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MD4003 > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

What can right hypochondrium abdominal pain suggest?

A
  • Cholecystitis/Cholangitis
  • Biliary colic
  • Hepatitis
  • Pneumonia
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2
Q

What can Epigastric abdominal pain suggest?

A
  • Biliary colic
  • Hepatitis
  • Peptic ulcer disease/gastritis
  • Acute coronary syndrome
  • Pancreatitis
  • Ruptured abdominal aortic aneurysm
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3
Q

What can left hypochondrium abdominal pain suggest?

A
  • Pneumonia

- Splenic rupture

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4
Q

What can right lumbar abdominal pain suggest?

A
  • Renal calculus

- Pyelonephritis

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5
Q

What can umbilical abdominal pain suggest?

A
  • Pancreatitis
  • Ruptured abdominal aortic aneurysm
  • Early appendicitis
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6
Q

What can left lumbar abdominal pain suggest?

A
  • Renal calculus

- Pyelonephritis

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7
Q

What can right iliac fossa abdominal pain suggest?

A
  • Renal calculus
  • Established appendicitis
  • Terminal ileitis (crohn’s disease)
  • Mesenteric adenitis
  • Diverticulitis
  • Colitis
  • Ectopic pregnancy
  • Pelvic inflammatory disease/ endometriosis
  • Ovarian torsion/ cyst rupture
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8
Q

What can suprapubic abdominal pain suggest?

A
  • Colitis
  • Ectopic pregnancy
  • Pelvic inflammatory disease/ endometriosis
  • Ovarian torsion/ cyst rupture
  • Lower urinary tract infection (UTI)/ cystitis
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9
Q

What can left iliac fossa abdominal pain suggest?

A
  • Renal calculus
  • Diverticulitis
  • Colitis
  • Ectopic pregnancy
  • Pelvic inflammatory disease/ endometriosis
  • Ovarian torsion/ cyst rupture
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10
Q

What can cause diffuse abdominal pain?

A
  • Early appendicitis
  • Splenic rupture
  • Mesenteric adenitis/ischaemia
  • Intestinal obstruction
  • Perforation
  • Gastroenteritis
  • Diabetic ketoacidosis/ hypercalcaemia/ adrenal crisis
  • Functional abdominal pain
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11
Q

When might visceral pain be chronic?

A

Bowel ischaemia

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12
Q

What is true “colicky” pain?

A

Intermittent episodes of intense smooth muscle contraction that produce short-lived spasms of discomfort lasting seconds to minutes before subsiding

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13
Q

Describe somatic pain?

A

Sharp, well localised, constant and often associated with local tenderness and guarding

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14
Q

What are the 3 indicators of systemic inflammation?

A
  1. Fever (>38oC)
  2. Increased CRP (>10mg/L)
  3. WBC (>11 or <4)
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15
Q

Describe peptic ulcer pain?

A
  • Recurrent episodes of burning discomfort
  • Relationship to food
  • Nausea
  • Relief with antacids
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16
Q

What are almost all duodenal ulcers and 70% of gastric ulcers attributed to?

A

H. pylori infection

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17
Q

Who are gastric cancers more frequent in?

A

Patients >55 years

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18
Q

What are gastroduodenal disorders best diagnosed by?

A

Upper gastrointestinal endoscopy (UGIE)

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19
Q

Most gallstones are ______?

A

Asymptomatic

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20
Q

What causes biliary colic?

A

Gallstone obstructs the cystic duct, causing gallbladder distention, 1-6hrs after a meal

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21
Q

Describe biliary colic pain?

A
  • Intense
  • Dull
  • Right upper quadrant/ epigastric pain
  • Radiation to the back or scapula
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22
Q

What test can diagnose gallstones?

A

Ultrasound

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23
Q

What is cholecystitis?

A

Infection in the bladder due to gallstones obstructing the cystic duct

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24
Q

Describe the pain of cholecystitis?

A
  • Persists over time
  • Fever
  • Jaundice
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25
Q

What is choledocholithiasis?

A
  • Stone in the common bile duct
  • Causes cholestatic jaundice
  • Less severe upper abdominal pain/ no pain
26
Q

What is ascending cholangitis?

A

Infection of biliary tree occurs upstream from a blockage in the common bile duct (gallstone, tumour)

27
Q

What do patients with ascending cholangitis present with?

A
  • Significant sepsis
  • Jaundice
  • Abdominal discomfort
28
Q

What do patients with acute pancreatitis present with?

A
  • Severe upper abdominal pain
  • Radiates to back
  • Repeated vomiting
29
Q

What can acute pancreatitis be associated with?

A

Systemic inflammatory response and may progress to multiorgan failure

30
Q

What are the major of acute pancreatitis cases caused by?

A
  • Gallstones passing down the common bile duct and irritating the pancreas
  • Alcohol direct injury
31
Q

Describe the different experiences of pain in chronic pancreatitis?

A
  • Constant and unremitting OR

- Provoked by alcohol or eating

32
Q

What are the associated features of chronic pancreatitis?

A
  • Weight loss
  • Anorexia
  • Diabetes mellitus
33
Q

How can chronic pancreatitis be diagnosed?

A

CT but endoscopic ultrasound with biopsy may be required to rile out malignancy

34
Q

Describe how pancreatic cancer presents?

A
  • Severe, unrelenting pain in upper abdomen
  • Radiates to back
  • Usually associated with cachexia and/or cholestatic jaundice
35
Q

What can subacute small bowel obstruction be due to?

A

Oedema or fibrosis

36
Q

Describe how bowel cancer can present?

A
  • Colicky lower abdominal pain
  • Change in bowel habit, weight loss
  • Rectal bleeding
  • Iron deficiency anaemia
37
Q

How can you diagnose bowel cancer?

A
  • Colonoscopy

- CT colonoscopy can be used for frail patients who are unfit for endoscopy

38
Q

Describe how renal stone disease presents?

A

Infrequent, discrete attacks of severe loin pain radiating to groin & haematuria

39
Q

Describe how renal cancer/adult polycystic kidney disease (APKD), loin pain-haematuria syndrome or chronic obstruction/pyelonephritis can present?

A

Chronic dull, aching or “dragging” discomfort

40
Q

Describe how ovarian torsion or ectopic pregnancy presents?

A

Sudden onset lower abdominal pain in women of reproductive age

41
Q

In abdominal pain, what can evidence of shock mean?

A
  • Resuscitate
  • Urgent surgical review
  • Consider ruptured AAA/ ectopic pregnancy
42
Q

In abdominal pain, what can NO evidence of shock mean and how would you respond?

A
  • Generalised peritonitis –> Likely perforated viscus

- Erect CXR, Urgent surgical review

43
Q

How would you respond to possible intestinal obstruction?

A

Abdominal X-ray

44
Q

How would you respond to possible renal colic?

A

CT kidney, ureter and bladder

45
Q

When should you suspect a ruptured AAA?

A
  • Pulsatile abdominal mass
  • Male >60yrs
  • Sudden-onset, severe abdominal/back or loin pain followed rapidly by haemodynamic compromise
46
Q

When should you suspect a splenic rupture?

A
  • Shocked patient
  • Abdominal pain
  • History of trauma
47
Q

When should you suspect generalised peritonitis?

A
  • Severe, non-colicky pain abdominal pain
  • Worse on movement, coughing or deep inspiration
  • Associated with inflammatory features & general abdominal rigidity
48
Q

What tests diagnose generalised peritonitis?

A
  • Free air under the diaphragm on erect CXR

- If CXR non-diagnostic then consider CT with oral and IV contrast

49
Q

What is the treatment for generalised peritonitis?

A
  • Aggressive resuscitation
  • Antibiotics
  • Immediate surgical referral
50
Q

What is the management for intestinal obstruction?

A
  • Check U&Es
  • Provide fluid resuscitation
  • Insert large bore nasogastric tube
  • Consider urinary catheter
  • Refer to surgery
51
Q

What 3 symptoms suggest infective gastroenteritis?

A
  1. Recent onset of acute diarrhoea
  2. Cramping abdominal pain
  3. Vomiting
52
Q

When should you suspect pyelonephritis?

A
  • Flank pain is non-colicky
  • Associated with inflammatory features
  • Leucocytes and nitrites on urinalysis
  • Loin/renal angle tenderness
  • Lower urinary tract symptoms
53
Q

What is the management for a perforated hollow viscus?

A
  • Secure IV access
  • Cross-match for blood
  • Resuscitate with IV fluids
  • Refer immediately to surgery
54
Q

How can you exclude an ectopic pregnancy?

A

Transabdominal and/or transvaginal ultrasound

55
Q

Describe the 2 different types of pain in acute appendicitis?

A
  1. Migration of pain from the periumbilical region to the RLQ
  2. RLQ tenderness or signs of local peritonism
56
Q

What 3 features accompany pain in the diagnosis of acute appendicitis?

A
  1. Mild fever
  2. Increased WBC
  3. Increased CRP
57
Q

What should you exclude if a patient has acute LLQ pain and tenderness with evidence of systemic inflammation, especially if they are >40years?

A

Sigmoid diverticulitis

58
Q

What features of a urinalysis makes UTI a possible diagnosis?

A

Presence of Nitrates & Leucocytes

59
Q

When should you consider mesenteric ischaemia in a patient?

A
  • Appear unwell
  • Unexplained lactic acidosis
  • Known vascular disease/ Atrial fibrillation
60
Q

How do you confirm successful H. pylori eradication?

A

With a urea breath test

MD4003 (22 decks)

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