Abdomen- Signs and Symptoms Flashcards
Memorize the signs and symptoms of each disease of the abdomen included in CP1
List the symptoms of acute appendicitis.
- Abdominal pain, starting dull and central before becoming localised and sharp in the RIF at McBurney’s point. (1/3rd of the way between the ASIS and the umbilicus)
- Constipation
- Anorexia
- Nausea and vomiting (AFTER the pain)
List the signs of acute appendicitis.
- Rebound (when examiner moves his hand away) in the RIF
- Percussion tenderness
- Guarding
- Rosving’s sign (more painful in RIF than LIF when LIF is pressed)
- PR painful on RHS (if pelvic appendix, or pus in pouch of Douglas)
- Tachycardia
- Mild fever, flushing and fetor
- Tender mass (occasionally)
- Psoas sign (pain on R. hip extension)
- Obturator sign (pain on internal rotation of R. hip: pelvic appendix)
What is the usual presentation of Meckel’s diverticulum, and what conditions may it mimic?
Meckel’s diverticulum is usually asymptomatic. The conditions it may mimic include;
- Caecal volvulus (if tethered to the umbilicus, the diverticulum may act as the apex of a volvulus)
- Intussusception (often gangrenous by the point of operation)
- Appendicitis (diverticulum becomes inflamed, presenting identical to appendicitis (sometimes also with umbilical cellulitis)
- Peptic Ulceration (pain around the umbilicus that is related to mealtimes, due to ulceration of the gastric secreting epithelium)
What is the location of Meckel’s diverticulum?
20 inches (60cm) from the ileocecal valve
Describe the symptoms that may suggest a diagnosis of IBS.
In the preceding 12 months there should be at least 12 consecutive weeks of abdominal discomfort or pain, with 2 out of 3 of the following features:
- Relieved with defecation - Onset associated with a change in frequency of stool - Onset associated with a change in form of stool
List other symptoms of IBS that may present alongside those within the definition of IBS.
- Bloating
- Passage of mucus
- Stool passage symptoms (tenesmus; feeling of incomplete evacuation)
- Associated gynaecological symptoms (dysmenorrhoea/ dyspareunia)
- Urinary symptoms (frequency, urgency, nocturia)
- back pain.
Describe the common presenting symptoms of Crohn’s disease.
- Abdominal pain - Diarrhoea (steatorrhea in ileal disease, bloody in colonic disease)
- Weight loss
- Severe apthous ulceration of the mouth (early sign)
- Anal complications (fissure, fistula, haemorrhoids, skin tags, abscesses)
- Extra GI manifestations
- Can present with acute RIF pain/mass
Describe the common presenting symptoms of Ulcerative Colitis.
- Crampy lower abdominal discomfort
- Gradual onset diarrhoea (often bloody)
- Urgency and tenesmus if disease confined to rectum
- Extra GI symptoms
List the extra-colonic manifestations of Inflammatory Bowel Disease.
- Eyes: conjunctivits/ episcleritis/ iritis
- Joints: Arthralgia of the large joints
- Skin: Erythema nodosum, Pyoderma gangrenosum
- Others: Venous thrombosis, fatty liver
List diseases associated with IBD, unrelated to disease activity.
- Autoimmune hepatitis
- Gallstones
- Renal calculi
- Primary sclerosing cholangitis
- Cholangiocarcinoma
- Ankylosing spondylitis (related to HLA B27)
Discuss the definition of ‘dyspepsia’.
- Chronic upper abdominal pain/ discomfort
- It can be subdivided into 1) Reflux type (heartburn and regurgitation aka GORD) 2) Ulcer type (epigastric pain)
3) Dysmotility type ( bloating and nausea)
Name the typical symptoms of gastro-oesophageal reflux disease
- Heartburn/ Indigestion (dyspepsia) (worse on bending/lying down, when drinking hot liquids or alcohol) (relieved by antacids)
- Regurgitation of food/acid (passive process, c.f vomiting) (More common when bending/ lying)
- Aspiration
- Odynophagia
- There may be atypical chest pain due to distal oesophageal muscle spasm and a nocturnal cough/ wheeze giving asthma type symptoms.
List the symptoms that would suggest gastric cancer
- Often non-specific
- Epigastric pain (as with gastric peptic ulcer)
- Nausea and vomiting
- Dysphagia (if the tumour is near the fundus)
- Anorexia and weight loss
List the signs that would suggest gastric cancer
- Palpable epigastric mass
- Large left supraclavicular node (Virchow’s)
- Hepatomegaly, jaundice, ascites
- Acanthosis nigracans
List the symptoms of gastric ulcer disease
- Epigastric pain (related to food intake, relieved by antacids)
- Nausea
- Anorexia and Weight Loss
- Haematemisis/ Maleana
List the symptoms and signs of Upper Gastrointestinal Bleeding
Symptoms: - Haematemis - Malaena - Haematochezia - Abdominal pain
Signs: of any underlying cause, and shock
List the clinical features of diverticular disease
- Left sided colic, relieved by defecation
- Altered bowel habit (including blood and mucus passage)
- Nausea
- Flatulence
- Severe pain and constipation if severe
List the symptoms of diverticulitis
- Severe left sided colic
- Constipation (or overflow diarrhoea)
- Symptoms mimicking appendicitis but on the left
List the signs of diverticulitis
- Fever and tachycardia
- Tenderness, guarding and rigidity on the left side
- Can be palpable mass in the LIF
- Raised WCC and inflammatory markers
List the common symptoms suggestive of carcinoma of the colon, rectum and anus
Any colorectal tumour may present with an abdominal mass, abdominal pain, perforation or fistula
- Right sided (proximal) tumours are often asymptomatic and may present with IDA/ weight loss
- Left sided tumours more commonly present with PR blood/mucus, altered bowel habit, tenesmus, obstruction and a mass on PR examination
- Anal tumours may present with bleeding, pain, changes in bowel habit, pruritis ani, masses or a stricture
Describe the symptoms of Haemorrhoids
- Rectal bleeding (bright red blood on paper)
- Prolapse
- Mucous discharge
- Pruritis ani
- Pain if the piles become thrombosed
Describe the complications of Haemorrhoids
- Anaemia (If severe/ continued bleeding)
- Thrombosis (If prolapsing piles are gripped by the anal sphincter the venous return is occluded, leading to thrombosis. The haemorrhoids swell , become purple and cause significant pain and distress)
Outline the symptoms of a patient with perianal infection
Present with a visibly red, exquisitely tender swelling next to the anus
Describe the symptoms of a patient with Fissure in Ano
- Pain (worse of defacation, lasting for hours afterwards)
- Associated constipation
- Pruritis ani
- Bleeding on defecation
