Abdominal pain Flashcards
Oesophageal chest pain features
Particularly behind the breastbone, that occurs with eating
Typically symptoms of intestinal obstruction
- abdominal colic
- vomiting
- constipation WITHOUT the passing of wind
- distension
- increased bowel sounds
- Marked tenderness
What kind of pain is associated with the pancreas?
midline and radiates through to the back because it is retroperitoneal.
What are non-GI possible causes for severe abdominal pain and nausea?
Torsion of the testis or ovary
Why do you get radiating pain around the shoulder/ interscapular region with acute cholecystitis?
Diaphragmatic irritation
what causes pain on the tip of the shoulder, and why?
irritation of the parietal pleura overlying the central diaphragm.
Innervation is the phrenic nerve; referring pain to the neck, shoulder tip, interscapular region. (C3, C4)
Supraclavicular nerves have the same cervical nerve origin as the phrenic nerve C3, C4
Causes;
ruptured ectopic pregnancy + others
What is dull, vague and poorly localised pain more like to be?
An inflammatory process or low-grade infection, eg. salpingitis, appendicitis or diverticulitis.
Where does pain radiate with acute cholecystitis?
from right hypochondrial region to shoulder/ interscapular region.
Where can renal colic radiate to?
the groin and genitalia
Central upper abdominal radiating through to the back and partially relieved by sitting forwards is…
pancreatitis
(pancreas is retroperitoneal)
causes; 30% Gallstones
30% alcohol
rest - mixed/ unknown
RED FLAG
Severe back and abdominal pain?
ruptured/ dissecting abdominal aortic aneurysm
suspect in any px over 50.
can be mistaken for renal colic.
atherosclerosis and hypertension are risk factors.
Epigastric pain that is not tender on palpation and has autonomic symptoms could be….
MI
RED FLAG
What are the signs and symptoms of peritonitis?
severe abdominal pain, tenderness and guarding.
(rigidity - invol contraction of abdo muscles)
Worse for movement as the inflammed peritoneum moves.
REBOUND pain (Blumberg sign) as the peritoneum snaps back into place after palpation.
fever, weight loss
When would a small bowel obstruction become an emergency?
When typical intestinal colic changed to persistent pain with abdominal tenderness suggesting intestinal ischaemia. (strangulated hernia)
>> lactate maybe the only clue.
old age, atherosclerosis and AF are risk factors.
How do patients appear if they have colicky abdominal pain?
They move around a lot, or draw their knees up towards the chest during painful spasms.
If excruciating pain that is not relieved by opiod analgesia then….
escalate; could be an ischaemic event
Abdominal distension
F
F
F
F
F
F
Fat
Flatus
Faeces
Fluid
Fetus
Functional
What is Murphy’s sign?
+ve; px stops an inspiratory breath when pressure is applied above the gallbladder.
(GB hits peritoneum). + fever or >> WCC
= biliary sepsis
vomiting, distension and an empty rectum usually indicates
LI or SI obstruction by adhesions or herniation
Where is Mc-Burney’s point?
2/3 from umbilicus to a point midway along the inguinal ligament.
What’s the risk with diverticular disease?
rupturing, bleeding, infection.
Common in elderly.
RED FLAGS
ECG and abdominal pain
always do with any patient over the age of 40.
MI
RED FLAGS
What’s the most common cause of lower GI bleeding?
Upper GI bleeding
Questions to ask about abdominal pain
- relationship of pain to food intake/ excretion
- Date of last menstrual period (IMP)
- SOCRATES
