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GI > Abdominal Pain and the Acute Abdomen > Flashcards

Abdominal Pain and the Acute Abdomen Flashcards

1
Q

What are the 3 different types of pain that can be felt in the abdomen?

A

Visceral pain
Parietal pain
Referred Pain

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2
Q

What causes visceral pain in the abdomen and how do patients describe the feeling?

A
  • 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
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3
Q

Where is visceral pain from organs in the Foregut usually felt?

A
  • Middle (i.e. pain from stomach, pancreas)
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4
Q

Visceral pain from the midgut is poorly localised to which region?

A
  • suprapubic (i.e. pain from small intestine)
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5
Q

Visceral pain originating from the hindgut is poorly localised to where?

A
  • lower abdomen (i.e. pain from colon)
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6
Q

What causes a patient to experience somato-parietal pain?

A
  • 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
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7
Q

Describe how somato-parietal pain feels different from visceral pain?

A
  • Pain signal is transmitted through myelinated A-delta fibres
    => pain is sharp, more intense and more localised
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8
Q

What is referred pain and how does this feel?

A
  • 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

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9
Q

How can a patient describe the characteristics/ nature of their abdominal pain?

A
  • is onset gradual or sudden?
  • Stabbing/ dull/ colicky?
  • does the pain Radiate anywhere?
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10
Q

What associated symptoms may occur with pain?

A
  • nausea/ sickness
  • temperature
  • malaise
  • diarrhoea
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11
Q

What could aggravate a patient’s pain?

A
  • movement
  • cough
  • sneeze
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12
Q

What is the difference between ACUTE and CHRONIC pain?

A

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
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13
Q

What should you ask about in a patient’s past medical history if they present with abdominal pain?

A

previous operations?

History of other medical problems (cancer; IBD etc)

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14
Q

What is meant by the term “acute abdomen”

A
  • sudden, severe abdominal pain,

- less than 24 hours duration

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15
Q

Give some examples of causes of an acute abdomen

A 
Appendicitis
Pancreatitis
Peptic ulcer
Diverticulitis
DKA
Ectopic preg.
Renal colic
AAA
Bowel perforation/ Volvulus
Pyelonephritis
Cholecystitis
Intestinal ischaemia
Peritonitis
Strangulated hernia
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16
Q

If a patient presents with an acute abdomen and is haemodynamically unstable (hypotensive and tachycardic), what differentials should you be considering?

A 
MI
AAA
Ruptured ectopic
Mesenteric ishaemia
Ruptured spleen/ Liver
Sepsis
17
Q

Why is observation of the patients abdomen important in the acute abdomen presentation?

A
  • 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
18
Q

Describe the difference between Normal bowel sound auscultation and pathology?

A

Normal = 4-8 bowel sounds over 2 mins

Quiet abdomen generally = sick abdomen

High pitched ”tinkles” = mechanical obstruction

19
Q

What can be felt on palpation of the acute abdomen?

A
  • guarding - voluntary or involuntary (Spasm)
  • rigidity
  • rebound tenderness (pain stimulated by releasing hand quickly)
20
Q

An abdominal XRay is not a cost effective investigation for an cute abdomen. TRUE/FALSE?

A

TRUE

  • <10% show abnormality
  • Useful to visualise free air or stones
21
Q

What must be given during a CT scan of the acute abdomen? What pathology can CT visualise?

A
  • oral/ IV contrast

> 90% sensitive for appendicitis, cholecystitis, pancreatitis, diverticulitis, mesenteric ishaemia

22
Q

When is an abdominal US indicated?

A
  • Trauma (as it is a FAST scan)
  • AAA: 75 – 80% sensitivity
  • Ectopic pregnancy
  • Gallstones/ Renal stones
23
Q

When is an ECG/CXR used in the investigation of an acute abdomen?

A
  • both used if upper abdominal pain of unknown origin
24
Q

When is immediate surgical intervention required for an acute abdomen?

A
  • 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
25
Q

What pathology requires NON-urgent surgical intervention (i.e taken to theatre within 48hrs)?

A
  • Acute cholecystitis
  • Acute diverticulitis
  • Simple small bowel obstruction
  • Incarcerated hernia
26
Q

What causes mesenteric ischaemia?

A
  • Arterial embolism – 50%
  • Arterial thrombosis – 25%
  • Non-occlusive ischaemia – 15%
  • Venous thrombosis – 10%
27
Q

What symptom indicates mesenteric ischaemia?

A
  • pain out of proportions to examination
28
Q

What investigation is most sensitive for detecting mesenteric ischaemia?

A

Angiography >95%

29
Q

How is mesenteric ischaemia treated?

A
  • thrombolytics

- surgery

30
Q

When does toxic megacolon usually occur and how do patients present?

A
  • Patients usually already hospitalised for exacerbation of IBD or C Diff colitis
  • Then sudden onset of worsening of abdominal pain, distension, tender RIF
31
Q

How do patients present with an incarcerated hernia?

A
  • Sudden onset of pain
  • Lump may not be obvious – think femoral hernia
  • Elderly women
  • Vomiting = early feature
32
Q

How do patients usually present with a ruptured AAA?

A
  • Elderly Pt with Hx of hypertension/ PVD
  • Present hypotensive, back and abdominal pain
  • abdominal mass and bruit
  • unequal and thready femoral pulse
33
Q

Most small bowel obstructions are due to what cause?

A

70% due to adhesions

GI (33 decks)

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