Abdominal Pain Flashcards
Give 7 differentials for GI abdominal pain:
- Peptic ulcer disease
- GI bleed
- Appendicitis
- Bowel Obstruction
- Biliary tract infection
- Diverticulitis
- Pancreatitis
When looking at an AXR, how would you tell the difference between large bowel and small bowel obstruction?
- Small bowel obstruction shows conniventes that completely cross the lumen
- Large bowel obstruction shows haustra that do not cross the full lumen’s width
What is a paralytic Ileus?
- A-dynamic bowel due to the absence of normal peristalsis contraction
What would you treat a pseudo-obstructive lesion with?
Neostigmine
What is a sigmoid volvulus?
The bowel twists on the mesentery causing severe, rapid strangulated obstruction
What sign can be seen with a sigmoid volvulus AXR?
Coffee bean
What signs would present in a gastric volvulus?
- Vomiting
- Pain
- Failed attempts to pass an NGT
- Regurgitation of saliva
- Noisy, gastric peristalsis
What size of closed loop obstruction indicates urgent decompression/surgery?
> 12cm
What immediate action should be taken in bowel obstruction?
- Drip and suck:
- NGT and IV fluids to rehydrate and correct electrolytes
What is oral gastrografin used for?
- Identifying partial small bowel obstruction
What is diverticulitis?
- Out-pouching and inflammation of gut wall usually at sites of entry of perforating arteries
Where do most diverticulum occur?
Sigmoid colon
What is a major cause of diverticulitis?
Low fibre diet
What is contraindicated during an acute attack of diverticulitis?
Barium enema + colonoscopy = increased risk of perforation
What are the main symptoms for diverticulosis?
- Altered bowel habit
- Left sided colic pain relieved by defecation
- Nausea
- Flatulence
What are the symptoms that differentiate diverticulosis from diverticulitis?
- Pyrexia
- Raised WCC, ESR, CRP
- Tender colon/peritoneum
When is surgery indicated in diverticulitis?
- Based on degree of infective complications
- At time of attack
- Stages 3-4 when evidence of peritonitis
What is Hartmann’s procedure?
- Surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy.
Where are peptic ulcers more commonly found?
Duodenum
Name 4 risk factors for peptic ulcer disease
- Age
- H.Pylori
- NSAIDs
- Smoking
Which signs/symptoms for PUD indicate urgent endoscopy?
Anaemia Loss of weight Anorexia Recent onset of progressive symptoms Malaena Swallowing difficulties
What other signs/symptoms are there for PUD?
- Burning sensation
- Pain in epigastric region relating to hunger
- Bloating/Belching/sickness
What signs help to differentiate between gastric and duodenal symptoms?
- Duodenal = pain before meals or at night, relieved by milk, epigastric tenderness
- Gastric = Mainly elderly and weight loss
What test would you do for PUD?
H.Pylori test = Carbon-13 urea breath test
