Abdominal Pain

Question 1

Patient presents with intermittent central abdominal pain radiating to the left iliac fossa. On examination: HR 88, RR 18, BP 88/53. What is the 1st line investigation to do?

Answer 1

Abdominal USS - sounds like potential AAA.

Question 2

A patient presents with sudden onset vomiting, fever and severe abdominal pain. What might you see on x-ray?

Answer 2

Air under the diaphragm. These are Sx of perforation.

Question 3

Diagnostic investigation for bowel perforation?

Answer 3

CT

Question 4

What might bloods show for bowel perforation?

Answer 4

Raised WCC, amylase, lactate. Low Hb. Raised lactate –> metabolic acidosis

Question 5

What are the categories for the causes of bowel obstruction?

Answer 5

Caused by something outside the bowel (mass, hernia, adhesion), within the wall (IBD, diverticular D, mass, atresia, infarct), inside the lumen (impacted faeces, stricture, polyp), and paralytic ileum (post-op, anticholinergic drugs, DM)

Question 6

How can you distinguish based on signs what type of bowel obstruction someone might have?

Answer 6

Small bowel = vomiting first, then constipation
Large bowel = absolute constipation, later vom
Strangulated = severe pain in unwell pt
Paralytic ileus = might not have pain

Question 7

Investigation of choice for obstruction?

Answer 7

AXR - see dilated loops of bowel. No gas distal to blockage

Question 8

How does pain progress over time in appendicitis?

Answer 8

Initially central colicky pain –> intense constant RIF pain (McBurney’s point)

Question 9

What is Rosving’s sign?

Answer 9

Palpate LIF –> pain RIF. +ve in appendicitis

Question 10

What are the main presenting features of acute pancreatitis?

Answer 10

Constant severe abdo pain, radiating to back. Relieved when sitting forwards. Distension, N/V, cullen’s, grey-turners, cold extremities

Question 11

How is mortality assessed in acute pancreatitis?

Answer 11

Modified Glasgow Score (PANCREAS mnemonic), score ≥3 = severe –> ICU.

Question 12

Mx of acute pancreatitis?

Answer 12

Supportive - analgesia (morphine), IV fluids, NBM, NGT, urinary catheter, O2

Question 13

Sx of chronic pancreatitis?

Answer 13

Intermittent epigastric pain radiating to back, general malaise, anorexia, weight loss etc

Question 14

What is Murphy’s sign?

Answer 14

Papation of RUQ –> pain elicited when pt takes deep breath in

Question 15

What are the ALARMS symptoms and what are they used for?

Answer 15

Signs that might suggest gastric cancer: Anaemia, Loss of weight, anorexia, recent rapid onset, malaena, swallowing problems

Question 16

Tx of H pylori?

Answer 16

Eradication therapy for 1w: Lansoprazole, clarithromycin, amoxicillin (ACL)

Question 17

Tx of peptic ulcer disease?

Answer 17

1-2 months of PPI

Question 18

Tx for diverticulitis?

Answer 18

NBM, analgesia, fluids, Abx - cefuroxime + metronidazole

Question 19

What are the potential causes of cullers & grey turners?

Answer 19

Ruptured AAA, pancreatitis, blunt abdominal trauma, ruptured ectopic pregnancy

Question 20

What are mucous coated faeces a sign of?

Answer 20

Appendicitis

Question 21

What is the Mx of bowel obstruction?

Answer 21

Drip + Suck - IV fluids, NGT (Ryle’s), NBM, correct any e- abnormalities, surgery

Question 22

What is the Mx for appendicitis?

Answer 22

IV Abx before surgery - cefuroxime + metronidazole

Surgery, NBM?, IV fluids, analgesia

Question 23

Pneumonic for causes of pancreatitis?

Answer 23

I - idiopathic
G - gallstones
E - Ethanol
T - trauma
S - steroids
M - mumps
A - autoimmune
S - scorpion sting
H - hypothermia, hyperlipidaemia, hypercalcaemia
E - ERCP
D - drugs

Question 24

What blood results might you see in acute pancreatitis?

Answer 24

Raised amylase >600.
Raised, WCC, CRP, glucose, urea
Low Ca, Hb
deranged clotting

Question 25

What are the Sx of diverticulitis?

Answer 25

Intermittent/constant pain, relieved when open bowels.
PR bleeding!!
Tender, palpable mass + bloating
Change in bowel habit.
Fever, tachycardia

Question 26

What risk is assoc with diverticulitis?

Answer 26

Sudden haemorrhage –> painless rectal bleeding, urge to defecate, clots

Question 27

What is the main Tx for diverticulitis?

Answer 27

Abx = metronidazole + cefuroxime

Question 28

What are the common sites for kidney stones?

Answer 28

Pelvic brim, pelvic-urethro junction, vesico-urethral junction

Question 29

What are the Sx of kidney stones?

Answer 29

Acute onset colicky pain, radiates to groin, N+V, sweaty + restless, poss urinary retention