Abdo pain differentials and presentations Flashcards
Abdo pain differentials
-appendicitis
-acute cholecystitis
-ovarian torsion
-bowel obstruction
-ruptured ectopic pregnancy
-ACS
-rAAA
-renal colic
Appendicitis presentations
-umbilical pain shifting to RLQ
-low grade fever
-nausea and vomiting
-diarrhoea/ constipation
-rovsing sign (when press in LLQ and feel pain in RLQ)
-psoas sign (can’t lift right leg or causes a lot of pain)
Appendicitis pathophysiology
-appendix becomes obstructed predominantly by fecaliths (hardened stool), tumours, foreign bodies
-obstruction prevents normal mucus drainage
-fluid accumulates and bacteria divides (proliferates) causing inflammation
-pressure on appendiceal blood vessels increases leading to ischaemia and necrosis
-if untreated can lead to rupture, bacteria spill into peritoneal cavity
Acute cholecystitis presentations
-RUQ pain
-worse after eating meals high in fat
-nausea and vomiting
-low grade fever
-murphy’s sign- ask breathe out, place fingers under ribs, on inspiration, liver and gallbladder move onto fingers causing pain
Acute cholecystitis pathophysiology
-inflammation of gall bladder, usually due to gallstone blocking cystic duct and the bladder distending
Pathophysiology
-gallstones form (hardened collection of bile)
-lodges in duct and blocks flow of bile
-gall bladder inflames and distends
-oedema of gall bladder or cystic duct
-oedema further obstructs bile and irritates
-cells become ischaemic and then infarct as the organ distends and presses on vessels, impeding blood flow
Ovarian torsion presentations
-sudden severe unilateral pelvic pain/ lower abdo
-N+V
-possible fever if necrosis
Ovarian torsion pathophysiology
-ovary enlarges making it more mobile commonly due to ovarian cysts, tumour
-ovary twists around its ligaments compressing ovarian arteries and veins
-this impairs venous drainage leading to oedema
-compressed ovarian arteries can lead to decrease O2 supply causing ischaemia or necrosis
-if this persists, ovary may rupture causing peritonitis and sepsis
Bowel obstruction presentations
-abdo distension
-faecal vomit
-absent (late)/ tinkling (early) bowel sounds
-absence of faeces
-crampy intermittent abdo pain
Bowel obstruction pathophysiology
-blockage prevents forward movement of intestine contents
-gas and fluid build up causing distension
-pressure builds up compressing intestinal blood vessels causing ischaemia
-stagnant intestine contents allow bacteria proliferation increasing risk of sepsis
Ruptured ectopic pregnancy presentations
-sudden sharp lower abdo pain (unilateral)
-missed period/ early pregnancy
-vaginal bleeding
Rupture
-dizzy, syncope, shock
-abdo distension and guarding
Ruptured ectopic pregnancy pathophysiology
-fertilized egg fails to reach uterus and implants most commonly in fallopian tube
-embryo stretches thin walled fallopian tube
-can’t stretch like uterus so ruptures 6-10 wks gestation
-causes severe internal bleeding
-leading to hypovolemic shock
Renal colic presentations
-acute severe flank pain radiates to groin
-restlessness
-N+V
-urgent need to urinate
-haematuria
-dysuria (painful urination)
Less common
-fever, tachycardia, hypotension
Renal colic pathophysiology
-electrolytes ppt into crystals which can enlarge to form kidney stones
-when stone moves to ureter it causes partial/ complete blockage causing urine build up
-increases pressure within ureter causing flank pain and can lead to oedema
-ureter becomes inflamed activating sensory nerves and severe pain perception
