Abdominal Pain

Question 1

Epigastric/umbilical pain, burning or sharp. Associated nausea, vomiting, feeling bloated.

Answer 1

Gastritis (inflammation of stomach lining) / Peptic Ulcers

Question 2

Risk factors for Gastritis/Peptic Ulcers?

Answer 2

Long term NSAID use, recreational drug use, chronic smoker.
Complications may lead to GI bleeding.

Question 3

Dull central/upper pain, can radiate into back. Fever, nausea/vomiting. Can be acute or chronic, often related to chronic alcohol consumption.

Answer 3

Pancreatitis
(Inflammation of pancreas)

Question 4

Assessment findings for Pancreatitis?

Answer 4

Blue-tinged right flank region, tenderness on palpation.

Question 5

Generalised/umbilical pain, radiates into right lower quadrant. Associated nausea/vomiting, fever, constipation or diarrhea.

Answer 5

Appendicitis
(Inflammation of appendix)

Question 6

Assessment findings for Appendicitis?

Answer 6

Right lower quadrant tenderness, rebound tenderness, positive McBurney’s, Rovsing’s and Aaron’s sign.

Question 7

Global abdo pain and tenderness (rebound?), distended abdomen.

Reduced urine output, altered bowel habits. Lethargy/fatigue, fever, nausea/vomiting, confusion, thirst.

Can be secondary to abdo trauma or infections (e.g. appendicitis).

Answer 7

Peritonitis
(Inflammation of peritoneum - intestine lining)

Question 8

Intermittent cramping epigastric pain, D&V, fever.

Answer 8

Gastroenteritis
(Inflammation of stomach and intestines)

Question 9

RUQ or epigastric pain, pain colicky in nature, often severe. May be exacerbated by eating fatty foods. May be associated with nausea and vomiting.

Answer 9

Biliary Colic
(Gallstone stuck in the cystic duct)

Question 10

Assessment findings for Biliary Colic?

Answer 10

It is NOT associated with fever or abdominal tenderness.

Question 11

RUQ or epigastric pain, often sharp or cramping, or dull and spasmodic, can radiate into the right shoulder or back. Associated nausea/vomiting, and fever.

Answer 11

Cholecystitis
(Inflammation of the gall bladder)

Question 12

Assessment findings for Cholecystitis?

Answer 12

RUQ/epigastric tenderness, positive Murphy’s sign, guarding.

Question 13

RUQ or generalised pain, fever, jaundice, nausea and vomiting. May be low BP and altered GCS.

Answer 13

Ascending Cholangitis

Question 14

What is Charcot’s Triad and Reynold’s Pentad?

Answer 14

Charcot’s Triad - fever, jaundice, RUQ pain.
Reynold’s Pentad - Charcot’s Triad plus low BP, and altered mental state = Septic shock.

Question 15

Chronic, often diagnosed. Typically global abdominal pain, PR bleeding, mouth sores, pain on opening bowels, weight loss, pain around anus due to inflammation of fistula.

Answer 15

Crohn’s disease (inflammation, often ileum or colon) / Ulcerative colitis (inflammation of large intestine and rectum)

Question 16

Sharp waves of global abdo pain, history of pelvic inflammatory disease. PV bleeding/discharge, syncope, shoulder tip pain.

Answer 16

Ectopic Pregnancy

Question 17

Hypogastric abdominal pain and/or pelvic pain. Pain whilst urinating. Vaginal discharge with an unpleasant odour.

Answer 17

Pelvic Inflammatory Disease

Question 18

Long and painful periods, lower back pain, lower back pain during period, pain during intercourse. PV bleeding. Pain during bowel movement and/or urination.

Answer 18

Endometriosis

Question 19

PV bleeding, pelvic pain, dull ache in the lower back and thighs. Unable to completely empty bladder or bowels, breast tenderness.

Answer 19

Ovarian Cysts

Question 20

Fatigue, pale, SOB, dizziness or lightheadedness, melaena (dark sticky faeces - blood), haematemesis (vomiting blood), abdominal pain.

Answer 20

GI Bleed

Question 21

Hypogastric pain, lower back pain/tenderness. Burning/stinging when urinating, increased frequency with reduced output. Confusion, fever.

Answer 21

Urinary Tract Infection

Question 22

Absent bowel sounds, global abdo pain, bloated abdomen. Constipation leading to diarrhea, faecal vomiting (late symptom).

Answer 22

Bowel Obstruction

Question 23

Severe pain, can radiate into the lower back. Associated dizziness, pale clammy and sweaty skin, nausea/vomiting, syncope, hypotension.

Answer 23

Abdominal Aortic Aneurysm

Question 24

Severe poorly localised, diffuse pain. Suspect in patients with co-existing AF. Recent MI or heart surgery also a risk factor. Heart murmur may be a clue.

Answer 24

Mesenteric Ischaemia

Question 25

Assessment findings for UTI?

Answer 25

Suprapubic abdominal tenderness, lower back tenderness.

Question 26

Assessment findings for AAA?

Answer 26

May be pulsating mass in the abdomen.

Question 27

What is McBurney’s sign?

Answer 27

Pain is elicited when pressing McBurney’s point between the hip and belly button.

Question 28

What is Aaron’s sign?

Answer 28

Pain in the epigastrium with continuous firm pressure over McBurney’s point.

Question 29

What is Murphy’s sign?

Answer 29

Firmly palpate the RUQ subcostal region, pushing under the ribs.
If patient experiences pain after taking a deep breath, this is a positive sign.

Question 30

What is Rovsing’s sign?

Answer 30

Pain to the RLQ after palpating the LLQ.

Question 31

What is Cullen’s sign? And indicates?

Answer 31

Discolouration of the umbilicus.
Indicates ectopic pregnancy or haemorrhagic pancreatitis.

Question 32

What is Grey-Turner’s sign? And indicates?

Answer 32

Discolouration of the flank.
Indicates haemorrhagic pancreatitis.