Abdominal Pain and the Acute Abdomen Flashcards
What are the 3 different types of pain that can be felt in the abdomen?
Visceral pain
Parietal pain
Referred Pain
What causes visceral pain in the abdomen and how do patients describe the feeling?
- Receptors located on sreosal surface, in
mesentery, intestinal muscle and mucosa of hollow organ - Stretching, tension and ishaemia cause pt to feel pain
- Visceral pain fibres = C fibres
=> pain often DULL and poorly localised
Where is visceral pain from organs in the Foregut usually felt?
- Middle (i.e. pain from stomach, pancreas)
Visceral pain from the midgut is poorly localised to which region?
- suprapubic (i.e. pain from small intestine)
Visceral pain originating from the hindgut is poorly localised to where?
- lower abdomen (i.e. pain from colon)
What causes a patient to experience somato-parietal pain?
- receptors located in parietal peritoneum, muscle and the skin
=> Pain results from:
- Inflammation/ stretching/ tearing of parietal peritoneum
- movement may aggravate pain so often these patients lie very still
Describe how somato-parietal pain feels different from visceral pain?
- Pain signal is transmitted through myelinated A-delta fibres
=> pain is sharp, more intense and more localised
What is referred pain and how does this feel?
- well localised
- felt in area distant from affected organ
- occurs when organs share common nerve pathway
e.g. gall bladder pain may be felt in the right shoulder tip
How can a patient describe the characteristics/ nature of their abdominal pain?
- is onset gradual or sudden?
- Stabbing/ dull/ colicky?
- does the pain Radiate anywhere?
What associated symptoms may occur with pain?
- nausea/ sickness
- temperature
- malaise
- diarrhoea
What could aggravate a patient’s pain?
- movement
- cough
- sneeze
What is the difference between ACUTE and CHRONIC pain?
Acute:
- Sudden, sharp, intense , localised
- Usually self limiting
- Assoc. with physiological changes: high heart rate, temperature etc
Chronic:
- Gnawing, aching, diffuse
- no clear beginning or end
- Varies in intensity
- Assoc. with physiological and social difficulties
What should you ask about in a patient’s past medical history if they present with abdominal pain?
previous operations?
History of other medical problems (cancer; IBD etc)
What is meant by the term “acute abdomen”
- sudden, severe abdominal pain,
- less than 24 hours duration
Give some examples of causes of an acute abdomen
Appendicitis Pancreatitis Peptic ulcer Diverticulitis DKA Ectopic preg. Renal colic AAA Bowel perforation/ Volvulus Pyelonephritis Cholecystitis Intestinal ischaemia Peritonitis Strangulated hernia
If a patient presents with an acute abdomen and is haemodynamically unstable (hypotensive and tachycardic), what differentials should you be considering?
MI AAA Ruptured ectopic Mesenteric ishaemia Ruptured spleen/ Liver Sepsis
Why is observation of the patients abdomen important in the acute abdomen presentation?
- Patient with peritonitis will be motionless, in foetal position, shallow respiration
- Pt may have visible signs of disease => previous surgery scars => distension => masses, hernias, organomegaly, pulsatile mass => discoloration => stigmata of liver disease
Describe the difference between Normal bowel sound auscultation and pathology?
Normal = 4-8 bowel sounds over 2 mins
Quiet abdomen generally = sick abdomen
High pitched ”tinkles” = mechanical obstruction
What can be felt on palpation of the acute abdomen?
- guarding - voluntary or involuntary (Spasm)
- rigidity
- rebound tenderness (pain stimulated by releasing hand quickly)
An abdominal XRay is not a cost effective investigation for an cute abdomen. TRUE/FALSE?
TRUE
- <10% show abnormality
- Useful to visualise free air or stones
What must be given during a CT scan of the acute abdomen? What pathology can CT visualise?
- oral/ IV contrast
> 90% sensitive for appendicitis, cholecystitis, pancreatitis, diverticulitis, mesenteric ishaemia
When is an abdominal US indicated?
- Trauma (as it is a FAST scan)
- AAA: 75 – 80% sensitivity
- Ectopic pregnancy
- Gallstones/ Renal stones
When is an ECG/CXR used in the investigation of an acute abdomen?
- both used if upper abdominal pain of unknown origin
When is immediate surgical intervention required for an acute abdomen?
- Haemorrhagic shock
- Ruptured AAA
- Trauma => spontaneous rupture of spleen / liver
- Ruptured ectopic pregnancy
- DO US NOT CT
- Get pt to theatre within 4-6 hours
