abdominal pain

Question 1

What can epigastric pain mean

Answer 1

The TOP 2: Peptic ulcer and pancreatitis

then work through organs
Peptic ulcer, Duodenal Ulcer, Gall stones, GERD, gastritis, 
MI, 
pancreatitis, 
malignancy

always think of risk factors-
ulcer-NSAIDs. GORD-better with antacids. Gastritis-worse with EtOH,
Pancreatitis-gallstones, high amylase?

always think whats around these areas-can come too
above-MI, Below-Aorta (AAA), Right-Liver/gallbladder (cholecystitis, Heptatis)

Question 2

Nature

Answer 2

Constant-inflammation

Colicky-obstruction

Question 3

Causes of RUQ abdominal pain?

Answer 3

organs: Gall bladder, Liver

Gall-cholecystitis, Cholangitis, gallstones (colicky)

Liver-hepatitis, Abscesses

above-lungs-basal pneumonia
Below (appendicix-retroperitoneal or pregnant)
Left-stomach, pancreas (Peptic ulcer, pancreatitis_
Right-Kidney-pylonephritis

Question 4

What can cause Right illiac Fossa pain

Answer 4

GI causes: Appendicitis, , GI cancer, IDB, Mesenteric adenines
Gyn causes: ectopic pregnancy, fibroids, ovarian cyst rupture, twist, bleed

above-kidneys-polynephritis
Right-

Question 5

Suprapubic pain

Answer 5

Cystitis, Urinary retention

+anything close to that

Question 6

Left iliac fossa

Answer 6

GI-constipation (more general, not localised), IBD, Malignancy, Diverticulutis
Gyn-Ectopic pregnancy, ovarian cyst rupture, torsion

Question 7

Causes of diffuse abdominal Pain

Answer 7

constipation/obstruction, Infect: peritonitis, gasterentitis
inflam: IBD
Ischem: Mesenteric ischiamia (ischemia in arteries to abdo organs-like angina after eating)
Medical causes:
diabetic keto-acidosis, anxiety, MI, Addison’s crisis, hypercalacemia, Porphyria, Lead poisoning

Question 8

Causes of high amylase?

Answer 8

can be up for nearly any cause of acute abdomen

Question 9

Management of acute abdomen

Answer 9

Acute Abdomen

Nil By Most, IV fluids, analgesics, consider antiemetics, consider antibiotics, consult surgeons, monitor vitals

if bleed, send for OGD

if variceal bleeds-abx and Terlipressin (sphlancic vasopression)

investigate-FBC, U&E, LFT, CRP, Clotting, C&S, Xmatch, Erect CXR, CT, STOOL sample, and Cdiff screen

Question 10

Investigation for PR bleed or dysphagia

Answer 10

OGD-dysphagia
PR bleed-colonoscopy

STOOL sample, and Cdiff screen

Question 11

Investigation for Dyspepsia with anaemia

Answer 11

check heamatinics (ferritin, b12, folate)
Coeliac screen (TTG ab)

(care red flags-weight loss, anaemia, change of bowel habit, blood in stool, hematemasis)
and then decide top (OGD) or bottom (colonoscopy)