Abdominal pain Flashcards
General management of abdominal pain
analgesia
resuscitate - IV access, fluids, bloods
antibiotics - if diagnosis so far suggests sepsis
oxygen if required
Causes of right hypochondriac pain
gallstones
cholangitis
hepatitis
liver abscess
cardiac causes
lung causes
Causes of right lumbar pain
ureteric colic
pyelonephritis
Causes of right iliac pain
appendicitis
Crohn’s disease
caecum obstruction
ovarian cyst
ectopic pregnancy
hernias
Causes of hypogastric/suprapubic pain
testicular torsion
urinary retention
cystitis
placental abruption
Causes of left iliac pain
diverticulitis
ulcerative colitis
constipation
ovarian cyst
hernias
Causes of left lumbar pain
ureteric colic
pyelonephritis
Causes of umbilical pain
appendicitis (early)
mesenteric lymphadenitis
meckel diverticulitis
lymphomas
Causes of left hypochondriac pain
spleen abscess
acute splenomegaly
spleen rupture
Causes of epigastric pain
oesophagitis
peptic ulcer
perforated ulcer
pancreatitis
What scans can be done for gallstones?
USS
CT
Acute cholecystitis differentials
pancreatitis
liver abscess
Factors that predispose a patient to acute diverticulitis
constipation
smoking
high BMI
How is diverticulitis diagnosed?
CT
Acute diverticulitis management
antibiotics
radiological drainage
surgery
How is acute mesenteric ischaemia diagnosed?
CT
What factors predispose a patient to acute mesenteric ischaemia?
arteriopath
AF
Acute mesenteric ischaemia treatment
laparotomy and revascularisation of SMA and resect already dead bowel
Where does tenderness localise to in acute appendicitis?
McBurney’s point
Differentials for appendicitis in a female?
pelvic inflammatory disease
ectopic pregnancy
Differential for appendicitis in an older patient?
carcinoma obstructing appendix orifice
Gold standard scan to diagnose acute cholangitis
MRCP
Acute cholangitis management
antibiotics
ERCP to remove common bile duct stone
+/- cholecystectomy
What signs might be seen in chronic abdominal pain
weight loss/emaciation
abdominal distension - fluid, faeces, mass
palpable masses or organomegaly
Differential diagnosis for chronic abdominal pain
surgical disorders - chronic cholethiasis, chronic pancreatitis
malignancy
GI disorders - IBS, IBD, coeliac, SIBO, peptic ulcer, chronic liver disease
gynae disorders - chronic PID, endometriosis
What investigations should be done in chronic abdominal pain?
FBC - anaemia, iron deficiency, LFTs, UEs
FIT
Faecal calprotectin + TTGs
young + change in bowel habit = colonoscopy, MRI, USS
younger female with lower abdo pain or cyclical element = USS, MRI pelvis, gynae referral
any other patient = CT
Most common site of Crohn’s disease
terminal ileum
