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Gastrointestinal (LECTURE NOTES) > Approach to the patient with abdominal pain > Flashcards

Approach to the patient with abdominal pain Flashcards

1
Q

Pain of acute onset may result from what

A

An acute vascular event
obstruction of a viscus
Infection

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2
Q

Pain of gradual onset may result from what

A

Chronic inflammatory processes

functional causes

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3
Q

If the pain is colick what does this usually realte to

A

A viscus - intestinal renal and biliary colic

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4
Q

If the pain is constant, what might the pain related to?

A

Solid organs

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5
Q

If the pain is poorly localised, what is it usually related to

A

A viscus (intestinal, renal and biliary colic)

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6
Q

If the pain is in the epigastrium where does this relate to?

A

The liver
pancreas
stomach
proximal small bowel

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7
Q

If the pain is located centrally, where does this relate to?

A

The small intestine and proximal colon

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8
Q

What are 4 alarm symptoms in the history

A

Weight loss
older age
nocturnal wakening
family history of cancer or IBD

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9
Q

What are 2 alarm symptoms on examination

A

Abnormal examination

fever

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10
Q

What are 5 alarm symptoms in the investigations

A 
Positive faecal occult bloood 
anaemia 
leucocytosis
elevated ESR or CRP
Abnormal biochemistry
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11
Q

If the pain is located to the suprapubic area, what does this relate to?

A

Disorders in the colon, renal tract and female reproductive organs

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12
Q

If the pain radiates, why might this be useful

A

In localising the origin of the pain

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13
Q

Why does referred pain occur

A

As a result of visceral afferent neurons converging with the somatic afferent neurons in the spinal cord and sharing second-order neurons

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14
Q

Describe visceral pain

A

Dull, crampy, burning or gnawing

Related to internal organs and the visceral peritoneum

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15
Q

Describe somatic pain

A

Sharp, pricking

Originates from the abdominal wall or parietal peritoneum

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16
Q

What might pain developing soon after a meal with upper abdominal bloating, nausea or vomiting indicate

A

Gastric or small intestinal pathology or sensitivity

17
Q

if the pain is associated with twisting or bending, where is the likely problem

A

Abdominal wall

18
Q

If haematuria is present, what does this indicate

A

renal colic

19
Q

what does vomiting or upper abdominal distension suggest

A

small bowel obstruction or ileus

20
Q

what should be asked when speaking about bowel habit

A 
Frequency
consistency 
urgency 
blood 
mucus 
ALWAYS ASK WHAT IS NORMAL FOR THE PATIENT!!
21
Q

If a patient is lying completely still not walnting to move and in severe pain what might they have

A

Peritonitis

22
Q

What type of pain would a patient have if they were constantly moving around and unable to get comfortable

A

Visceral pain (obstruction of a viscus)

23
Q

What might leg swelling be an indicator of

A

decreased blood albumin related to liver disease or malnutrition

24
Q

When might a GI patient have clubbing

A

Chronic liver disease

IBD

25
Q

What are some other features found on general examination that are indicative of chronic liver disease

A

Palmar erythema
asterixis
Dupytren’s contractures
spider naevi

26
Q

What are some other features found on general examination that are indicative of chronic liver disease

A

Palmar erythema
asterixis
Dupytren’s contractures
spider naevi

27
Q

What might be seen in the mouth with vitamin B12 deficiency

A

Glossitis

28
Q

How does referred pain occur

A

Due to convergence of visceral afferent and somatic afferent neurons in the spinal cord

29
Q

Where does gall bladder referred pain occur

A

The right scapula

30
Q

Where does referred pain occur from a ruptured spleen or pancreatitis

A

Left shoulder region

31
Q

Where does referred pain occur from a ruptured spleen or pancreatitis

A

Left shoulder region

32
Q

Patients with previous abdominal surgeries are at risk for what

A

Intestinal obstruction

33
Q

What is occasionally seen in acute haemorrhagic pancreatitis

A

Brusing at the flanks (grey Turner’s sign) and periumbilically (Cullen’s sign)

34
Q

If there are no bowel sounds, what does this indicate

A

Ileus and in the presence of severe pain suggests peritonitis

35
Q

If there are high pitched or tinkling bowel sounds, what does this indicate

A

Intestinal obstruction

36
Q

What blood tests should be done for most patients with abdominal pain

A

FBC
U&E
Creatinie
Urinalysis

Gastrointestinal (LECTURE NOTES) (29 decks)

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