Abdominal Pain Flashcards
Describe ‘visceral’ abdominal pain?
Dull, poorly localised often to midline - (epi/umbilical/suprapubic)
May be crampy and paroxysmal (colicky) if hollow organ involved
Patients often writing around in pain
Describe ‘somatic’ abdominal pain?
Sharp and severe pain often well localised
Patient will often lie very still
Where might pain arising from acute cholecystitis be referred to?
R shoulder tip = diaphragmatic irritation
Comes on with fever/leucocytosis
Where might pain arising from pancreatitis be referred to?
Back
Better on leaning forwards
Pain typically lasts less than 24 hours
Where might pain arising from renal colic be referred to and describe characteristics of the pain?
Flank - groin to loin Tip of labia Tip of glans penis Brought on after fatty meal Pain lasts for 4-24 hours
From what conditions for boys and what conditions for girls might pain be referred to the abdomen?
Boys - testicular torsion
Girls - ectopic pregnancy/endometriosis/ruptured ovarian cysts
A patient presents with severe back and abdominal pain of sudden acute onset, they are noted to have radio-radial delay O/E - what is the most likely diagnosis?
Aortic dissection/ruptured AAA
How might a patient present with proximal small bowel obstruction and how might this differ from a patient presenting with distal small bowel obstruction?
Proximal = severe vomiting W/O significant pain Distal = faeculant vomiting
Describe the two types of oesophageal tears?
Mallory-Weiss = mucosal layer only Boerhav's = oesophageal wall tear
Describe the characteristics of GORD pain?
Retrosternal - burning (heartburn)
Worse at night
Worse on lying flat
Worse with hot drinks/straining
Describe the characteristics of gastric ulcer pain?
Epigastric pain
Worse BEFORE a meal
Can wake patient up from sleep = nocturnal pain
Describe the characteristics of duodenal ulcer pain?
Epigastric pain
Worse AFTER a meal
Often alleviated by food?
Constant pain
What 5 questions should be asked from a patient with suspected GORD?
- Burning quality of the pain
- Associated upwards regurgitation
- Associated ‘acid’ taste in the mouth
- Occurrence lying flat
- Associated increase of salivation (waterbrash)
What are the five F’s in abdominal distension?
Fluid Fat Flatus Foetus Faeces
Describe the two main types of diarrhoea and clinically how would you differentiate between the two?
Osmotic - (more common in IBD/inflammation)
Secretary - malabsorption
Differentiated between via patient FASTING - if osmotic the diarrhoea stops
