Abdominal pain Flashcards
What is defined as constipation
2 or more of the following
- Straining >25%
- Sensation of incomplete evacuation >25%
- 25%
Red flags in constipation
recent contipation in >40 yrs of age for greater then 6wks
Rectal bleeding
FmHx of cancer
What to ask of Hx for constipation
Onset Drug and diet hx Tenesmus Blood in stool Abdominal pain Diarrhoea
What to examine for in constipation
Abdomen exam for masses and organomegaly
Rectal exam
Occult presentation of contipation in elderly
Confusion Urinary retention Abdominal pain Overflow diarrhoea Loss of appetite and nausea
Organic causes of constipation
Colonic disease Anorectal disease Pelvic disease Endocrine/metabolic disorders Drugs Other
Colonic disease causing constipation
Carcinoma Diverticular disease Crohn's disease Stricture Intussusception Volvulus
Anorectal disease causing constipation
Anterior mucosal prolapse
Distal proctitis
Anal fissure
Perianal abscess
Pelvic disease causing constipation
Ovarian tumour
Uterine tumour
Endometriosis
Drugs that causes constipation
Opioids Antacids containing calcium or aluminium Antidepressants Iron Antiparkinsonian drugs Anticholinergics Anticonvulsants Antihistamines Calcium antagonists
Other cause of constipation
Pregnancy
immobility
Poor fluid intake
Gastritis
Presents: Dyspepsia, bleeding from acute mucosal ulceration occasionally, Incidental finding on endoscopy
Associated with NSAIDS and alcohol use and ICU patients
Chronic gastritis = H pylori, chemical irritation eg bile reflux, autoimmune eg Atrophic gastritis = pernicious anaemia eg Ig against Parietal cells or intrinsic factor.
Tx - Antacids, PPI or H2 antagonist
Peptic ulcer
Cause: NSAIDS, Smoking, drinking, hyperparathyriodism, H Pylori, Zollinger Ellison syndrome.
Presentation: Dyspepsia, Epigastrium pain “gnawing, hunger pain”, May be hours after eating or middle of the night. Eating may relieve pain.
Hx - Smoking, alcohol, NSAIDs use. PMHx of Peptic ulcer, any Cx or surgery.
Cx - Perforation causing pertonitis and shock, GI haemorrhage causing Haematemesis or melaena, Anaemia, Outflow tract obstruction due to scarring
Ix - FBC, IS, Serum Lipase (Acute DDX), ECG(DDX), U and E if vomiting, Endoscopy if active bleeding and biopsy to test for H pylori. Breath test for Urea or faecal Ag.
Mx
- Lifestyle - Quit smoking and alcohol,
- Meds - consider stoping NSAIDS if possible. Iron tablets, PPI (AE headache and diarrhoea is low)
- H Pylori tripple therapy - Amoxcillin, PPI and Clarithromycin.
Mx of acute Upper GI bleed eg Severe Haematemesis
D
R
S - ask Senior for help, Surgical consult
A
B - O2
C - Decrease BP, HR, Peripheral perfusion
- 2 large IV cannulas, Group and Hold 8 units, Hb, Coag, U and E, Blood gas
- Give plasma expander
Ask Hx and examine pt for cause and other problems
DDX - Reflux Oesophaitis, Varices, Mallory Weisis tear, gastric ulcer, gastric carcinoma, gastritis, Duodenal ulcer and duodenitis, small bowel.
Endoscopy - Adrenaline injection, Heat coagulation, Banding or sclerotherapy for varices
High dose PPI
Iron tb
Alarms symptoms of dyspepsia
Anaemia Loss of wt Anorexia Recent onset of progressive symptoms Melaena or haematemesis Swallowing difficulties
Ix Diveritculitis
FBC CRp PR examination Sigmoidoscopy Barium enama Colonoscopy
Mx of Diverticulitis
Resus
A
B
C
ABX -
Treat complication
Perforation
Triple antibodic therapy - Amplicillin, Gentamycin, Metronitrazole
Surgery - Hartman’s procedure - Temporary colostomy and partial colectomy
Abscess - Percutances drainage - CT guided
Triple ABX
haemorrhage - Embolixation or colonic resection after locating bleeding by Angiography or colonscopy.
Fistula - surgery colon resection
Presents with air in urine or non stop UTi.
Follow up with Colonscopy to check for stricture formation or anastomsis formation.
Presentation of appendicitis
Peri-umbilical pain moves to RLQ, anorexia, pain precedes vomiting, constipation and diarrhoea may occu Tachycardia Fever Furred tongue Lying still Coughing Heurts Foefor and flushing Shallow breathing Signs - Guarding - Rebound and percussion tenderness PR painful on right side - Mcburney's point - Rovsing sign - Psoas sign - Obturator sign
Ix Appendicitis
FBC - Neutrophillia
CRP increase
USS
CT is unclear
Tx Appendicitis
Appendicectomy or laparoscopy
ABX - Metronidazole, plus ? Local guideline
Fluids
Cx appendicits
Perforation
Abscess
Cholelithiasis
PC - RUQ 30 min after meal and last for 4-6 hrs, No fever, may have nausea and vomiting Examination - Scleral icterus, Murphy's sign neg. IX - FBC - Normal - LFTs - Normal - USS - stones in GB MX - Analgesia - Supportive therapy - Elective cholecystectomy
Cholelangitis
Charcot Triad: Fever, RUQ, Jaundice Examination: Shock or pain Ix FBC - increase WCC LFT - Deranged with bilirubin, Lipase and amylase USS - Dilation and thinking of ducts Mx - Analgesia, supportive ABX,
Cholecystitis
PC - RUQ 30 min after meal and last more than 6 hr and fever, may have nausea and vomiting Examination - Scleral icterus, Murphy's sign positive. IX - FBC - increase WCC - LFTs - Increase? - USS - stones in GB, thickened wall MX - Analgesia - Supportive therapy - Admit. - cholecystectomy
