Abdominal Pain Flashcards
Unusual medical causes of abdominal pain
-ACS
-DKA
-Pneumonia
-Acute intermittent porphyria
-Lead poisoning
-Gynae
-Kidneys
-Liver
-Pancreas
-Spleen
-Urological
GI causes of abdo pain
-Peptic ulcer disease
-Appendicitis
-Acute pancreatitis
-Biliary colic
-Acute cholecystitis
-Diverticulitis
-AAA
-Intestinal obstruction
Peptic ulcer disease
-Duodenal: more common than gastric, epigastric pain relieved by eating vs worse (gastric)
-UGI bleed (haematemesis, melena)
Appendicitis
-Pain in central abdomen then localising to RIF
-Anorexia common
-Tachycardia, low-grade pyrexia, tenderness in RIF
-Rovsing’s sign: more pain in RIF than LIF when palpating LIF
Acute pancreatitis
-Alcohol/gallstones
-Severe epigastric pain
-Vomiting common
-Examination: tenderness, ileus, low-grade fever
-Periumbilical discolouration (Cullen’s), flank discolouration (Grey-Turner): rare
Biliary colic
-Pain RUQ radiating to back and interscapular region following fatty meal (may persist for hours)
-Obstructive jaundice: pale stools, dark urine
-Female, forties, fat, fair
Acute cholecystitis
-Gallstones
-Continuous RUQ pain
-Fever
-Raised inflammatory markers and white cells
-Murphy’s sign +ve (arrest of inspiration on RUQ palpation)
Diverticulitis
-Colicky pain typically LLQ
-Fever
-Raised inflammatory markers and white cells
AAA
-Severe central pain radiating to back
-Sudden collapse
-Sub acute (persistent pain developing shock)
-CVD
Intestinal obstruction
-Hx malignancy/ ops
-Vomiting
-Not opened bowels recently
-Tinkling bowel sounds
Infective causes of acute abdominal pain
-Gastroenteritis
-Appendicitis
-Diverticulitis
-Pyelonephritis
-Cholecystitis
-Cholangitis
-Pelvic inflammatory disease
-Hepatitis
-Pneumonia
Inflammatory causes of acute abdo pain
-Pancreatitis
-Peptic ulcer disease
Vascular causes of acute abdo pain
-Ruptured abdominal aortic aneurysm
-Mesenteric ischaemia
-Myocardial infarction
Traumatic causes of acute abdo pain
-Ruptured spleen
-Perforated viscus (e.g. oesophagus, stomach, bowel)
Metabolic causes of acute abdo pain
-Renal/ureteric stone
-Diabetic ketoacidosis
Hepatobiliary problems
-Biliary colic
-Acute cholecystitis
-Ascending cholangitis
-Acute pancreatitis
Ascending cholangitis
RUQ pain
Ascending cholangitis is a bacterial infection of the biliary tree. The most common predisposing factor is gallstones.
Charcot’s triad of right upper quadrant pain, fever and jaundice occurs in about 20-50% of patients
GI causes of abdo pain
-Peptic ulcer disease
-Appendicitis
-Acute diverticulitis
-Intestinal obstruction
Urological causes of acute abdo pain
-Renal colic
-Acute pyelonephritis
-Urinary retention
Gynae causes of acute abdo pain
-Ectopic pregnancy
Renal colic
-Loin pain radiating to groin
-Pain is often severe but intermittent. Patient’s are characteristically restless.
-Visible or non-visible haematuria may be present
Acute pyelonephritis
-Loin pain
-Fever and rigors are common as is vomiting
Urinary retention
-Suprapubic pain
-Caused by obstruction to the bladder outflow.
-Much more common in men, who often have a history of benign prostatic hyperplasia
Ectopic pregnancy
-IF pain
-Typically presents with pain and a history of amenorrhoea for the past 6-9 weeks. Vaginal bleeding may be present
Mesenteric ischaemia
-Central abdo pain
-Patients often have a history of atrial fibrillation or other cardiovascular disease
-Diarrhoea, rectal bleeding may be seen
-A metabolic acidosis is often seen (due to ‘dying’ tissue)
