Abdominal

Question 1

What are the red flags for an abdominal pain presentation?

Answer 1

• acute onset abdominal pain

Populations:

• pregnant
• over 65
• alcoholic
• recent abdo surgery
• CVD

GIT:

• dysphagia
• new onset dyspepsia
• persistent vomiting
• haematemesis
• changes in bowel habit over 3 weeks

GU:

• unusual vaginal discharge
• post coital bleeding
• rectal or vaginal bleeding
• haematuria
• amenorrhea

Pre-syncopal episode:

• dizziness / vertigo
• blurry / narrowed vision
• nausea / vomiting
• headache
• sweating
• palpitations

Other:

• pallor / sweating
• rebound tenderness
• guarding

Question 2

What are the 9 serious conditions that need to be considered in an abdominal pain presentation?

Answer 2

Myocardial ischaemia
Aortic dissection
Mesenteric artery ischaemia
Cancer (bowel, stomach, ovarian)
Hepatitis
Appendicitis
Diverticulitis
Pelvic inflammatory disease
Ectopic pregnancy

Question 3

Which 6 gastrointestinal complaints can commonly cause abdominal pain?

Answer 3

Gastroenteritis
Gastritis
Peptic ulcer
Food allergies
IBS
IBD

Question 4

Which 4 GU / reproductive complaints can commonly cause abdominal pain?

Answer 4

Dysmennorhea
Endometriosis
Uterine fibroids
PCOS

Question 5

Which 4 musculoskeletal complaints can commonly cause abdominal pain?

Answer 5

Myofascial tear
Myofascial adhesions
Abdominal hernia
Side strain

Question 6

What is the typical presentation of appendicitis?

Answer 6

• diffuse visceral pain over right lower quadrant progressing to severe somatic pain over 2-6 hours (as infection spreads to parietal peritoneum)
• positive McBurney’s
• nausea / anorexia
• dyspepsia
• maybe bowel change and mild fever

Question 7

What is the typical presentation of diverticulitis?

Answer 7

• severe left iliac fossa pain
• guarding and rigidity at left iliac fossa
• constipation and/or diorrhea
  (most common in elderly patients)

Question 8

Describe the condition of an abdominal hernia including presentation, mechanism and pathology, and prognosis

Answer 8

Pathology:
- protrusion of small intestine through abdominal wall (inguinal or abdominal)

Mechanism:

• direct (acute overload of abdo mm)
• indirect (typically congenital, occurs in infants)

Presentation:

• sharp, well localized pain
• agg by: lifting, coughing, bending over, Valsalva, post eating

Rel by:
- rest, lying supine

• may have a palpable or visible bulge

Risk factors:

• weak abdo mm
• overuse of abdo mm (pregnancy, obesity, chronic cough, heavy lifting, straining during bowel movements)
• trauma (surgery)

Prognosis:
- requires surgical intervention

Question 9

Describe the presentation of pancreatitis

Answer 9

• severe LUQ pain, maybe referring to Lt scapula
• bloating, nausea, vomiting
• fever

Question 10

Describe the presentation of cholecystitis

Answer 10

(inflammation of gall bladder caused by impacted gallstone and biliary stasis)

• acute onset RUQ pain, maybe referring to right shoulder
• positive Murphy’s sign
• maybe fever

If gall stone impacted in bile duct, classic triad of SSX:

• RUQ pain
• jaundice
• fever