Abdominal Pain Flashcards by Alfie Saunders

Sudden and severe abdominal pain causes?

Perforated ulcer
Ruptured aortic aneurism
Ureteral colic

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Colicky, crampy, intermittent pain causes?

Biliary colic
Small bowel obstruction
Colonic obstruction
Ureteral colic

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Gradual and more progressive pain causes?

Cholecystitis, hepatitis
Pancreatitis
Diverticulitis
Appendicitis
Tubo-ovarian abscess or ectopic pregnancy

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Cullen sign?

Periumbilical discolouration

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Grey-turner sign?

Bruising of flanks

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Lab tests for abdo pain?

FBC
Serum electrolytes
Urinalysis
Pregnancy test

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Imaging?

X-ray
US
MRI
CT
Fluroscopy
Endoscopy

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Right hypochondriac pain?

Gallstones
Cholangitis
Hepatitis
Liver abscess
Cardiac
Lung

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Epigastric pain?

Esophagitis
Peptic ulcer
Perforated ulcer
Pancreatitis

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Left hypochondriac pain?

Spleen abscess
Acute splenomegaly
Spleen rupture

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Right lumbar pain?

Ureteric colic
Pyelonephritis

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Umbilical pain?

Early appendicitis
Mesenteric lymphadenitis
Meckel diverticulitis
Lymphomas

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Left lumbar pain?

Ureteric colic
Pyelonephritis

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Right iliac pain?

Apendicitis
Crohn’s
Caecum obstruction
Ovarian cyst
Ectopic pregnancy
Hernias

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Hypogastric pain?

Testicular torsion
Urinary retention
Cystitis
Placental abruption

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Left iliac pain?

Diverticulitis
Ulcerative colitis
Constipation
Ovarian cyst
Hernias

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Acute cholecystitis?

Severe epigastric, RUQ abdominal pain
Radiates to scapula
Fever, nausea, vomiting
Murphy’s sign (inspiratory pause)
Emphysematous cholecystitis (diabetic elderly male)
Systemically unwell, raised inflammatory markers

Ascending cholangitis?

Abdominal pain, jaundice, fever (Charcot triad)
Charcot triad + confusion, hypotension (Reynolds pentad)
Hepatomegaly
Pale stools, dark urine, sepsis
High WCC + CRP

Biliary colic/choleliliathis

Epigastric, RUQ abdominal pain
Steady pain, often after eating
Radiates to scapula
Systemically well, normal bloods

Hyperechoic

Lots of echoes on an US

Bile composition?

97-98% water
0.7% bile salts
0.5% fats
0.2% bilirubin

Factors for stone formation?

Supersaturation
Nucleation
Hypomotility

5 Fs

Fair
Fat
Female
Fertile
Forty

Gallstone complications?

Biliary obstruction (in common bile duct)
Acute cholecystitis (in cystic duct)
Gallstone pancreatitis (in pancreatic duct)
Gallstone ileus
Fistula
Mirizzi syndrome (in common hepatic duct)

Fistula?

Inflammation and damage due to gallstones, which can cause a perforation and a connection between organs that shouldn’t be there

Gallstone ileus?

Stone blocks ileocaecal valve after migrating through fistula

Consent 7 principles?

1. Right to be involved 2. Meaningful dialogue 3. Right to be listened to 4. Benefits and harms 5. Capacity 6. Must benefit them if they lack capacity 7. If consent affected by law, should still be part of decision-making process

3 elements of consent

Voluntary Informed Capacity

3 types of consent?

Written Verbal Implied

Things to discuss when getting consent

Explain procedure Benefits and risks - common risks (1%) and serious risks What happens if they don’t go through with the surgery Alternative options

Ways to categorise complications

Generic vs specific Early vs late

Generic complications of laporascopic cholecystectomy

Infections Bleeding Damage to surrounding structures Anaesthetic risk Scarring Hernia development Clots (DVT, PE)

Specific complications of lap-cho

Bile duct injury Liver or intestine injury

What is supersaturation?

Cholesterol concentration exceeds the concentration at which it remains soluble Can result in the formation of multilamellar vesicles that may then fuse and aggregate as solid cholesterol crystals, which can grow in size to form stones

How does gut hypomotility cause stones?

Usually stones are flushed from the gallbladder during postprandial contractions, but impaired gallbladder motility means they stay

How can kinetic factors cause stones (nucleation)

Formation of microcrystals in supersaturated bile is modulated by kinetic protein factors Mucin (glycoprotein mixture that is secreted by biliary epithelial cells) is a nucleation-promoting protein in gallbladder sludge

Biliary obstruction involves?

Common bile duct

Acute cholecystitis involves?

Cystic duct

Gallstone pancreatitis involves?

Pancreatic duct

Mirizzi syndrome involves?

Common hepatic duct