Abdominal Pain Flashcards
What can right hypochondrium abdominal pain suggest?
- Cholecystitis/Cholangitis
- Biliary colic
- Hepatitis
- Pneumonia
What can Epigastric abdominal pain suggest?
- Biliary colic
- Hepatitis
- Peptic ulcer disease/gastritis
- Acute coronary syndrome
- Pancreatitis
- Ruptured abdominal aortic aneurysm
What can left hypochondrium abdominal pain suggest?
- Pneumonia
- Splenic rupture
What can right lumbar abdominal pain suggest?
- Renal calculus
- Pyelonephritis
What can umbilical abdominal pain suggest?
- Pancreatitis
- Ruptured abdominal aortic aneurysm
- Early appendicitis
What can left lumbar abdominal pain suggest?
- Renal calculus
- Pyelonephritis
What can right iliac fossa abdominal pain suggest?
- Renal calculus
- Established appendicitis
- Terminal ileitis (crohn’s disease)
- Mesenteric adenitis
- Diverticulitis
- Colitis
- Ectopic pregnancy
- Pelvic inflammatory disease/ endometriosis
- Ovarian torsion/ cyst rupture
What can suprapubic abdominal pain suggest?
- Colitis
- Ectopic pregnancy
- Pelvic inflammatory disease/ endometriosis
- Ovarian torsion/ cyst rupture
- Lower urinary tract infection (UTI)/ cystitis
What can left iliac fossa abdominal pain suggest?
- Renal calculus
- Diverticulitis
- Colitis
- Ectopic pregnancy
- Pelvic inflammatory disease/ endometriosis
- Ovarian torsion/ cyst rupture
What can cause diffuse abdominal pain?
- Early appendicitis
- Splenic rupture
- Mesenteric adenitis/ischaemia
- Intestinal obstruction
- Perforation
- Gastroenteritis
- Diabetic ketoacidosis/ hypercalcaemia/ adrenal crisis
- Functional abdominal pain
When might visceral pain be chronic?
Bowel ischaemia
What is true “colicky” pain?
Intermittent episodes of intense smooth muscle contraction that produce short-lived spasms of discomfort lasting seconds to minutes before subsiding
Describe somatic pain?
Sharp, well localised, constant and often associated with local tenderness and guarding
What are the 3 indicators of systemic inflammation?
- Fever (>38oC)
- Increased CRP (>10mg/L)
- WBC (>11 or <4)
Describe peptic ulcer pain?
- Recurrent episodes of burning discomfort
- Relationship to food
- Nausea
- Relief with antacids
What are almost all duodenal ulcers and 70% of gastric ulcers attributed to?
H. pylori infection
Who are gastric cancers more frequent in?
Patients >55 years
What are gastroduodenal disorders best diagnosed by?
Upper gastrointestinal endoscopy (UGIE)
Most gallstones are ______?
Asymptomatic
What causes biliary colic?
Gallstone obstructs the cystic duct, causing gallbladder distention, 1-6hrs after a meal
Describe biliary colic pain?
- Intense
- Dull
- Right upper quadrant/ epigastric pain
- Radiation to the back or scapula
What test can diagnose gallstones?
Ultrasound
What is cholecystitis?
Infection in the bladder due to gallstones obstructing the cystic duct
Describe the pain of cholecystitis?
- Persists over time
- Fever
- Jaundice
What is choledocholithiasis?
- Stone in the common bile duct
- Causes cholestatic jaundice
- Less severe upper abdominal pain/ no pain
What is ascending cholangitis?
Infection of biliary tree occurs upstream from a blockage in the common bile duct (gallstone, tumour)
What do patients with ascending cholangitis present with?
- Significant sepsis
- Jaundice
- Abdominal discomfort
What do patients with acute pancreatitis present with?
- Severe upper abdominal pain
- Radiates to back
- Repeated vomiting
What can acute pancreatitis be associated with?
Systemic inflammatory response and may progress to multiorgan failure
What are the major of acute pancreatitis cases caused by?
- Gallstones passing down the common bile duct and irritating the pancreas
- Alcohol direct injury
Describe the different experiences of pain in chronic pancreatitis?
- Constant and unremitting OR
- Provoked by alcohol or eating
What are the associated features of chronic pancreatitis?
- Weight loss
- Anorexia
- Diabetes mellitus
How can chronic pancreatitis be diagnosed?
CT but endoscopic ultrasound with biopsy may be required to rile out malignancy
Describe how pancreatic cancer presents?
- Severe, unrelenting pain in upper abdomen
- Radiates to back
- Usually associated with cachexia and/or cholestatic jaundice
What can subacute small bowel obstruction be due to?
Oedema or fibrosis
Describe how bowel cancer can present?
- Colicky lower abdominal pain
- Change in bowel habit, weight loss
- Rectal bleeding
- Iron deficiency anaemia
How can you diagnose bowel cancer?
- Colonoscopy
- CT colonoscopy can be used for frail patients who are unfit for endoscopy
Describe how renal stone disease presents?
Infrequent, discrete attacks of severe loin pain radiating to groin & haematuria
Describe how renal cancer/adult polycystic kidney disease (APKD), loin pain-haematuria syndrome or chronic obstruction/pyelonephritis can present?
Chronic dull, aching or “dragging” discomfort
Describe how ovarian torsion or ectopic pregnancy presents?
Sudden onset lower abdominal pain in women of reproductive age
In abdominal pain, what can evidence of shock mean?
- Resuscitate
- Urgent surgical review
- Consider ruptured AAA/ ectopic pregnancy
In abdominal pain, what can NO evidence of shock mean and how would you respond?
- Generalised peritonitis –> Likely perforated viscus
- Erect CXR, Urgent surgical review
How would you respond to possible intestinal obstruction?
Abdominal X-ray
How would you respond to possible renal colic?
CT kidney, ureter and bladder
When should you suspect a ruptured AAA?
- Pulsatile abdominal mass
- Male >60yrs
- Sudden-onset, severe abdominal/back or loin pain followed rapidly by haemodynamic compromise
When should you suspect a splenic rupture?
- Shocked patient
- Abdominal pain
- History of trauma
When should you suspect generalised peritonitis?
- Severe, non-colicky pain abdominal pain
- Worse on movement, coughing or deep inspiration
- Associated with inflammatory features & general abdominal rigidity
What tests diagnose generalised peritonitis?
- Free air under the diaphragm on erect CXR
- If CXR non-diagnostic then consider CT with oral and IV contrast
What is the treatment for generalised peritonitis?
- Aggressive resuscitation
- Antibiotics
- Immediate surgical referral
What is the management for intestinal obstruction?
- Check U&Es
- Provide fluid resuscitation
- Insert large bore nasogastric tube
- Consider urinary catheter
- Refer to surgery
What 3 symptoms suggest infective gastroenteritis?
- Recent onset of acute diarrhoea
- Cramping abdominal pain
- Vomiting
When should you suspect pyelonephritis?
- Flank pain is non-colicky
- Associated with inflammatory features
- Leucocytes and nitrites on urinalysis
- Loin/renal angle tenderness
- Lower urinary tract symptoms
What is the management for a perforated hollow viscus?
- Secure IV access
- Cross-match for blood
- Resuscitate with IV fluids
- Refer immediately to surgery
How can you exclude an ectopic pregnancy?
Transabdominal and/or transvaginal ultrasound
Describe the 2 different types of pain in acute appendicitis?
- Migration of pain from the periumbilical region to the RLQ
- RLQ tenderness or signs of local peritonism
What 3 features accompany pain in the diagnosis of acute appendicitis?
- Mild fever
- Increased WBC
- Increased CRP
What should you exclude if a patient has acute LLQ pain and tenderness with evidence of systemic inflammation, especially if they are >40years?
Sigmoid diverticulitis
What features of a urinalysis makes UTI a possible diagnosis?
Presence of Nitrates & Leucocytes
When should you consider mesenteric ischaemia in a patient?
- Appear unwell
- Unexplained lactic acidosis
- Known vascular disease/ Atrial fibrillation
How do you confirm successful H. pylori eradication?
With a urea breath test
