Abdominal Pain

Question 1

Signs, symptoms and Ix of Perforation

Answer 1

Rapid onset, severe abdominal pain
Peritonitis +/- bowel sounds
Ix - gas under diaphragm, acidotic

Question 2

Signs, symptoms and Ix

Bowel obstruction

Answer 2

Pain, distension, vomiting, nausea, constipation
Tenderness, tinkling bowel sounds
AXR - dilated loops of bowel

Question 3

Signs symptoms and Ix

Bowel ischaemia/infarction

Answer 3

Sudden onset, severe pain, previous arterial disease, +/- AF
Shock, generalized tenderness
Increase WCC, increased lactate/acidotic, +/- AF or previous MI

Question 4

Signs, symptoms and Ix

Appendicitis

Answer 4

RIF pain (initially periumiblical), anorexia, N&V
Slight temp, RIF tenderness, +/-peritonitic
Increase WCC and CRP

Question 5

Signs, Symptoms and Ix

Strangulated hernia

Answer 5

Sudden onset pain, previous hernia
Tender hernial mass
URGENT SURGERY

Question 6

Signs, symptoms and Ix

GORD/ulcer

Answer 6

Dyspepsia, heartburn, anorexia, NSAIDs
Epigastric tenderness
Consider OGD

Question 7

Signs, symptoms and Ix

Acute Pancreatitis

Answer 7

Constant epigastric pain radiates to back, vomiting, anorexia, alcohol or gallstones
Shock, epigastric tenderness, reduced bowel sounds
Elevated amylase, WCC, CRP and glucose
Decreased Ca2+

Question 8

Signs, symptoms and investigations

AAA

Answer 8

Abdo and back pain, collapse, prev heart disease/hypertension, age 50+, male
Expansile mass
Low BP, weak/absent leg pulses
STRAIGHT TO THEATRE