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TCD Gastrointestinal > Central/Lower Abdominal Pain > Flashcards

Central/Lower Abdominal Pain Flashcards

1
Q

What features of an abdominal chest x-ray indicate bowel obstruction? (3)

A

Small bowel diameter > 3cm
Colon diameter > 6cm
Caecum diameter > 9cm

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2
Q

What structures give central abdominal pain? (5)

A

Medical causes (rarely - DKA, porphyria)
Intra-abdominal structures (midgut)
Retroperitoneal structures (pancreas, aorta, duodenum)
Abdominal wall (hernia, muscle, skin)
Referred pain (from back, base of lung, inferior heart)

[MIRAR]

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3
Q

What are possible differentials for continuous abdominal pain radiating to the back? (2)

A

Abdominal aortic aneurysm (AAA)
Pancreatitis

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4
Q

What are possible differentials for colicky abdominal pain that is now constant? (2)

A

Bowel obstruction with/without hernia
Irritable Bowel Syndrome

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5
Q

What are the possible differentials for colicky abdominal pain associated with diarrhoea? (2)

A

Gastroenteritis
Inflammatory Bowel Disease

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6
Q

What are the possible differentials for central abdominal pain that shifted to the right iliac fossa? (2)

A

Appendicitis
Rarely perforated Duodenal Ulcer

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7
Q

What are possible differentials of sudden severe pain radiating to the back, flank and/or groin? (2)

A

Abdominal aortic aneurysm (AAA) until proven otherwise
Renal colic

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8
Q

What is a possible differential of severe generalised pain with shoulder tip pain?

A

Diaphragm irritation by free fluid/blood within the abdomen

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9
Q

What symptoms can indicate the location of a colon malignancy? (2)

A

Change in bowel habits —> associated with left colon tumours
Anaemia —> associated with right colon tumours

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10
Q

What combination of signs suggest an infection or inflammation process in one organ? (3)

A

Pyrexia
Localised tenderness
Guarding

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11
Q

What is McBurney’s Point?

A

The classical point of maximum tenderness in appendicitis, corresponding to the position of the base of the appendix - one third of the way across the line between the anterior superior iliac spine and the umbilicus.

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12
Q

What is the most common cause of appendicitis?

A

Obstruction

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13
Q

What classical signs and symptoms are indicative of appendicitis? (4)

A

Fever
Right lower quadrant abdominal pain (at McBurney’s point)
Nausea and vomiting
Raised serum white blood cell count

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14
Q

What signs and symptoms indicate a ruptured appendix? (2)

A

Rebound tenderness (at McBurney’s point)
Abdominal guarding

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15
Q

What is involved in the standard treatment of appendicitis? (3)

A

Draining of abscesses if present
Appendectomy
Antibiotics

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16
Q

What symptoms can indicate retroperitoneal appendicitis? (2)

A

Lateral/lumbar pain
Ureter irritation

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17
Q

What symptoms can indicate intra-peritoneal appendicitis? (3)

A

-Pain localised to Right Iliac Fossa (RIF) as appendix tip irritates surrounding peritoneum
-Right hypochondrial pain if inflamed tip of appendix is subhepatic
-Diarrhoea due to irritation in patients with retro-ileal irritation

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18
Q

What is a hernia?

A

A protrusion of an organ through its containing wall and into a different cavity.

19
Q

What are in the commonest abdominal wall hernias in order of frequency? (5)

A

Inguinal
Umbilical/ paraumbilical
Femoral
Incisional
Epigastric/midline

20
Q

Describe the two types of inguinal hernia. (2)

A

-Direct: leading area of weakness is posterior wall of inguinal canal, where viscera herniate anteriorly through Hesselbach’s triangle and not into the scrotum.
-Indirect: leading area of weakness is the deep inguinal ring where intra-peritoneal contents herniate into the inguinal canal alongside the spermatic cord, and can exit the canal through the superficial inguinal ring and into the scrotum.

21
Q

Where would a femoral hernia be located?

A

Below the inguinal ligament, inferior and lateral to the pubic tubercle.

22
Q

What is a strangulated hernia?

A

A hernia where the ‘neck’ of the sac is quite tight, leading to blood supply to the herniated organ being cut off.

23
Q

What is an incarcerated hernia?

A

A hernia where the contents are fixed in the sac with adhesion (the hernia is therefore irreducible).

24
Q

What is an obstructed hernia?

A

A hernia where the bowel loop trapped within the sac causes bowel obstruction; with further oedema it can become strangulated.

25
Q

What is the gold standard imaging for peritonitis of any cause?

A

CT scan

26
Q

What is a sentinel loop?

A

A short segment of adynamic ileus (functional motor paralysis of digestive tract) close to an intra-abdominal inflammatory process.

27
Q

How may the sentinel loop sign on an abdominal x-ray be helpful clinically?

A

It may aid in localising the source of inflammation.

28
Q

What are three complications of an appendectomy that the patient would need to be counselled on?

A

-Conversion to open surgery
-Postoperative wound infection or intra-abdominal collection
-Bleeding

29
Q

What part of the digestive system does ulcerative colitis affect?

A

Only the colon and rectum.

30
Q

In what age group does inflammatory bowel disease (IBD) most commonly present?

A

Between ages of 15 and 40

31
Q

Give five symptoms of inflammatory bowel disease (IBD).

A

Abdominal pain
Bloating
Bloody diarrhoea
Weight loss
Extreme tiredness

32
Q

When during the menstrual cycle can irritable bowel syndrome (IBS) symptoms be worsened?

A

During the progesterone dominant premenstrual phase.

33
Q

What are the common, whilst variable, symptoms of irritable bowel syndrome (IBS)? (7)

A

Diarrhoea
Constipation
Alternation between both of above
Abdominal pain
Diurnal bloating
Mucus in stool
Tiredness

34
Q

What are diverticula?

A

Small bulges or pouches in the lining of the large intestine.

35
Q

What is diverticulosis?

A

The presence of asymptomatic diverticula.

36
Q

What is diverticulitis?

A

Infection or inflammation of the diverticula, causing severe pain (often in left lower quadrant), bloating, fever and bloody diarrhoea.

37
Q

What is coeliac disease?

A

An autoimmune condition triggered by sensitivity to gluten; repeated exposure to gluten causes inflammation of the small intestine.

38
Q

What skin rash is indicative of coeliac disease?

A

Dermatitis herpetiformis

39
Q

What is faecal calprotectin?

A

A biomarker of bowel inflammation; the principle way to distinguish between irritable bowel syndrome (IBS has a normal faecal calprotectin) and inflammatory bowel disease (IBD has elevated faecal calprotectin).

40
Q

What is involved in coeliac serology?

A

Blood tests for tissue transglutaminase antibody (tTGA) or endomysial antibody (EMA); these antibodies are formed in response to eating gluten in a patient with coeliac disease, and so a positive result is suggestive of coeliac disease and should prompt referral for consideration for a confirmatory duodenal biopsy.

41
Q

What interventions should be recommended as first line management for irritable bowel syndrome with diarrhoea (IBS-D)? (4)

A

-Reducing caffeine intake
-Regular exercise
-Reducing intake of fizzy drinks
-Loperamide (an anti-motility drug used to treat diarrhoea associated with IBS).

42
Q

What are the Rome-IV criteria for diagnosis of irritable bowel syndrome (IBS)?

A

Recurrent abdominal pain on average at least 1 day a week in the last 3 months, associated with two or more of the following criteria:
-related to defecation
-associated with a change in frequency of stool
-associated with a change in form (appearance) of stool

(Symptom onset must be at least 6 months prior to diagnosis)

43
Q

What may be recommended for irritable bowel syndrome (IBS) if general dietary and lifestyle advice does not improve symptoms?

A

A low FODMAP diet may be recommended, under the supervision of a dietician.

TCD Gastrointestinal (6 decks)

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