Abdominal pain and diarrhoea Flashcards
What are the differential diagnoses for acute pain in the upper abdomen?
- Gallstone colic
- Acute cholecystitis
- Acute pancreatitis
- Acute cholangitis
- Gastric carcinoma
- Gastritis
- Oesophagitis
- Hiatus hernia
- ACS
- Pericarditis, pneumonia, empyema, herpes zoster, Boerhaave
What are the differential diagnoses for acute pain in the central abdomen?
- Small bowel obstruction
- Abdominal aortic dissection
- Crohn’s disease
- Mesenteric artery occlusion
What are the differential diagnoses for acute pain in the lateral abdomen?
- Appendicitis
- Pyelonephritis
- Renal calculus
- Ureteric calculus
- Salpingitis
- Ruptured ovarian cyst or torsion, endometriosis, Meckel’s diverticulitis
What are the differential diagnoses for acute pain in the lower abdomen?
- Cystitis
- Pelvic inflammatory disorder
- Pelvic endometriosis
- Ectopic pregnancy
- Large bowel obstruction
- Infective or ulcerative colitis
What characterises acute pancreatitis? And what would you suggest?
Pain radiating straight through to the back, better on sitting up or leaning forward. General tenderness, reduced bowel sounds
Suggest: FBC, U&E, CXR, AXR, amylase (will be high), CT pancreas
How would you manage acute pancreatitis?
Pethidine, fluids, NG tube and nil by mouth
Monitor calcium and glucose
What characterises acute cholangitis? And what would you suggest?
RUQ abdominal pain, jaundice, hypotension, fever
Suggest: FBC, U&E, CXR, AXR, US scan gallbladder, US biliary duct, blood culture
How would you manage acute cholangitis?
Fluid, analgesia, IV ABx
What characterises gastric carcinoma? And what would you suggest?
Anorexia, fullness, pain, Virchow’s node
Upper GI endoscopy and biopsy
What characterises gastritis? And what would you suggest?
Epigastric pain, dull or burning discomfort, nocturnal pain
Oesophagogastroscopy, barium meal and pH study
How would you manage gastritis?
Antacids, H2 blocker, PPI
What characterises oesophagitis? And what would you suggest?
Retrosternal pain, heartburn
Oesophagogastroscopy
How would you manage oesophagitis?
Small, often meals. Elevate head of bed. Antacids, PPI, H2 blocker
What characterises hiatus hernia? And what would you suggest?
Heartburn, worsens with stooping or lying, relieved with antacids
Oesophagogastroscopy, barium meal
What characterises small bowel obstruction? And what would you suggest?
Vomiting, constipation with complete obstruction
AXR
How would you manage small bowel obstruction?
NG tube, nil by mouth, fluids, surgery
What characterises abdominal aorta dissection? And what would you suggest?
Tearing pain, hypertension
US scan, CT abdomen
How would you manage abdominal aorta dissection?
Pain control, group and crossmatch. IV access, reduce BP and surgical intervention
What characterises Crohn’s disease? And what would you suggest?
Chronic diarrhoea, abdominal pain, weight loss, RLQ mass and fullness, mouth ulcers
Colonoscopy with biopsy, barium studies
What characterises mesenteric artery occlusion? And what would you suggest?
Vomiting, bowel urgency, melaena, diarrhoea
Mesenteric angiography, exploratory laparotomy
What characterises appendicitis? And what would you suggest?
Pain initially central, but moves to RLQ, anorexia, low-grade fever, constipation, RLQ tenderness and guarding
US appendix, laparotomy
How would you manage appendicitis?
nil by mouth, cross matching, broad spectrum ABx, surgical intervention
What characterises pyelonephritis? And what would you suggest?
Pain in loin, riggers, fevers, vomiting, frequency of urination, renal angle tenderness
FBC: leucocytosis, MSU: pyuria, urine and blood culture and sensitivities
How would you manage pyelonephritis?
Ampicillin, gentamicin, 3rd generation cephalosporin
