Acute Abdo Pain Flashcards
Why acute abdo pain is potentially serious
Body fluid changes
- blood loss => shock
- plasma loss (from inflammation, necrosis
- saline loss (from V+D)
Sepsis
Classifying pain
-location
Visceral peritoneum
-stretch and overdistention of viscera => dull generalised pain according to foregut, midgut and hindgut
Parietal peritoneum
- irritation/inflammation of peritoneum => intense and localised pain
- likely organ involvement within abdomen
Extraabdominal pain
Classifying pain
-nature
Intermittent
-peristalsis against obstruction => colicky pain
Continuous
- inflammatory, ischemia, infarction
- biliary pain can be cont
Both
-large bowel obstruction - colic => cont (stretching of wall)
Classifying pain
-onset
Sudden => perforation
Gradual => inflammation
Use all this info and location of pain to determine organ involved
Any vomiting?
Irritation of peritoneal/mesenteric nerves
Obstruction of muscular tube
-biliary duct, ureter, intestine
Possible locations of obstruction
Compression of tube
- enlarged LN, cancer?
- adhesion?
Within wall
-inflammation, colon carcinoma
In lumen
-stones blocking tube
Possible causes in RUQ
- characteristic signs
- pathophysiology
Biliary colic - gallstone stuck in bile duct
- pain after fatty meal
- no fever or raised inflammatory markers
Acute cholecystitis - gallstone blockage => inflammation/infection of GB
- Murphy’s, Boas
- fever, raised inflammatory markers
Ascending cholangitis - bacterial infection of biliary tree often after GS
-Charcot’s triad (pain, fever, jaundice)
Acute pancreatitis - most often due to alcohol/GS
- epigastric pain => back
- severe pain, fever
Possible causes in epigastrium
Peptic ulcer disease - often on background of NSAIDs/alcohol
- duodenal - pain relieved by eating
- gastric - pain worse by eating
- UGI bleed (vomit, melena)
Possible causes in LGI tract
Appendicitis - E => RIF
- anorexia, tachycardia, fever, RIF tenderness
- Rovsing’s sign
Acute diverticulitis - LLQ
- diarrhoea, may be blood
- fever, high inflammatory markers, WBCs
Intestinal obstruction - C
- history of malignancy, adhesions
- vomiting
- no bowel opening
- tinkling sounds
Possible causes in GU tract
Renal colic - colicky loin to groin
-hematuria may be found
Acute pyelonephritis - back pain
-fevers, rigors
Urinary retention - SP
- Bladder distention, tenderness
- common in BPH
Possible causes in women
DO A PREGNANCY TEST TO RULE OUT PREGNANCY
Ectopic pregnancy - R/LIF
-amenorrhea for past 6-9wks
-vaginal bleeding may be found
PID -
- deep pelvic pain, esp in sex
- menstrual irregularities
Possible vascular causes
Ruptured AAA - E => back
- sudden collapse, shocked
- history of CVD
Mesenteric ischemia - E
- history of AF, CVD
- diarrhea, rectal bleeding due to dying tissue
- metabolic acidosis
Signs of retroperitoneal bleeding
Grey Turner - flanks
Cullens - periumbilical
Possible extraperitoneal causes
Resp
-basal pneumonia
CV
-MI
Neuro
-neuropathic pain
Diabetes
-DKA
Blood
- Sickle cell crisis
- hemolytic anemia
Good further investigations to ask for and why
Blood tests
- amylase - high in pancreatitis
- WBC, serial - infection
- CRP - inflammation
- LFT - liver/GB issue
- U&E - electrolyte imbalances
- glucose - DKA
- sickle test - if needed
- ABG - metabolic acidosis
Urine dipstick
-rule out GU causes
Pregnancy test
-rule out ectopics
AXR
USS - free fluid
CT - isolate location of problem
FAST - blunt abdo trauma (AAA, free fluid)
