Abdominal Pain

Question 1

Peptic Ulcer Disease

Answer 1

Duodenal ulcers: more common than gastric ulcers, epigastric pain relieved by eating
Gastric ulcers: epigastric pain worsened by eating
Features of upper gastrointestinal haemorrhage may be seen (haematemesis, melena etc)

Question 2

Appendicitis

Answer 2

Pain initial in the central abdomen before localising to the right iliac fossa
Anorexia is common
Tachycardia, low-grade pyrexia, tenderness in RIF
Rovsing’s sign: more pain in RIF than LIF when palpating LIF

Question 3

Acute Pancreatitis

Answer 3

Usually due to alcohol or gallstones
Severe epigastric pain
Vomiting is common
Examination may reveal tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare

Question 4

Biliary Colic

Answer 4

Pain in the RUQ radiating to the back and interscapular region, may be following a fatty meal. Slight misnomer as the pain may persist for hours
Obstructive jaundice may cause pale stools and dark urine
It is sometimes taught that patients are female, forties, fat and fair although this is obviously a generalisation

Question 5

Acute Cholecystitis

Answer 5

History of gallstones symptoms (see above)
Continuous RUQ pain
Fever, raised inflammatory markers and white cells
Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)

Question 6

Diverticulitis

Answer 6

Colicky pain typically in the LLQ

Fever, raised inflammatory markers and white cells

Question 7

Abdominal Aortic Aneurysm

Answer 7

Severe central abdominal pain radiating to the back
Presentation may be catastrophic (e.g. Sudden collapse) or sub-acute (persistent severe central abdominal pain with developing shock)
Patients may have a history of cardiovascular disease

Question 8

Intestinal Obstruction

Answer 8

History of malignancy/previous operations
Vomiting
Not opened bowels recently
‘Tinkling’ bowel sounds