Acute abdominal pain

Question 1

Name as many infective causes of abdominal pain (9)

Answer 1

Gastroenteritis
Appendicitis 
Diverticulitis 
Pyelonephritis 
Cholecystitis 
Cholangitis
Pelvic inflammatory disease
Hepatitis 
Pneumonia§

Question 2

Name the two inflammatory causes of acute abdominal pain

Answer 2

Pancreatitis

Peptic ulcer disease

Question 3

Name the 3 vascular conditions that lead to acute abdominal pain

Answer 3

ruptured AAA
mesenteric ischaemia
Myocardial infarction

Question 4

Name 2 conditions caused by trauma which gives abdominal pain

Answer 4

Ruptured spleen
Perforated viscus (oesophagus, stomach, bowel)

Question 5

Name 2 metabolic conditions that give acute abdominal pain

Answer 5

renal/ureteric stone

diabetic ketoacidosis

Question 6

What are the symptoms and where would you find biliary colic?

Answer 6

right upper quadrant

Gallstone lodged in the bile duct, provoked by eating a fat meal. No fever or inflammation

Question 7

What are the symptoms and where would you find acute cholecystitis?

Answer 7

Right upper quadrant
Inflammation/infection of the gallbladder secondary to impacted gallstones. Murpheys sign positive - pain on palpation on RUQ
Fever and raised inflammatory markers

Question 8

What are the symptoms and where would you find ascending cholangitis?

Answer 8

Right upper quadrant
Ascending cholangitis is a bacterial infection of the biliary tree, usually caused by gall stones
Get Charcot’s triad - RUQ pain, fever and jaundice

Question 9

What are the symptoms and where would you find acute pancreatitis?

Answer 9

Epigastrium radiates to the back

Severe pain, tenderness, ileus and low-grade fever

Question 10

What are the symptoms and where would you find a peptic ulcer disease?

Answer 10

Epigastrium
History of NSAID or excess alcohol use
Possible haematemesis seen

Question 11

What is the distinguishing features of gastric and duodenal ulcers?

Answer 11

Duodenal - more common, the epigastric pain is relieved by eating
Gastric - epigastric pain is worsened by eating

Question 12

What are the symptoms of appendicitis and where would find it?

Answer 12

right iliac fossa pain
Pain starts in the central abdomen before localising to the right iliac fossa pain
Anorexia, tachycardic, low grade pyrexia, tenderness are all common
Rovsing’s sign: more pain in RIF than LIF when palpating the LIF

Question 13

What are the symptoms of acute diverticulitis and where would you find it?

Answer 13

Lower left quadrant
Colicky pain
Diarrhoea, sometimes with blood
Fever raised inflammatory markers and white cells

Question 14

What are the symptoms of intestinal obstruction and where would you find it?

Answer 14

Central pain
History of malignancy or previous operations
Vomiting, not opened bowels recently
Tinkling bowel sounds

Question 15

What are the symptoms of renal colic and where would you find it?

Answer 15

Loin pain radiating to the groin

Severe but intermittent pain, characteristically restless patient, haematuria may be present

Question 16

What are the symptoms of acute pyelonephritis and where would you find it?

Answer 16

Loin pain

Fever, rigours and vomiting

Question 17

What are the symptoms of urinary retention and where would you find it?

Answer 17

Suprapubic pain
Caused by obstruction to the bladder outflow
Common in men with benign prostatic hyperplasia

Question 18

What are the symptoms of ectopic pregnancy and where would you find it?

Answer 18

Right or left iliac fossa, shoulder tip pain
Presents with pain, history of amenorrhoea for the past 6-9 weeks.
Vaginal bleeding may be present

Question 19

what are the symptoms of ruptured AAA and where would you find it?

Answer 19

Central abdominal pain radiating to the back

History of cardiovascular disease, patients often in shock, the presentation could be sudden collapse or sub acute

Question 20

What are the symptoms of mesenteric ischaemia and where would you find it?

Answer 20

Central abdominal pain
History of atrial fibrillation or other CVD
Metabolic acidosis is often seen due to dying tissue