Approach to the patient with abdominal pain Flashcards
Pain of acute onset may result from what
An acute vascular event
obstruction of a viscus
Infection
Pain of gradual onset may result from what
Chronic inflammatory processes
functional causes
If the pain is colick what does this usually realte to
A viscus - intestinal renal and biliary colic
If the pain is constant, what might the pain related to?
Solid organs
If the pain is poorly localised, what is it usually related to
A viscus (intestinal, renal and biliary colic)
If the pain is in the epigastrium where does this relate to?
The liver
pancreas
stomach
proximal small bowel
If the pain is located centrally, where does this relate to?
The small intestine and proximal colon
What are 4 alarm symptoms in the history
Weight loss
older age
nocturnal wakening
family history of cancer or IBD
What are 2 alarm symptoms on examination
Abnormal examination
fever
What are 5 alarm symptoms in the investigations
Positive faecal occult bloood anaemia leucocytosis elevated ESR or CRP Abnormal biochemistry
If the pain is located to the suprapubic area, what does this relate to?
Disorders in the colon, renal tract and female reproductive organs
If the pain radiates, why might this be useful
In localising the origin of the pain
Why does referred pain occur
As a result of visceral afferent neurons converging with the somatic afferent neurons in the spinal cord and sharing second-order neurons
Describe visceral pain
Dull, crampy, burning or gnawing
Related to internal organs and the visceral peritoneum
Describe somatic pain
Sharp, pricking
Originates from the abdominal wall or parietal peritoneum
What might pain developing soon after a meal with upper abdominal bloating, nausea or vomiting indicate
Gastric or small intestinal pathology or sensitivity
if the pain is associated with twisting or bending, where is the likely problem
Abdominal wall
If haematuria is present, what does this indicate
renal colic
what does vomiting or upper abdominal distension suggest
small bowel obstruction or ileus
what should be asked when speaking about bowel habit
Frequency consistency urgency blood mucus ALWAYS ASK WHAT IS NORMAL FOR THE PATIENT!!
If a patient is lying completely still not walnting to move and in severe pain what might they have
Peritonitis
What type of pain would a patient have if they were constantly moving around and unable to get comfortable
Visceral pain (obstruction of a viscus)
What might leg swelling be an indicator of
decreased blood albumin related to liver disease or malnutrition
When might a GI patient have clubbing
Chronic liver disease
IBD
What are some other features found on general examination that are indicative of chronic liver disease
Palmar erythema
asterixis
Dupytren’s contractures
spider naevi
What are some other features found on general examination that are indicative of chronic liver disease
Palmar erythema
asterixis
Dupytren’s contractures
spider naevi
What might be seen in the mouth with vitamin B12 deficiency
Glossitis
How does referred pain occur
Due to convergence of visceral afferent and somatic afferent neurons in the spinal cord
Where does gall bladder referred pain occur
The right scapula
Where does referred pain occur from a ruptured spleen or pancreatitis
Left shoulder region
Where does referred pain occur from a ruptured spleen or pancreatitis
Left shoulder region
Patients with previous abdominal surgeries are at risk for what
Intestinal obstruction
What is occasionally seen in acute haemorrhagic pancreatitis
Brusing at the flanks (grey Turner’s sign) and periumbilically (Cullen’s sign)
If there are no bowel sounds, what does this indicate
Ileus and in the presence of severe pain suggests peritonitis
If there are high pitched or tinkling bowel sounds, what does this indicate
Intestinal obstruction
What blood tests should be done for most patients with abdominal pain
FBC
U&E
Creatinie
Urinalysis
