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TCA 3 - Liver, Biliary and Pancreatic disease > Differentials of acute abdominal pain > Flashcards

Differentials of acute abdominal pain Flashcards

1
Q

Which areas do you need to consider with abdominal pain?

A

Structures above and below the diaphragm

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2
Q

What is peritonitis?

A

Inflammation of the peritoneum

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3
Q

What causes peritonitis?

A
  • Peptic ulcer
  • Tumour
  • Gallbladder
  • Appendix
  • Spleen
  • AAA
  • Ectopic
  • Spontaneous Bacterial Peritonitis
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4
Q

What is the classical Hx of peritonitis?

A

Severe generalised abdominal pain

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5
Q

What are the classical examination findings of peritonitis?

A
  • Rebound and percussion tenderness
  • Later on, distention of abdomen
  • Guarding
  • No abdominal movement with respiration
  • Severe pain to light palpation
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6
Q

What investigations would you order for peritonitis and what would they show?

A
  • Erect CXR: air under diaphragm

* CT abdo/pelvic: reveals cause

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7
Q

What is the management for peritonitis?

A

Urgent laparotomy and repair

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8
Q

What is the classical Hx of ruptured AAA?

A
  • Elderly
  • Severe generalised abdominal pain
  • Back pain
  • Reduced GCS/collapse
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9
Q

What are the classical examination findings of ruptured AAA?

A
  • Shock
  • Peritonitis
  • Expansile mass
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10
Q

What investigations would you order for ruptured AAA and what would they show?

A
  • USS abdomen if freely available
  • CT only if stable
  • Don’t delay theatre
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11
Q

What is the management for ruptured AAA?

A
  • Aim for permissive hypotension (SBP–100)
  • Activate ‘massive haemorrhage protocol
  • Urgent open repair
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12
Q

What is appendicitis?

A

Inflammation of the appendix

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13
Q

What is the classical Hx of appendicitis?

A
  • Young patient
  • Periumbilical pain initially
  • Moves to RIF
  • Anorexia, nausea
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14
Q

What are the classical examination findings of appendicitis?

A
  • Tender RIF
  • Worse at McBurney’s point
  • Guarding/local peritonitis
  • Rovsing’s +ve
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15
Q

What investigations would you order for appendicitis and what would they show?

A
  • Clinical diagnosis
  • USS abdo/pelvis if gynae differentials
  • Inflammatory markers: raised
  • Urine: beta-HCG: rule out ectopic
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16
Q

What is the management for appendicitis?

A
  • Appendicectomy
  • Antibiotics
  • Nil by mouth
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17
Q

What are gallstones?

A

Presence of solid concretions in the gallbladder.

Symptoms are caused if a stone obstructs the cystic, bile or pancreatic duct.

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18
Q

What is biliary colic?

A

Blockage of bile duct

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19
Q

What is cholecystitis?

A

Inflammation of gallbladder

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20
Q

What is cholangitis?

A

Inflammation of bile duct system

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21
Q

What is acute pancreatitis?

A

A disorder of the exocrine pancreas. It is associated with acinar cell injury with local and systemic inflammatory responses.

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22
Q

What is cholelithiasis?

A

Formation of gallstones

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23
Q

What is the classical Hx of biliary colic?

A
  • Intermittent RUQ pain
  • Radiation of pain to right scapula
  • Exacerbated by fatty food
  • Cannot sit still
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24
Q

What is the classical examination signs of cholecystitis?

A
  • Continuous RUQ pain
  • Murphy’s +ve
  • Tender and guarding RUQ
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25
Q

What is the classical Hx of common bile duct (CBD) stones?

A
  • Jaundice

* RUQ pain

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26
Q

What is the classical Hx of cholangitis?

A
  • Jaundice

* RUQ pain

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27
Q

What is the classical Hx of acute pancreatitis?

A
  • Severe epigastric/ central pain
  • Radiating to back
  • Relieved by sitting forwards
  • Vomiting
  • Hx of possible cause: gallstones, alcohol, trauma, surgery, medications
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28
Q

What are the classical examination findings of acute pancreatitis?

A
  • Epigastric tenderness
  • Tachycardia
  • Fever
  • Shock
  • Guarding
  • Grey-Turner’s and Cullen’s signs
  • Reduced or absent bowel sounds
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29
Q

What investigations would you order for gallstones and what would they show?

A

• LFTs: obstructive picture if CBD stones/cholangitis
Rise in ALT, AST &laquo_space;rise in alk phos
• Inflammatory markers: raised in cholecystitis/cholangitis
• Abdominal USS

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30
Q

What investigations would you order for acute pancreatitis and what would they show?

A
  • Amylase or lipase: raised
  • LFTs: deranged
  • CT abdo if diagnostic uncertaincy
  • Apache II / Glasgow score
  • ABG required
  • Calcium
  • Confirm cause
  • USS abdo (exclude gallstones)
  • Triglycerides
  • Immunoglobulins
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31
Q

What is the management for acute pancreatitis?

A
  • Supportive management
  • IV crystalloids
  • Stop causative meds
  • No antibiotics unless proven infection
  • Treat cause
  • ITU may be required
  • Analgesia
  • Consider - antiemetic
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32
Q

What is the management for biliary colic?

A
  • Analgesia

* OPT cholecystectomy

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33
Q

What is the management for cholecystitis?

A
  • Antibiotics (ciproflocacin or cephalosporin)

* Cholecystectomy

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34
Q

What is the management for CBD stone?

A
  • Continuous IVI (prevent hepato-renal syndrome)

* ERCP

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35
Q

What is the management for cholangitis?

A
  • IV antibiotics (sipro/tazocin)

* Treat cause

36
Q

What is diverticulitis?

A

Inflammation of the diverticulum or diverticula and may be caused by an infection.

37
Q

What is the classical Hx of diverticulitis?

A
  • Elderly
  • Epigastric pain that migrated to the LIF
  • Change in bowel habits
  • Rectal bleeding
  • Dysuria, urinary frequency
38
Q

What are the classical examination findings of diverticulitis?

A
  • Tender LIF
  • Guarding/local peritonism
  • PR (confirm no CA/abscess)
39
Q

What investigations would you order for diverticulitis and what would they show?

A
  • Inflammatory marker: raised
  • CXR: pneumoperitoneum (perforation)
  • AXR: dilated bowel loops, obstruction or abscesses
  • CT abdo/pelvis
40
Q

What is the management for diverticulitis?

A
  • NBM (nil by mouth) and IV fluids

* Bowel antibiotics (cef + Met)

41
Q

What is renal colic?

A

Urinary stones block part of the urinary tract (kidneys, ureter or bladder)

42
Q

What is the classical Hx of renal colic?

A
  • Spasm of loin to groin pain (excruciating)
  • Nausea and vomiting
  • Cannot lie still
43
Q

What are the classical examination findings of renal colic?

A

• Soft abdomen may be renal angle tendernes

44
Q

What investigations would you order for renal colic and what would they show?

A

• Urine dip: microscopic haematuria
• KUB X-ray
Kidney, ureter and bladder
• CT KUB

45
Q

What is the management for renal colic?

A
  • Diclofenac analgesia
  • Smooth muscle relaxants
  • Antibiotics (cefuroxime) if infection
  • Pelvic stone treatment
  • Ureteric stone treatment
46
Q

What is bowel obstruction?

A

Mechanical or functional obstruction of the small or large intestines which prevents the normal movement of the products of digestion

47
Q

What is the classical Hx of bowel obstruction?

A

• Colicky abdominal pain

Small bowel:
• Vomiting (may be faeculent)

Large bowel:
• No bowel motions or flatus

48
Q

What are the classical examination findings of bowel obstruction?

A
  • Distended, tender abdomen
  • Then later on, tender and rigid abdomen
  • Tinkling bowel sounds
49
Q

What investigations would you order for bowel obstruction and what would they show?

A
  • AXR: distended bowel loops

* CT abdo/pelvic: confim and determine cause

50
Q

What is the management for bowel obstruction?

A
  • NBM and Iv fluids
  • Wie-bore NG tube
  • Laparoscopy/laparotomy depending on cause
51
Q

What is acute mesenteric ischaemia?

A

Inadequate blood flow through mesenteric arteries, resulting in ischaemia and eventual gangrene of the bowel wall.

52
Q

What is the classical Hx of acute mesenteric ischaemia?

A
  • Age >50 yrs
  • Severe abdominal pain
  • Bloody darrhoea
  • Nausea, vomiting
  • Risk factors: AF, CVS risk factors
53
Q

What are the classical examination findings of acute mesenteric ischaemia?

A
  • Hypovolaemia -> shock
  • Variable tenderness and guarding
  • Absent bowel sounds
  • Asymmetrical peripheral pulses
54
Q

What investigations would you order for acute mesenteric ischaemia and what would they show?

A
  • VBG: Increase lactate
  • CT abdo/pelvic: ischaemic bowel
  • Mesenteric angiography: if required
55
Q

What is the management for acute mesenteric ischaemia?

A
  • Aggressive IV fluids
  • Antibiotics (gentamicin + metronidazole)
  • Surgical bowel resection
  • Heparin may be used
56
Q

What is a perforated viscus?

A

A perforation that can occur at any anatomical location from the upper oesophagus to the anorectal junction

57
Q

What is the classical Hx of a perforated viscus?

A
  • Rapid onset and sharp pain
  • Malaise, vomiting, lethargy
  • Features of sepsis
58
Q

What are the classical examination findings of a perforated viscus?

A
  • Localised or generalised peritonism
  • Thoracic perforation (e.g. oesophageal rupture)
  • Pain: chest or neck pain, radiating to the back, worsens on inspiration
59
Q

What investigations would you order for a perforated viscus and what would they show?

A
  • FBC: raised WCC and CP
  • CXR: free air under diaphragm
  • CT scan: shows free air presence and shows location of perforation
60
Q

What is the management for a perforated viscus?

A
  • Broad spectrum antibiotics

* Urgent theatre

61
Q

What is a gastric/ peptic ulcer?

A

Break in the mucosal lining of the stomach or duodenum >5mm in diameter, with depth to the submucosa.

62
Q

What is the classical Hx of a peptic ulcer?

A
  • Epigastric pain
  • Related to meals (peptic ulcer = during meals; duodenal ulcer = before meals/at night)
  • Risk factors; NSAIDs, alcohol, spicy food
63
Q

What are the classical examination findings of a gastric/ peptic ulcer?

A
  • Tender epigastrium

* Soft abdomen

64
Q

What investigations would you order for a peptic ulcer and what would they show?

A
  • FBC: may be microcytic anaemia
  • Erect CXR: exclude perforation
  • OGD: if severe
65
Q

What is the management for a gastric/ peptic ulcer?

A
  • PPI

* H-pylori eradication

66
Q

What is pyelonephritis?

A

Severe infectious disease of the renal parenchyma, calices and pelvis that can be acute, recurrent or chronic.

67
Q

What is the classical Hx of pyelonephritis?

A
  • Fever, chills rigors
  • Loin pain
  • Urinary frequency and dysuria
68
Q

What are the classical examination findings of pyelonephritis?

A
  • Loin tenderness

* Renal angle tenderness

69
Q

What investigations would you order for pyelonephritis and what would they show?

A
  • Urine dip and culture: positive leukocytes and nitrites

* Inflammatory markers: raised

70
Q

What is the management for pyelonephritis?

A

• Antibiotics (ciprofloxacin or cephalosporin)

71
Q

What is an ectopic pregnancy?

A

A fertilised ovum implanting and maturing outside of the uterine endometrial cavity.

72
Q

What is the classical Hx of an ectopic pregnancy?

A
  • Severe unilateral pelvic pain
  • 6-8 weeks pregnant, not using contraception, missed period
  • Shoulder tip pain
  • May have spotting
  • ‘Prune-juice’ vaginal discharge
73
Q

What are the classical examination findings of an ectopic pregnancy?

A
  • Tenderness RIF/ LIF
  • Guarding
  • Adnexal tenderness with or without mass
  • Cervical excitation
74
Q

What investigations would you order for an ectopic pregnancy and what would they show?

A
  • Urinary beta-HCG: +ve
  • Serum beta-HCG: + trend
  • Transvaginal USS
75
Q

What is the management for an ectopic pregnancy?

A
  • Laparoscopy/laparotomy

* Anti-D prophylaxis

76
Q

What is an ovarian cyst rupture/ torsion/ haemorrhage?

A

Cyst - Enlarged, fluid-filled ovary or portion of ovarian tissue.

Torsion – twisting or torsion or the ovary around its ligamentous supports

77
Q

What is the classical Hx of an ovarian cyst rupture/ torsion/ haemorrhage?

A
  • Sudden unilateral pelvic pain
  • May be light vaginal bleeding
  • May be fever/vomiting
78
Q

What are the classical examination findings of an ovarian cyst rupture/ torsion/ haemorrhage?

A
  • Tenderness RIF/LIF
  • Guarding
  • Adnexal tenderness with or without mass
79
Q

What investigations would you order for an ovarian cyst rupture/ torsion/ haemorrhage and what would they show?

A
  • Transvaginal/abdo USS

* Urinary beta-HCG: r/o ectopic

80
Q

What is the management for an ovarian cyst rupture/ torsion/ haemorrhage?

A

• Laparoscopy/laparotomy

81
Q

What is pelvic inflammatory disease?

A 
Spectrum of inflammatory disorders of the upper female genital tract, including any combination of;
•	Endometritis
•	Salpingitis
•	Tubo-ovarian abscess
•	Pelvic peritonitis
82
Q

What is the classical Hx of pelvic inflammatory disease?

A
  • Bilateral pelvic pain
  • Vaginal discharge
  • Dyspareunia and dysmenorrhoea
  • May be post-coital and inter-menstrual bleeding
83
Q

What are the classical examination findings of pelvic inflammatory disease?

A
  • Suprapubic tenderness
  • Vaginal discharge, cervicitis
  • Bilateral adnexal tenderness
  • Cervical excitation
  • May be fever
84
Q

What investigations would you order for pelvic inflammatory disease and what would they show?

A
  • Inflammatory markers: raised

* Triple vaginal swabs

85
Q

What is the management for pelvic inflammatory disease?

A

• Broad spectrum antibiotics (metronidazole + doxycycline + quinolone)

TCA 3 - Liver, Biliary and Pancreatic disease (6 decks)

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