flank pain
Fever
Positive renal punch
Consider pyonephrosis if there is obstructed system
Pelvic Inflammatory disease
Young sexually active lady. With lower abdo pain and features of infection.
Exam finds cervical excitation, adnexal tenderness, adnexal masses. Vaginal speculum may find vaginal discharge.
Ovarian torsion
Ruptured ovarian cyst
Acute-onset unilateral pelvic pain.
Can have adnexal mass.
Hypercalcemia
Abdo pain is cardinal feature, tgt with altered mental state, urolithiasis, bony pain and constipation.
Adrenal crisis
Can present with abdo pain.
Other clues include borderline hypotension, postural hypotension, hypoNa, HyperK and hypoglycemia
Biliary colic
Episodic RHC pain
Often post-fatty meals, can have N/V
No jaundice. Liver enzymes normal
GERD
Post-prandial heartburn-like discomfort.
Worse on supine. Can have cough
Dyspepsia
Mostly functional causes.
Look out for red flags such as malignancy signs
Irritable Bowel Syndrome
Recurrent abdo pain.
Classically relieved by defecation, with changes in stool frequency and consistency
Inflammatory bowel disease
Present with flares of abdo colic and bloody diarrhoea
Dysmenorrhoea
Cause of cyclical pelvic pain.
Can be 1! or 2! to endometriosis or leiomyoma.
Can have heavy menstrual bleeding.
Exam can find Pouch of Douglas tenderness, adnexal masses or enlarged uterus
Chronic pancreatitis
Steatorrhoea, new-onset or worsening diabetes..
Patients can have significant weight loss, mimicking pancreatic Ca.
Abdo imaging shows pancreatic calcification
Other cancers or masses!!! All abdo pain
