Abdominal pain

Question 1

Should be defined by:

Answer 1

Site
Nature of pain
Speed of onset
Progression
Associated features and odynophagia

Question 2

Site

Answer 2

Upper abdominal pain
– epigastric pain:
—- very common and is often related to food intake
—- dyspepsia is the normal diagnosis, however symptoms of peptic ulcer disease can be identical
—- heartburn- common symptom of GORD

– Right hypochondriac pain:
—- may originate from the gall bladder or biliary tract
—- biliary pain- often intermittent and severe, lasts a few hours and remits spontaneously, to recur weeks or months later
—- peptic ulcer disease can present in the right hypochondrium

Lower abdominal pain
– pain in the LIF:
—- may be colonic in origin (acute diverticulitis)
—- chronic pain in this region is most commonly associated with functional bowel disorders

Lower abdominal pain in women:
– occurs in a number of gynaecological disorders

Question 3

Nature of pain

Answer 3

Intermittent?
Constain pain usually arises from a solid organ
‘colic’ from obstruction usually intermittent

Question 4

Speed of onset

Answer 4

Rapid progression in a previously well patient suggests perforation of a hollow viscus, ruptured AAA, mesenteric infarction

Question 5

Progression

Answer 5

Abdominal complaints such as appendicitis may progress to peritonitis

Question 6

Associated features

Answer 6

Changes in bowel habits usually accompanies organic visceral pathology