CT 2.1 Abdominal Pain Flashcards
Upper abdominal pain may be related to which organs or systems
Oesophagus, stomach or duodenum
Liver, gallbladder and pancreas
Spleen
Abdominal aorta
Chest disease eg MI
Abdominal wall disease
Organic causes of dyspepsia
GERD
Peptic ulcer disease
Helicobacter pylori infection
Gastric cancer
Gastroparesis in diabetics or post surgery
Medication induced (nsaids, aspirin and bisphosphonates)
What investigations for dyspepsia
- test for h.pylori - urea breath test or stool sample
- FBC to look for anaemia or other abnormalities
- imaging such as upper endoscopy in presence of red flag symptoms or persistent symptoms. Ultrasound or CT for gallstones or masses
- gastric emptying study
What is the treatment for dyspepsia
- diet and lifestyle advice
- PPIs
- H2 receptor antagonists - ranitidine, famotidine
- eradicate H.pylori with triple therapy — PPI + amoxicillin + clarithromycin
If functional dyspepsia consider amitryptilline
What is Barrett’s oesophagus
Change in the endothelium of the osephagus from stratified squamous to simple columnar. Causes no symptoms but those with symptoms of GERD and obesity at higher risk
In a small % of people progresses to oesophageal adenocarcinoma
What is the difference between true and false diverticulae
True contain all the layers of the intestinal wall: mucosa, submucosa, muscularis propria and Serosa) ‘
Often due to congenital weakness in bowel wall. Mostly congenital and occur in the SI
Eg meckels diverticulum. Found in the ileum caused by persistence of the vitelline duct
False diverticula don’t involve all the layers of the bowel wall and are acquired over age due to low fibre diets and constipation. Most common location is the sigmoid colon
Visceral pain nature:
Non specific, poorly localised, gradual onset and dull ache due to embrylogical distribution of organs.
It is not affected by moment
Characteristics of parietal pain
Localised, well defined, sharp and peritonitic pain. Is worse on movement
What are the acute causes of intense abdominal pain
Volvulus
Ischaemic
Perforation
Bleeding, ruptured AAA
Obstruction
Associated symptoms to ask in an abdominal pain history
GI pathology: vomiting, bowel changes, weight loss or fever
Gynaecology - PV bleeding or severe menstrual cramps
Urology - fever, frequency, UTI or bleeding
Vascular: dizziness, sweaty or palpitations
What investigations will support in confirming your differential diagnosis
Blood tests: FBC, U&Es, LFTs, amylase and ABG
Urine analysis
ECG
Imaging (CXR, USS, CT, MRI)
What is zollinger Ellison syndrome:
Gastrinomas found in the pancreas and duodenum which release gastrin leading to excessive acid production and peptic ulcer formation
What are the four key causes of upper GI bleeding:
Peptic ulcers
Mallory Weiss tears (tear in the oesophageal mucosa) tend to occur after heavy retching or vomiting (gastroenteritis, hyperemesis gravidarum, or binge drinking)
Oesophageal varices - liver cirrhosis and portal hypertension - associated signs include jaundice, as cites and Caput medusae
Gastric cancer
What scale is used to assess risk of bleeding
Glasgow blatchford bleeding score
What happens to urea in an upper GI bleed
As acid and digestive enzymes are broken down they form urea which is absorbed via the intestines
