Abdominal Pain Flashcards
What is shifting pain?
Sore in one spot, then jumps into another: no longer sore in original place
What is spreading pain?
Starts in one place and gradually spreads into another
What is somatic pain?
Sore to touch
Localised
What is visceral pain?
Sore whether you press or not
Regional
Which organs are most likely to be affected in epigastric pain?
Stomach
Duodenum
Pancreas
Oesophagus
Where is stomach pain usually felt?
In the front
Epigastric
Where is pain form the pancreas and duodenum commonly felt?
Epigastric pain
In the front, but radiating to then back
What is the epigastrium the site of referred pain for?
MI
Pneumonia
Indigestion
Which organs are most likely to be affected by RUQ pain?
Liver
Gall bladder
Which organs are most likely to be affected by LUQ?
Spleen
Tail of pancreas
What is the RUQ the site of referred pain for?
Right basal pneumonia
Right renal angle
Which organs are most likely to be affected by central pain?
Small bowel
Large bowel up to transverse colon
Starting point of acute appendicitis
Which organs are most likely to be affected by RIF pain?
Appendicitis
Ruptured ovarian cyst
Pelvic inflammatory disease
Which organs are most likely to be affected by LIF pain?
Diverticular disease
Acute diverticulitis
Ruptured ovarian cyst
Pelvic inflammatory disease
Which organs are most likely to be affected by suprapubic pain?
Bladder
Pelvic organs in females
What is the LUQ the site of referred pain for?
Left basal pneumonia
Left renal angle
How do you differentiate between gastric and duodenal ulcer pain?
Gastric = worse on eating Duodenal = improves on eating
Where does liver pain commonly refer and why?
Left shoulder
Causes diaphragmatic irritation
What is the differential for pain which is specifically related to movement?
MSK causes
What is the cause of throbbing pain?
Inflammation
What is the cause of colicky pain?
Obstruction
What are the main categories for causes of pain?
Inflammation Underlying malignancy Related to drugs Related to infection Iatrogenic (self or medical profession)
How might a colicky pain present in a patient?
Patient moving around
How might an inflammatory pain present in a patient?
Patient lying still (worse on movement)
How might general peritonitis present in a patient?
Abdomen not moving with respiration
What are you looking for when asking the patient to “take a deep breath in”?
Murphy’s sign
Gallbladder pain
How do you check for peritonitis in a patient?
“Puff up your tummy” “Suck your tummy in” “Give me a gentle cough” “Give me a big cough” Pain on percussion
What is dull percussion a sign of?
Normal
Fluid
What is tympanic percussion a sign of?
Gas
When might listening to bowel sounds be important?
After bowel surgery
What are bruits and what causes them?
Noise caused by turbulence
Heard well in abdominal aortic aneurysms
What is the classic presentation of appendicitis?
1 - Pain, usually epigastric or umbilical and generalised
2 - Anorexia, nausea, or vomiting
3 - Tenderness somewhere in the abdomen or pelvis. Commonly localised at RIF.
4 - Fever
5 - Leucocytosis
What is the classic presentation of a perforated appendix?
Generalised pain and guarding with peritonism
What is the classic presentation of biliary colic?
Gradual onset Colicky pain, comes and goes Worse on eating: dairy, spicy, fatty Nausea and anorexia Pain radiates to right back Some pain and irritation in right shoulder Tender in deep palpation Murphy's negative No temperature and normal bloods
What is the classic presentation of acute cholecystitis?
Same as biliary colic + Murphy's positive High temperature Leukocytosis Localised peritonitis in RUQ
What is the common presentation of diverticulitis?
Sluggish bowels Pain relieved by moving bowels/passing wind Localised severe pain in LIF on exam Temperature High pulse rate
What are the three presentations of abdominal pain that you must differentiate very quickly?
Ischaemic gut
Ruptured AAA
Acute pancreatitis
