Abdominal Pain Flashcards
What is Murphy’s sign?
Place two fingers on the RUQ; pain on inspiration and cessation of inspiration
Where is pain from obstruction of paired structures referred to?
The flank
What is acute cholecystitis?
Inflammation of the gall bladder
What the types of abdominal hernia’s?
Umbilical
Fermoral
Inguinal
Incisional
What is choledocholithiasis?
Stone in the common bile duct
(Not causing inflammation)
How does acute appendicitis usually appear on examination?
Tenderness in R iliac fossa (McBurney’s point)
Guarding
+/- Rovsing’s sign (palpation of L lower quadrant causes pain to be felt in RLQ)
Percussion tenderness
Normal auscultation
What type of pain is typically relieved by leaning forward?
Epigastric that radiates to the back
High pitched bowel sounds are indicative of what usually?
Obstruction
What is ascending cholangitis?
Inflammation of the common bile duct
What is biliary colic?
Pain due to obstruction of the cystic duct by gall stones
(Not inflammatory pain)
Where is pain from obstruction of the gut felt?
Midline
What is McBurney’s point?
The point, 1/3 third of the way between the ASIS and the umbilicus where pain from appendicitis is felt
How does peritonitis present?
Generalised tenderness
Generalised pain
Abdominal guarding and rebound tenderness
What are some non-abdominal causes of abdominal pain?
Heart
Lung/diaphragm
Back/muscular pain
Herpes/zoster
What is colicky pain?
What typically causes it?
Pain that waxes and wanes
Obstruction of a hollow viscus
How does inflammatory pain usually present?
Usually localised
Sharp
Often severe
Constant
What is the pain of gastroenteritis typically like?
Epigastric/central
Colicky
Variable
Gradual onset
How does pain progress in appendicitis?
Initially visceral and referred
Once inflammation becomes transmural and touches the peritoneum in the right iliac fossa the pain moves
- Patient can finger the spot
What is rebound tenderness?
Pain on removal of pressure applied during examination
What special physical signs are looked for in appendicitis?
Rovsing’s sign - Pain > in RIF than LIF when the LIF is pressed
Psoas sign - Pain on extending R hip while the patient lies on left (if retrocaecal appendix)
Cope/Obturator sign - pain on flexion and internal rotation of R hip if appendix in close relation to obturator internus
How does pain from perforation present?
Localised
Sharp
Usually severe
Sudden, can be on a background of pre-existing pain
What are the three types of hollow viscus obstructions?
Intraluminal eg stone
In the wall eg colon cancer
Extrinsic eg adhesion
What are the causes of pancreatitis?
I GET SMASHED
Idiopathic
Gall stones
EtOH
Trauma
Steroids
Malignancy
Autoimmune
Scorpion
Hyperlipidaemia
ERCP
Drugs - particularly flucloxicilin
What is ERCP?
What risk is associated with it?
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems.
Pancreatitis
