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Year 4 diagnostics > Acute abdomen - localised pain > Flashcards

Acute abdomen - localised pain Flashcards

1
Q

Differential diagnosis for pain in the right upper quadrant

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

Differential diagnosis for pain in the left upper quadrant

A
  • Gastric ulcer
  • Pyelonephritis
  • Ureteric colic
  • Pneumonia
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3
Q

Differential diagnosis for pain in the rigth lower quadrant

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

Differential diagnosis for pain in the left lower quadrant

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

Differential diagnosis for pain in the epigastric region

A
  • Peptic ulcer
  • Cholecyctitis
  • Pancreatitis
  • Myocardial infarction
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6
Q

Differential diagnosis for pain the the peri-umbilical region

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

What is cholecystitis?

A

Inflammation of the gallbladder

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8
Q

What is cholangitis?

A

Inflammation of the bile duct system

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9
Q

Cholecyctitis signs and symptoms

A
  • Sudden onset RUQ pain radiating to back
  • Associated with possitive Murphy’s sign and raised inflammatory markers
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10
Q

What is Charcot’s triad and Raynaud’s pentad and what do they indicated?

A

Charcot’s triad

  • fever, RUQ pain, jaundice
  • ascending cholangitis

Raynaud’s triad

  • in addition to above symptoms
  • shock (low BP, tachycardia), altered mental status
  • obstructive picture
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11
Q

Imaging investigations for cholangitis?

A

Abdominal ultrasound is the preferred imaging method for the evaluation of cholecystitis - also allows for assessment of compressibility of the gallbladder

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12
Q

Cholecyctitis management

A

Initial management

  • fasting to take strain off gallbladder
  • intravenous fluids to prevent dehydration
  • antibiotics if suspected infection

If recurrect cholecyctitis

  • cholecyctectomy
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13
Q
A
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14
Q

Symptoms of renal colic

A

Colicy loin to groin pain

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15
Q

Pathophysiology of renal colic

A

Obstruction of flow in the ureter leading to increased wall tension in the urinary tract.

This leads to increased prostaglandin synthesis which results in vasodilation causing diuresis which further increases pressure.

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16
Q

Renal colic investigations

A
  • Urinalysis - microscopic haematuria in 90% of cases
  • 24 hour urine collection - for recurrent stone formers (calcium, oxalate, uric acid, citrate, sodium creatinine) to direct specific therapy if indicated
  • Abdominal X-ray - low sensitivity for detecting stones
  • CT-KUB
    • imaging modality of choice
    • non-contrast examination
  • Ultrasound - lower sensitivity than CT but often used as first line in pregnant women and children
17
Q

What medication would be indicated for uric acid stones?

A

Allopurinol

18
Q

Management of renal colic

A
  • Extracorporeal shock wave lithotripsy
  • Ureteroscopy
  • Percutaneous nephrolithotomy
19
Q

Diagnostic criteria for pancreatitis

A

Must have at least 2/3 of the following:

  • Acute onset of severe epigastric pain (relieved by bending forward)
  • Elevated amylase/lipase
  • Imaginig features consistent on CT, MRI or ultrasound

Imaging is only necessary if the first 2 criteria are not met

20
Q

Causes of pancreatitis

A
  • Gallstones
  • Alcohol abuse
  • Metabolic disorders
    • hypertrigylcerideaemia
    • hypercalcaemia
  • Autoimmune
  • Trauma
  • Malignancy
  • Infection
  • Toxins
  • Drugs
21
Q

Complications of panceatitis

A
  • Pancreatic fluid collections
  • Necrosis
  • Pseudocysts
  • Pancreatic abscess
  • Vascular - haemorrhage, pseudoaneurysm, splenic/portal vein thrombosis
22
Q

Investigations for pancreatitis

A
  • CT
    • Focal or diffuse enlargement
    • Oedema
    • Surrounding retroperitoneal fat stranding
    • Necrosis
    • Abscess
    • Haemorrhage
    • Calcification - evidence of chronic pancreatitis
  • Ultraound
    • Gallstones as a possibe cause
    • Vascular complications - thrombosis
    • Necrosis - hypoechoic regions
23
Q

Pathophysiology of peptic ulcer disease/ gastric ulcer

A

Result of gastric mucosal ulceration secondary to the effects of gastric acid

24
Q

Presentation of peptic ulcer disease/ gastric ulcer

A

Epigastric pain relieved by eating or antacids

25
Q

Complications of peptic ulcer disease/ gastric ulcer

A
  • Upper GI tract haemorrhage → malaena, haematemesis
  • Perforation → generalised acute abdominal pain, peritonitis, shock
26
Q

Investigations for peptic ulcer disease/ gastric ulcer

A
  • CT is the modality of choice in the acute setting, may be useful in identifying site of bleeding prior to endoscopy
  • erect chest X-ray - look for pneumoperitoneum
27
Q

Signs and symptoms of appendicitus

A
  • Initially poorly localised peri-umbilical pain that migrates to the RLQ
  • Nausea, vomiting, anorexia
  • Tachycardia, pyrexia, RLQ tenderness, gaurding
  • Raised inflammatory markers
28
Q

Appendicitis investigations

A

Clinical diagnosis - imaging not required

  • Urine pregnancy test
    • Vital in females of reproductive age
    • Rule out ectopic pregnancy’
  • Ultrasound
    • for ruling out gynaecological disease
    • appenix not often visualised
  • CT
    • to confirm diagnosis when not clear
29
Q
A

Year 4 diagnostics (6 decks)

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