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4th Year GI > Acute abdomen > Flashcards

Acute abdomen Flashcards

1
Q

Differential diagnosis for right upper quadrant pain

A
  • Cholecystitis
  • Ureteric colic
  • Pyelonephritis
  • Hepatitis
  • Pneumonia
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2
Q

Differential diagnosis for left upper quadrant pain

A
  • Ureteric colic
  • Pyelonephritis
  • Pneumonia
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3
Q

Differential diagnosis for right lower quadrant pain

A
  • Appendicitis
  • Inguinal hernia
  • IBD
  • Testicular torsion
  • Gynaecological causes
  • UTI
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4
Q

Differential diagnosis for left lower quadrant pain

A
  • Diverticulitis
  • Inguinal hernia
  • IBD
  • Testicular torsion
  • Gynaecological causes
  • UTI
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5
Q

Differential diagnosis for epigastric pain

A
  • Peptic ulcer disease
  • Pancreatitis
  • Cholecystitis
  • Myocardial infarction
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6
Q

Differential diagnosis for periumbilical region pain

A
  • Appendicitis
  • Small bowel obstruction
  • Large bowel obstruction
  • Abdominal aortic aneurysm
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7
Q

What clinical features would make you suspect that right upper quadrant pain was due to biliary colic / cholecystitis?

What diagnostic test would you perform?

A

Biliary colic: Recurrent attacks after fatty meal

Cholecystitis: fever, positive Murphy’s sign

Diagnostic test: Ultrasound

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8
Q

What clinical features would make you suspect that right upper quadrant pain was due to ascending cholangitis?

Diagnostic tests?

A

Charcot’s triad: RUQ pain, fever, jaundice

Dark urine, pale stools

Diagnostic tests: ultrasound, MRCP

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9
Q

What would make you suspect that right upper quadrant pain was due to viral hepatitis?

Diagnostic tests?

A

Jaundice, decompensated liver disease

Risk factors: IVDU, blood transfusion, tattoos

Diagnostic tests: LFTs, viral hepatitis serology

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10
Q

What clinical features would make you suspect that right upper quadrant pain was due to pyelonephritis?

Diagnostic tests?

A

Flank/loin pain, urinary symtoms

Nausea, vomiting, fever

Diagnostic tests: Urinalysis, FBC/U&Es/CRP

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11
Q

What clinical features would make you suspect the right upper quadrant pain was due to renal colic?

A

Flank/loin-to-groin pain, acute, severe, colicky

Nausea and vomiting

Diagnostic tests: Urinalysis, CT KUB

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12
Q

What clinical features would make you suspect that right/left upper quadrant pain was due to pneumonia?

Diagnostic tests?

A

Productive cough, pleuritic chest pain, SOB

Diagnostic test: CXR

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13
Q

A 28 year old male presents to the emergency department via ambulance following a road traffic accident.

You perform the primary survey and, on examination of the abdomen, the patient has severe pain in the left upper quadrant.

No other obvious injuries are found.

HR 130, BP 85/60, RR 24, SpO2 95%, Temp 36.5

What is the likely diagnosis?

Diagnostic tests?

A

Splenic injury/laceration

Diagnostic tests: FAST scan, CT abdomen

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14
Q

A 44 year old male presents to the emergency department via ambulance with severe, sudden onset epigasric pain. He has vomited several times and feels very thirsty.

Over the last few months, he has noticed that his stools have been bulky and difficult to flush.

He works at a supermarket and drinks half a bottle of vodka every day.

Observations: HR 135, BP 110/85, RR 22, SpO2 95%, Temp 37.2

What is the likely diagnosis?

A

Acute on chronic pancreatitis

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15
Q

Clinical features that would make you suspect that epigastric pain was due to pancreatitis?

Diagnostic tests?

A

Severe epigastric pain, nausea and vomiting, anorexia

Steatorrhoea: if acute-on-chronic

Cullen’s sign/Grey-Turner’s sign

Presence of risk factors: eg gallstone, alcohol excess

Diagnostic tests: Serum amylase or lipase

Consider USS or CT abdomen

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16
Q

Clinical features that would make you suspect epigastric pain was due to peptic ulcer disease?

Diagnostic tests?

A

Burning epigastric pain

Duodenal: worse when hungry, relieved by eating

Gastric: worse when eating

Nausea, vomiting, coffee-ground vomit, meleana

Diagnostic tests: Erect CXR (?perforation)

UGIE

H.Pylori breath test/stool antigen

17
Q

Clinical features that would suggest epigastric pain is due to myocardial infarction?

Diagnostic tests?

A

Crushing pain, non-pleuritic, sweating

Cardiovascular risk factors

ECG

18
Q

A 19 year old male presents to the emergency department with his mother due to a 3 day history of gradually worsening abdominal pain.

The pain has originally started around his belly button and has now moved towards the right iliac fossa.

He has felt nauseous, has a reduced appetite and feels slightly feverish.

Which scoring system is used to assess the likelihood of the underlying cause?

A

Alvarado score (eg migratory RIF pain, anorexia, fever WBC etc)

19
Q

Clinical features which would suggest that right lower quadrant pain is due to Crohn’s disease?

Diagnostic tests?

A

RIght iliac fossa pain, diarrhoea, weight loss

Fever, anal fissures/fistulae/blood in stool

Diagnosstic tests: Faecal calprotectin

Colonoscopy

20
Q

Clinical features which suggest that right lower quadrant pain is due to a hernia?

Diagnostic tests:

A

Groin mass, discomfort or pain with bulge

Clinical diagnosis

21
Q

Clinical features which suggest that right lower quadrant pain is due to appendicitis?

Diagnostic tests?

A

Peri-umbilical pain migrating to right iliac fossa

Low grade fever, reduced appetite, nausea

Rovsing’s sign, obturator sign, psoas sign

Diagnostic tests: Clinical diagnosis

USS/abdominal CT

22
Q

Clinical features which suggest that right/left lower quadrant pain is due to ectopic pregnancy?

Diagnostic tests?

A

Lower cramping, constant abdominal pain

Vaginal bleeding and amenorrhoea (6-8 weeks often)

Nausea, vomiting; dizziness, syncope suggest rupture

Diagnostic tests: beta HCG

Transvaginal ultrasound scan

23
Q

A 12 year old boy presents to the emergency department with sudden-onset severe lower abdominal pain, particularly on the right hand side.

He has vomited twice with this pain and is walking with a waddling gait.

What is the likely diagnosis?

A

Testicular torsion

24
Q

Clinical features which suggest that right/left lower quadrant pain is due to UTI?

Diagnostic test?

A

Suprapubic pain, dysuria, frequency, cloudy urine

Diagnostic test: urine dip

25
Q

Clinical features which suggest that right lower quadrant pain is due to testicular torsion?

Diagnostic tests?

A

Sudden onset severe unilateral testicular pain

Nausea and vomiting; absent cremasteric reflex

Diagnostic tests: Clinical diagnosis

Occasionally USS

26
Q

Clinical features which suggest that left lower quadrant pain is due to IBD (ulcerative colitis)?

Diagnostic tests?

A

Left lower quadrant pain, diarrhoea, mucus, fresh rectal bleeding

Faecal urgency and tenesmus

Diagnostic tests: Faecal calprotectin

Colonoscopy (not during acute flare as high risk of perforation)

27
Q

Clinical features which would suggest the left lower quadrant pain is due to acute diverticulitis?

Diagnostic tests?

A

Fresh rectal bleeding, fever, history of constipation

Diagnostic test: CT abdomen/pelvis

28
Q

A 56 year old male presents to the emergency department via ambulance with severe central abdominal pain.

He has a history of hypertension, type 2 diabetes mellitus. He has a 30 pack year smoking history.

Observations: HR 145, BP 92/45, SpO2 94%, Temp 37.1

What is the most likely diagnosis?

A

Abdominal aortic aneurysm

Diagnostic tests: abdominal USS

CT angiogram

4th Year GI (15 decks)

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