Abdominal pain

Question 1

General management of abdominal pain

Answer 1

analgesia
resuscitate - IV access, fluids, bloods
antibiotics - if diagnosis so far suggests sepsis
oxygen if required

Question 2

Causes of right hypochondriac pain

Answer 2

gallstones
cholangitis
hepatitis
liver abscess
cardiac causes
lung causes

Question 3

Causes of right lumbar pain

Answer 3

ureteric colic
pyelonephritis

Question 4

Causes of right iliac pain

Answer 4

appendicitis
Crohn’s disease
caecum obstruction
ovarian cyst
ectopic pregnancy
hernias

Question 5

Causes of hypogastric/suprapubic pain

Answer 5

testicular torsion
urinary retention
cystitis
placental abruption

Question 6

Causes of left iliac pain

Answer 6

diverticulitis
ulcerative colitis
constipation
ovarian cyst
hernias

Question 7

Causes of left lumbar pain

Answer 7

ureteric colic
pyelonephritis

Question 8

Causes of umbilical pain

Answer 8

appendicitis (early)
mesenteric lymphadenitis
meckel diverticulitis
lymphomas

Question 9

Causes of left hypochondriac pain

Answer 9

spleen abscess
acute splenomegaly
spleen rupture

Question 10

Causes of epigastric pain

Answer 10

oesophagitis
peptic ulcer
perforated ulcer
pancreatitis

Question 11

What scans can be done for gallstones?

Answer 11

USS
CT

Question 12

Acute cholecystitis differentials

Answer 12

pancreatitis
liver abscess

Question 13

Factors that predispose a patient to acute diverticulitis

Answer 13

constipation
smoking
high BMI

Question 14

How is diverticulitis diagnosed?

Answer 14

CT

Question 15

Acute diverticulitis management

Answer 15

antibiotics
radiological drainage
surgery

Question 16

How is acute mesenteric ischaemia diagnosed?

Answer 16

CT

Question 17

What factors predispose a patient to acute mesenteric ischaemia?

Answer 17

arteriopath
AF

Question 18

Acute mesenteric ischaemia treatment

Answer 18

laparotomy and revascularisation of SMA and resect already dead bowel

Question 19

Where does tenderness localise to in acute appendicitis?

Answer 19

McBurney’s point

Question 20

Differentials for appendicitis in a female?

Answer 20

pelvic inflammatory disease
ectopic pregnancy

Question 21

Differential for appendicitis in an older patient?

Answer 21

carcinoma obstructing appendix orifice

Question 22

Gold standard scan to diagnose acute cholangitis

Answer 22

MRCP

Question 23

Acute cholangitis management

Answer 23

antibiotics
ERCP to remove common bile duct stone
+/- cholecystectomy

Question 24

What signs might be seen in chronic abdominal pain

Answer 24

weight loss/emaciation
abdominal distension - fluid, faeces, mass
palpable masses or organomegaly

Question 25

Differential diagnosis for chronic abdominal pain

Answer 25

surgical disorders - chronic cholethiasis, chronic pancreatitis
malignancy
GI disorders - IBS, IBD, coeliac, SIBO, peptic ulcer, chronic liver disease
gynae disorders - chronic PID, endometriosis

Question 26

What investigations should be done in chronic abdominal pain?

Answer 26

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

Question 27

Most common site of Crohn’s disease

Answer 27

terminal ileum