Approach to Abdominal pain Flashcards
Describe the location of pain in a px with appendicitis?
Initial: Visceral central (umbilical) (T10)
Subsequent: Somatic localised to right iliac fossa
(appendicitis progresses to irritate the parietal peritoneum
What is the difference between colic and sharp pain in abdominal pain?
Colic:
- usually visceral
- tubular w peristalsis eg. S/LI, ureteric colic, biliary colic
Sharp:
- somatic
How does pain radiate in appendicitis?
Central to right iliac
How does pain radiate in pancreatitis?
Central to back
How does pain radiate in ureteric colic?
Loin to groin
What are 3 red flags for abdominal pain?
1) Bleeding
2) Unintentional weight loss
3) Fever
What are some associated symptoms of abdominal pain?
GI symptoms:
- vomiting, diarrhoea, constipation
Hepatobiliary:
- jaundice
GU symptoms:
- dys/pyuria
- haematuria, per-vaginal bleeding
- amenorrhea
Extra-abdominal
- chest pain, SOB, cough
- back pain
How do biliary colic and ureteric colic pain differ in their duration?
Both intermittent
Ureteric (w relief)
Biliary (w/o relief: pain from bad to worse, bad to worse)
What are 4 exacerbating factors used to diagnose abdominal pain?
1) Hungry: duodenal ulcer
2) After meals: gastric ulcer
3) Oily food: Biliary colic
4) After alcohol: Alcohol-related GI: alcoholic gastritis, pancreatitis
What is an example of an alleviating factor used to diagnose abdominal pain?
Better after defecation: Constipation colic
What are 4 examples of emergent conditions associated with very severe abdominal pain?
1) Ischaemic bowel
2) Perforated viscus
3) Ruptured aortic aneurysm
4) MI
Insult to the liver parenchyma (does/does not) typically lead to pain.
Does not
- at most dull, non-specific discomfort
How does a hepatic cyst cause pain?
Cyst stretches liver capsule → stimulate visceral pain fibers → RUQ pain
What is the (i) characteristic, (ii) exacerbating and (iii) alleviating factors of cholelithiasis?
Biliary colic: smooth muscle contraction against obstructed duct
i) Intermittent colic pain
ii) fatty meal
iii) stone dislodge
How does cholecystitis pain present?
Right hypochondriac pain referred to right shoulder
(somato-somatic referred pain via phrenic nerve)
How does pancreatitis pain present?
Central abdomen/epigastric
- radiate to back
What is the (i) characteristic, (ii) exacerbating factors of peptic ulcer disease?
i) pain variable and depends on location (may radiate to back)
ii) duodenal worse when hungry; gastric worse after food
What are 2 emergent conditions for stomach and small intestine and their associations?
Perforation:
- acute, sharp abdo pain
Intestinal obstruction
- abdo pain, abdo distension, complete constipation, vomitting
What are 2 association of colitis with abdominal pain?
1) Diarrhea
2) Per-rectal bleeding
What is acute appendicitis associated with?
Fever
What is diverticulitis associated with?
Fever
What is constipation colic associated with?
1) Hx of infrequent/hard stool
2) Pre-disposed risk factors for constipation: immobility, opiate use
3) Peristalsis → colicky pain
What are 3 red flags for abdominal pain arising from the large intestine?
1) Tenesmus
2) Decreased stool calibre
3) Unexplained change in bowel habits
How does pyelonephritis pain present?
Back pain over affected kidney
- pain on light pressure of lower back on affected side (renal punch)
How does renal colic pain present?
Severe cramping flank pain radiating towards groin (“loin to groin”)
What are 2 bladder causes of abdominal pain?
1) Cystitis
- suprapubic discomfort
- associated w fever, LUTI symptoms
2) Acute urinary retention
- anuria
- preceding symptoms of UTI/LUT obstructive symptoms
What are 2 signs associated with abdominal emergencies?
1) Guarding
2) Rebound tenderness
What are 3 signs associated with abdominal emergencies?
1) Abdominal distension, abdominal pain
2) Severe constipation/obstipation
3) Vomiting
What are 4 causes of abdominal pain beyond the abdominal viscera?
1) AMI
2) HZV
3) Psoas abscess
4) Ruptured abdominal aortic aneurysm
