Abdo pain common causes

Question 1

RUQ pain

Caused by a gallstone getting lodged in the bile duct

Classically provoked by eating a fatty meal

In contrast to acute cholecystitis no fever and inflammatory markers are normal

Answer 1

Biliary colic

Question 2

RUQ pain

Inflammation/infection of the gallbladder secondary to impacted gallstones

Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)

Fever and raised inflammatory markers

Answer 2

Acute cholecystitis

Question 3

RUQ pain

Ascending cholangitis is a bacterial infection of the biliary tree. The most common predisposing factor is gallstones.

Charcot’s triad of right upper quadrant pain, fever and jaundice occurs in about 20-50% of patients

Answer 3

Ascending cholangitis

Question 4

Epigastric pain, sometimes radiating to back

Usually due to alcohol or gallstones

Pain is often very severe. Examination may reveal tenderness, ileus and low-grade fever

Answer 4

Acute pancreatitis

Question 5

Epigastric pain

There may be a history of NSAID use or alcohol excess.

Duodenal ulcers: more common than gastric ulcers, epigastric pain relieved by eating

Gastric ulcers: epigastric pain worsened by eating

Features of upper gastrointestinal haemorrhage may be seen (haematemesis, melena etc)

Answer 5

Peptic ulcer disease

Question 6

RIF pain

Pain initial in the central abdomen before localising to the right iliac fossa (RIF).

Anorexia is common. Tachycardia, low-grade pyrexia, tenderness in RIF

Rovsing’s sign: more pain in RIF than LIF when palpating LIF

Answer 6

Appendicitis

Question 7

LLQ pain

Colicky pain typically in the LLQ

Diarrhoea, sometimes bloody.

Fever, raised inflammatory markers and white cells

Answer 7

Acute diverticulitis

Question 8

Central pain

History of malignancy (intraluminal obstruction)/previous operations (adhesions)

Vomiting. Not opened bowels recently

‘Tinkling’ bowel sounds

Answer 8

Intestinal obstruction

Question 9

Loin pain radiating to the groin

Pain is often severe but intermittent. Patients are characteristically restless.

Visible or non-visible haematuria may be present

Answer 9

Renal colic

Question 10

Loin pain

Fever and rigors are common as is vomiting

Answer 10

Acute pyelonephritis

Question 11

Suprapubic pain

Caused by obstruction to the bladder outflow.

Much more common in men, who often have a history of benign prostatic hyperplasia

Answer 11

Urinary retention

Question 12

RIF or LIF pain

Typically presents with pain and a history of amenorrhoea for the past 6-9 weeks. Vaginal bleeding may be present

Answer 12

Ectopic pregnancy

Question 13

Central abdominal pain radiating to the back

Presentation may be catastrophic (e.g. Sudden collapse) or sub-acute (persistent severe central abdominal pain with developing shock)

Patients may be shocked (hypotension, tachycardic)

Patients may have a history of cardiovascular disease

Answer 13

Ruptured abdominal aortic aneurysm

Question 14

Central abdo pain

Patients often have a history of atrial fibrillation or other cardiovascular disease

Diarrhoea, rectal bleeding may be seen

A metabolic acidosis is often seen (due to ‘dying’ tissue)

Answer 14

Mesenteric ischaemia