Abdominal Pain Flashcards
Suspect ___ for indigestion type pain.
Cardiac origin
Obtain an ECG for _ and _ presenting with upper abdominal pain.
Older patients and those with cardiac risk factors
These three groups may have atypical presentations of abdominal pain.
Eldery, alcohol dependent, immunosuppressed.
Patients aged 65+ have a mortality rate of __ due to atypical presentations & comorbidities.
6-8 times!
Tenderness is:
pain when pressure is applied.
Rebound tenderness is:
more pain when pressure is quickly released, than when it is applied.
Guarding is:
localised firmness to protect an area i.e. the appendix
Rigidity is:
generalised firmness
Hyperactive bowel sounds can mean:
increased muscular contraction caused by infection, bleeding, blockage
Hypoactive bowel sounds can mean:
constipation, obstruction, IBD IBS
Associated symptoms:
Change in bowel habits, change in urinary habits, nausea, vomiting, bleeding, trauma, menstrual and sexual changes.
Further advice:
Paracetamol if no vomiting, avoid aspirin, drink clear fluids, eat bland foods if hungry.
Why to avoid aspirin:
It can increase indigestion, nausea and ulcers.
Pain and Associated Symptoms of: Abdominal migraine
Recurrent bouts of generalised abdo pain. N&V.
Pain and Associated Symptoms of: Acute Cholecystitis
Sharp UR pain, increased on deep breathe and palpation (MURPHYS SIGN).
N&V
Shoulder tip pain*
Fever (Infection)
Hx of fat intolerance*
Pain and Associated Symptoms of: Acute Pancreatitis
Constant UL/M pain.
Possible radiation to the back.
Tenderness.
Hypotension.
N&V.
Dehydration.
Shock.
Hx of alcohol abuse (directly toxic to pancreatic cells, moreso chronic)
Hx of gallstones (gallstone blocks the flow of bile and pacnreatic juice into the duodenum)
Glascow Score for pancreatitis (The only risk factors we can identify is BM>10 and Age>55, the others are all blood tests)
https://www.google.com/search?sca_esv=9baac4670fe3aaf8&rlz=1CAEOHR_enGB903GB903&sxsrf=AHTn8zqNqa3BDVfRJk8Cjpc03So2nQNKNw:1740057190982&q=acute+pancreatitis&udm=7&fbs=ABzOT_CWdhQLP1FcmU5B0fn3xuWpA-dk4wpBWOGsoR7DG5zJBr1qLlHFB6ZBcx-Arq68_wc6NXO-nGlA3Ez9ZCbR-p2qkj4GBH3gRAK9zWefPKg-Fs_gKZO-qV74rsNazCZcCrvVFCYENvUAwz8ri9GUWM4Bkd5QfO6RbRrSVsdxGFeS6tWwCv9OYq8fdL8NuzZRhCCq-Qbx&sa=X&sqi=2&ved=2ahUKEwiph4eWqtKLAxUd2QIHHc93IrUQtKgLegQIDhAB&biw=1536&bih=695&dpr=1.25#fpstate=ive&vld=cid:d4531edb,vid:HPNJQi_b7NM,st:0
Pain and Associated Symptoms of: Appendicitis
S - starting in the peri umbilical area, settling in the LR, location can vary early on.
O -
C - Constant, tender, max tenderness over McBurneys point
R - Rovsings sign
A - Infection signs, abdominal signs + dry tongue, halitosis
T -
E - Coughing, walking, hopping in children, Psoas sign, Obturator sign,
S - ++
Pain and Associated Symptoms of: Diverticulosis, Diverticular Disease, Diverticulitis
Pain to LL.
Altered bowel habits, blood, mucus, bloating, fever, N&V, pain postprandial
Pain and Associated Symptoms of: Gastritis (Inflammation of gastric lining)
Upper pain, epigastric pain.
N&V, reduced appetite, haematemesis.
Pain and Associated Symptoms of: Intestinal Obstruction
Cramping, intermittent colicky pain with screaming and drawing up of legs.
Distension, N&V, late stage total constipation, “currant jelly stool” blood & mucus, faecal vomit, bile stained vomit, absence of usual flatulence, distension, hyperactive bowel sounds, visible peristalsis, scars, swelling of hernias/external genitalia.
Causes, Pain and Associated Symptoms of: Ischaemic Bowel. (Mesenteric Ischaemia)
Medical emergency, high mortality.
Primarily caused by thrombus.
\rf incl AF, miral stenosis, vasopressors, strangulated hernia.
Colic type pain ++
Left iliac fossa pain ++
Vitals are out of proportion to pain level.
GI symptoms
May have reduced abdominal findings at first.
Pain and Associated Symptoms of: Pelvic inflammatory disease
Lower abdo, pelvic or back pain.
Abdo tenderness.
Vaginal discahrge.
Nausea.
Fever.
Pain and Associated Symptoms of: Peritonitis
Refusal/inability to walk.
Slow walk, stooped forward.
Pain on coughing, jolting.
Lying motionless.
Reduced abdo wall movement on respiration.
Distention.
Tenderness.
Guarding/rigidity.
Palpable mass.
Absent/decreased bowel sounds.
Non specific signs i.e. HR+
