Abdo Pain & Swelling

Question 1

Severe abdo pain with collapse - can be constant or coming in waves, rigidity, guarding, and rebound tenderness.

Answer 1

2/3 star
These symptoms are dangerous.
Could be caused by:
Acute Pancreatitis - presents with severe central abdo and back pain, vomiting and dehydration.

Ruptured aortic aneurysm, acute abdo pain with collapse, shock (low bp and rapid pulse)

Obstructed GB, rhs hypochondriac pain, intense and comes in waves, possibly jaundice, fever and vomiting.

Question 2

Pelvic inflammatory disease (acute)

Answer 2

2/3 star
Low abdo pain with collapse and fever and foul smelling discharge.
See A35 STD’s

Question 3

Acute testicular pain radiating to groin, scrotum, or lower abdo. May be vomiting and collapse

Answer 3

2/3 star
See A36. 11 red flags for diseases of the reproductive system.
Could be inflammation of the testicle (orchitis) or a twisted testicle (torsion). If pain very intense refer as emergency.

Question 4

Acute loin pain

Answer 4

2/3 star
Pain in flanks radiating to pubic region, possible vomiting agitation and collapse - could be kidney stones.
See A30.1

Question 5

Severe abdo pain in pregnancy

Answer 5

2/3 star
Refer as emergency if signs of shock (low bp <90/50, dizziness fainting, cold and clammy confusion heigh heart rate >100bpm)
If periodic and increasing in intensity in later pregnancy - this could be labour or pre eclampsia, In early pregnancy could be ectopic pregnancy. If mild periodic in later pregnancy likely to be braxton hicks.
See A

Question 6

Pre eclampsia - HELLP syndromes (haemolysis, liver abnormalities and low platelets)

Answer 6

3 star
Absolute emergency
Headaches, abdo pain visual disturbance, nausea, vomiting and oedema (in mid to late pregnancy)
See A37

Question 7

Right hypochondriac pain with malaise >3 days

Answer 7

**/*
Suggest chronic biliary or hepatic disease even in the absence of jaundice.
See A8 red flags of liver
A9 red flags of gall bladder

Question 8

Recurrent or persistent uti’s

Answer 8

**/*
Cloudy urine, burning, abdo discomfort, blood in urine, fever (esp. in men as they are particularly uncommon and so are more likely to signal un underlying disorder of the urinary tract ). If in women no need to refer if settling down within 5 days.
See A30 diseases of ureters, bladder and urethra.

Question 9

Recurrent or persistent uti’s

Answer 9

**/*
Cloudy urine, burning, abdo discomfort, blood in urine, fever (esp. in men as they are particularly uncommon and so are more likely to signal un underlying disorder of the urinary tract ). If in women no need to refer if settling down within 5 days.
See A30 diseases of ureters, bladder and urethra.

Question 10

Signs of an inguinal hernia.

Answer 10

**/*
Swelling in groin which is worse on standing. Due to weakness in abdo wall in region of the groin. Abdo contents can bulge outwards. Carries the risk of a loop of bowel becoming obstructed. This can cause a strangulation. The patient should be referred for surgical assessment. Refer urgently if it has become very painful over just a few hours.
See A10.5

Question 11

Pelvic inflammatory disease. (Chronic)

Answer 11

**/*
Vaginal discharge, gripy abdo pain, pain with intercourse, dysmenorrhea, infertility. Chronic PID poses a threat to fertility and may suggest an STD.
See A36 STD’s

Question 12

Pelvic inflammatory disease. (Chronic)

Answer 12

**/*
Vaginal discharge, gripy abdo pain, pain with intercourse, dysmenorrhea, infertility. Chronic PID poses a threat to fertility and may suggest an STD.
See A36 STD’s

Question 13

Pelvic pain or deep pain during intercourse

Answer 13

**/*
Suggests ovaries or uterine inflammation. If PID suspected refer as ** as STD likely. Otherwise refer routinely
See A36

Question 14

Early shingles

Answer 14

**
Intense 1 sided abdo pain, with fluid filled crops of blisters, red and crusting. Pain may precede blisters by a few days. Refer for early consideration of anti vitals. Shingles is an outbreak of the chicken pox virus that has laid dormant in the spinal nerve root since an earlier outbreak. Flare ups tend to happen when the person is rundown, been exposed to direct sunlight and is more common in the elderly. Refer same day so anti viral aciclovir may be administered asap. The condition is contagious so should be treated within 48 hrs of onset to ensure aciclovir has best chance of reducing the severity of pain.
See A25 diseases of spinal cord and peripheral nerves.

Question 15

Stable aortic aneurysm

Answer 15

• Pulsatile tubular mass in the abdomen over 5cm in length. Usually effects people >50 and associated with degenerative changes of atherosclerosis. Merits ultrasonography. Refer urgently if accompanied by a central abdo or back pain as early treatment can be life saving.
  See A11 diseases of the blood veins.

Question 16

Chronic pancreatitis

Answer 16

*
Central abdo and back pain weight loss and loose stools over weeks to months.
Can be caused by long term alcohol abuse, episodes of acute pancreatitis or due to inherited tendency.
See A7

Question 17

Epigastric pain or dyspepsia

Answer 17

*
Only if 1st time in someone >40 or if resistant to treatment after 3 months. Pain from stomach or duodenum typically radiates to the epigastrium. If stomach is inflamed it can be tender on palpation. There may be a sensation of dyspepsia (acidity or fullness) and respond well to dietary changes and complimentary medicines. Only refer if not responding to acu within 6weeks or if 1st time after age of 40 as risk of cancer more common. Persistent dyspeptic symptoms may result in Helicobacter pylori and may respond well to antibiotics. Helicobacter pylori is associated with increased risk of cancer.
See A6 diseases of the stomach.

Question 18

Abdominal swelling

Answer 18

*
Discrete suprapubic or inguinal mass, possible fibroids, ovarian cyst, tumour, pregnancy. If increasing over days to weeks could be ascites (fluid accumulation from a tumour)
See A36 structural disorders of the repro system.

Question 19

Chronic dull testicular pain

Answer 19

*
May radiate to the groin, scrotum or lower abdo. Possible epididymitis or varicocele.
See A36 structural disorder of reproductive system.