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YA - Interactive seminars/University lectures > Approach - Abdominal pain > Flashcards

Approach - Abdominal pain Flashcards

1
Q

Describe the characteristics of abdominal pain due to obstruction of hollow viscus

  • localisation
  • quality
  • severity
  • chronology
A
  • Poorly localised (visceral)
  • Colicky (except biliary “colic”)
  • Variable severity
  • May be episodic if obstruction is intermittent
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2
Q

Describe the characteristics of abdominal pain due to inflammation

  • localisation
  • quality
  • severity
  • chronology
A
  • Well localised (parietal)
  • Usually sharp
  • Often severe
  • Constant pain
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3
Q

Describe the characteristics of abdominal pain due to perforation

  • localisation
  • quality
  • severity
  • chronology
A
  • Well localised (unless generalised peritonitis)
  • Sharp
  • Usually severe
  • Sudden onset (may be sudden exacerbation of pre-existing pain)
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4
Q

Compare the frequency of pain & vomiting depending on the anatomical site of abdo pain cause

  • foregut
  • midgut
  • hindgut
A

Foregut: e.g. pyloric stenosis
- Immediate vomiting, pain not prominent

Midgut: e.g. SBO
- Every few minutes to half hourly

Hindgut: e.g. LBO
- Infrequent exacerbation or vomits

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5
Q

What are 3 anatomical groups of causes of obstruction of a hollow viscus?

A
  1. Intraluminal obstruction
    –Stone blocking a narrow tube
    e.g. Renal colic
  2. In the wall
    –Colon cancer blocking the colon
    e.g. Large bowel obstruction
  3. Extrinsic
    –Adhesion
    e.g. Small bowel obstruction
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6
Q

Name (4) non-abdominal causes of abdominal pain

A
  • Heart
  • Lung, diaphragm
  • Back / muscular skeletal
  • Herpes zoster (pain precedes rash)
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7
Q

Describe abdominal pain due to biliary colic (& choledocolithiasis)

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • RSC (but often epigastric, occasionally LSC)
  • Right side of back or interscapular
  • Various (“sharp”, “pushing”), NOT colicky
  • Variable, often severe
  • Intermittent, fairly sudden onset, lasts at least 15 mins, up to several hours
  • better with Antispasmodics
  • nausea
  • Often occurs 30 mins to a few hours after fatty meal

NOTE: Choledocolithiasis: may present with obstructive jaundice

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8
Q

Describe abdominal pain due to acute cholecystitis

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • RSC
  • Usually sharp
  • Severe
  • Onset may be sudden or gradual, persistent
  • worse with movement
  • better with analgesia
  • Nausea, sometimes vomiting
  • Not necessarily related to meal
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9
Q

Describe abdominal pain due to acute pancreatitis

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • Epigastrium
  • Through to back
  • Usually sharp
  • Usually severe
  • Fairly sudden onset, persistent, sometimes recurrent
  • worse with movement
  • better with analgesia
  • Vomiting
  • Recent heavy alcohol use, known gallstones, ERCP
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10
Q

Describe abdominal pain due to peptic ulcer

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • Epigastrium (+ no radiation)
  • Aching
  • Variable
  • Intermittent, often at night
  • better with PPIs
  • NSAIDs, smoking
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11
Q

Describe abdominal pain due to perforated peptic ulcer

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • Epigastrium
  • Shoulder tip (radiation)
  • Sharp
  • Severe
  • Sudden onset, persistent
  • worse w/ movement
  • better w/ analgesia
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12
Q

Describe abdominal pain due to gastroenteritis

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • Epigastrium/centra
  • Colicky
  • Variable
  • Usually gradual onset
  • vomiting +/- diarrhoea
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13
Q

Describe abdominal pain due to AMI

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • Epigastrium + retrosternal +/- left arm/jaw
  • Heavy
  • Severe
  • Usually sudden onset
  • better w/ analgesia, vasodilators
  • +/- sweating, nausea, dyspnoea
  • activity
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14
Q

Acute cholecystitis O/E

A

RUQ tenderness +/- guarding +/- positive Murphy’s sign

+/- Percussion tenderness RUQ

May have ileus (silent)

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15
Q

Acute pancreatitis O/E

A

+/- Grey Turner’s or Cullen’s sign

Epigastric tenderness, usually no involuntary guarding

+/- percussion tenderness in epigastrium

May have ileus (silent)

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16
Q

Describe abdominal pain due to inflammatory bowel disease

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • central
  • Colicky if obstructive, otherwise sharp
  • variable
  • recurrent, relapsing
  • worse w/ oral intake
  • better a/ analgesia, steroids, antibiotics
  • Diarrhoea, rectal bleeding/mucus (UC), tenesmus (UC), weight loss, fever, fistulae (CD)
  • A/w PSC (UC), iritis/uveitis, ankylosing spondlylitis, pyoderma gangrenosum, erythema nodosum
17
Q

Describe abdominal pain due to ruptured AAA

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • central & radiates to the back
  • tearing pain
  • severe
  • sudden onset
18
Q

Which abdominal pain cause is aggravated by oral intake?

A

Small bowel obstruction
Early acute appendicitis
Inflammatory bowel disease

19
Q

Which abdominal pain cause is aggravated by movement?

A 
Acute cholecystitis
Acute pancreatitis
Perforated peptic ulcer
Acute appendicitis
Ruptured ectopic pregnancy
Testicular torsion
20
Q

What should you ask in small bowel obstruction?

A

Previous abdo surgery, hernias & previous episodes of SBO

21
Q

Describe abdominal pain due to large bowel obstruction

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • infra-umbilical
  • colicky
  • Variable
  • Progressive
  • better w/ Analgesia
  • Constipation, preceding alteration of bowel habit/rectal bleeding
  • a/w Known diverticulosis, previous colonic polyps, previous episodes of volvulus, family history of colon cancer
22
Q

Describe abdominal pain due to diverticulitis

  • usual site
  • radiation
  • quality
  • severity
  • chronology
  • aggravating factors
  • relieving factors
  • other symptoms
  • associations
A
  • Usually LIF (varies depending on position of sigmoid colon)
  • Sharp
  • variable
  • constant often recurrent
  • better w/ analgesia, Abx
  • Preceding alteration of bowel habit/rectal bleeding
  • a/w Known diverticulosis, previous episodes of diverticulitis
23
Q

Acute appendicitis O/E

A

Tender, usually RIF (classically McBurney’s point), guarding +/- positive Rovsing’s sign

Percussion tenderness

Usually normal (ileus if ruptured appendix)

24
Q

Mx of possible appendicitis

A
  • Admit, nil orally, IV fluids, analgesia
  • Consent
  • Laparoscopy, ?appendicectomy
  • DVT and antibiotics prophylaxsis

Post-op:

  • Explain findings to pt
  • Analgesia ?oral
  • Trial of fluids and food
  • Discharge planning (?home today to family, timing of follow up visit)
  • Check pathology of appendix
  • Medical certificate

YA - Interactive seminars/University lectures (87 decks)

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