Abdominal Pain Flashcards
Cholecystitis
Inflammation of the gall bladder without infection
Caused by obstruction of the cystic duct
RUQ sometimes radiating to epigastric region
Associated with diarrhoea and vomiting
Usually systemically well
Murphy’s sign positive
Bloods: FBC, Inflammatory markers
Imaging: ultrasound (thickening of gall bladder walls)
Management: surgery
Ascending Cholangitis
Acute inflammation and infection of the common bile duct
Normally caused by gallstone obstruction leading to infection
Charcots triad: pain in right upper quadrant, jaundice, rigor/fever
No association with food
May be systemically unwell (septic shock)
Murphy’s sign negative
Investigations: FBC, Inflammatory markers, LFTs (bilirubin, ALP, GGT),blood cultures
Management: ABC, antibiotics, surgery
Gall stones
Female fat fertile and forties
Acute Pancreatitis
Inflammation of pancreas
Onset over hours
Severe epigastric pain radiating to the back
Associated with vomiting
Test for amylase (4-6xnormal)
Treatment: analgesia and supportive measures
Causes: gallstones, ethanol
Biliary colic
Gall stones stop bile from leaving gall bladder when it contracts
Constant pain in RUQ following fatty meals
Likely to be a recurring problem
No systemic inflammatory response
Peptic ulcer
Pain in the epigastric region strongly correlates to meals
May present with nausea, vomiting and weight loss
Other features include haemoptysis and melena
NSAIDs are biggest risk factor
Caused by helicobacter pylori
Gastric ulcer pain straight after eating whereas duodenal ulcer comes on a few hours after eating
Ectopic pregnancy
Implantation of fertilised egg outside uterus
Clinical presentation is normally 4-8 weeks after LMP
Shoulder pain is characteristic of severe internal bleeding associated with ectopic pregnancies
Pyelonephritis
Inflammation of the kidneys caused by a bacterial infection, can be chronic as well as acute
Often systemically unwell
Left flank pain radiating to back
Dysuria
Urine dip positive for WBC, urine and blood cultures can be useful
Treatment: IV amoxicillin and gentamicin
Renal colic
Classically loin to groin pain
Comes and goes with the waves of ureteric peristalsis
Terrible pain
Kidney Ureter Bladder (KUB) X-ray can be used to visualise the stones
Movement stops pain so patient will be restless
Treatment: advise them to drink plenty of fluids, give analgesia and wait for stone to pass, all stones <5mm will pass
Ulcerative colitis
Relapsing and remitting inflammatory disorder of colonic mucosa
Starts in rectum and extends proximally, continuous lesions
15-25 non smokers
Presentation: gradual onset of diarrhoea, crampy abdo, systemic symptoms
Management: hospital if severe, colonoscopy, biopsy, FBC for haemoglobin and platelets, ESR measure level of inflammation, stool culture
Treatment: oral prednisalone and mesalazine, steroid enema, admit to hosp nil by mouth, IV maintenance
Crohn’s disease
May affect any part of GI tract but favours terminal ileum and proximal colon, skip lesions
Risk factors: smoking, NSAIDs, low fibre high sugar diet
Presentation: diarrhoea, abdo pain, weight loss, systemic
Treatment: oral prednisalone, IV steroids, nil by mouth, IV hydration IV hydrocortisone
Appendicitis
Peri-umbilical abdo pain, later localises to right iliac fossa
Nausea and vomiting, mild pyrexia, flushed, tachycardia
Peritonitis is appendix perforated (rigid abdo)
Investigation: FBC (inc CRP and WCC) abdo ultrasound, beta hCG
Management: antibiotics and appendectomy
C. Difficile infection
5-10 days post broad spec antibiotics
Produce toxins resulting in colitis and diarrhoea
Severe abdo pain
FBC shows inc CRP inc WCC low albumin
Stool sample test for c. Diff toxin
Treatment: oral rehydration, metronidazole, vancomycin
