Abdominal Pain

Question 1

Unusual medical causes of abdominal pain

Answer 1

-ACS
-DKA
-Pneumonia
-Acute intermittent porphyria
-Lead poisoning

-Gynae
-Kidneys
-Liver
-Pancreas
-Spleen
-Urological

Question 2

GI causes of abdo pain

Answer 2

-Peptic ulcer disease
-Appendicitis
-Acute pancreatitis
-Biliary colic
-Acute cholecystitis
-Diverticulitis
-AAA
-Intestinal obstruction

Question 3

Peptic ulcer disease

Answer 3

-Duodenal: more common than gastric, epigastric pain relieved by eating vs worse (gastric)
-UGI bleed (haematemesis, melena)

Question 4

Appendicitis

Answer 4

-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

Question 5

Acute pancreatitis

Answer 5

-Alcohol/gallstones
-Severe epigastric pain
-Vomiting common
-Examination: tenderness, ileus, low-grade fever
-Periumbilical discolouration (Cullen’s), flank discolouration (Grey-Turner): rare

Question 6

Biliary colic

Answer 6

-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

Question 7

Acute cholecystitis

Answer 7

-Gallstones
-Continuous RUQ pain
-Fever
-Raised inflammatory markers and white cells
-Murphy’s sign +ve (arrest of inspiration on RUQ palpation)

Question 8

Diverticulitis

Answer 8

-Colicky pain typically LLQ
-Fever
-Raised inflammatory markers and white cells

Question 9

AAA

Answer 9

-Severe central pain radiating to back
-Sudden collapse
-Sub acute (persistent pain developing shock)
-CVD

Question 10

Intestinal obstruction

Answer 10

-Hx malignancy/ ops
-Vomiting
-Not opened bowels recently
-Tinkling bowel sounds

Question 11

Infective causes of acute abdominal pain

Answer 11

-Gastroenteritis
-Appendicitis
-Diverticulitis
-Pyelonephritis
-Cholecystitis
-Cholangitis
-Pelvic inflammatory disease
-Hepatitis
-Pneumonia

Question 12

Inflammatory causes of acute abdo pain

Answer 12

-Pancreatitis
-Peptic ulcer disease

Question 13

Vascular causes of acute abdo pain

Answer 13

-Ruptured abdominal aortic aneurysm
-Mesenteric ischaemia
-Myocardial infarction

Question 14

Traumatic causes of acute abdo pain

Answer 14

-Ruptured spleen
-Perforated viscus (e.g. oesophagus, stomach, bowel)

Question 15

Metabolic causes of acute abdo pain

Answer 15

-Renal/ureteric stone
-Diabetic ketoacidosis

Question 16

Hepatobiliary problems

Answer 16

-Biliary colic
-Acute cholecystitis
-Ascending cholangitis
-Acute pancreatitis

Question 17

Ascending cholangitis

Answer 17

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

Question 18

GI causes of abdo pain

Answer 18

-Peptic ulcer disease
-Appendicitis
-Acute diverticulitis
-Intestinal obstruction

Question 19

Urological causes of acute abdo pain

Answer 19

-Renal colic
-Acute pyelonephritis
-Urinary retention

Question 20

Gynae causes of acute abdo pain

Answer 20

-Ectopic pregnancy

Question 21

Renal colic

Answer 21

-Loin pain radiating to groin
-Pain is often severe but intermittent. Patient’s are characteristically restless.
-Visible or non-visible haematuria may be present

Question 22

Acute pyelonephritis

Answer 22

-Loin pain
-Fever and rigors are common as is vomiting

Question 23

Urinary retention

Answer 23

-Suprapubic pain
-Caused by obstruction to the bladder outflow.
-Much more common in men, who often have a history of benign prostatic hyperplasia

Question 24

Ectopic pregnancy

Answer 24

-IF pain
-Typically presents with pain and a history of amenorrhoea for the past 6-9 weeks. Vaginal bleeding may be present

Question 25

Mesenteric ischaemia

Answer 25

-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)