Epigastric Abdominal Pain Flashcards
What is meant by the term ‘distended abdomen’?
The abdomen is greater in size than normal (may need to ask patient about this!).
What is meant by the term ‘tympanic abdomen’?
The abdomen is distended due to air (like a balloon).
What is meant by the term ‘tender abdomen’?
Abdominal pain is present in response to touch/pressure.
What is meant by the term ‘soft abdomen’?
There is no peritonism, even though pain might be present.
What is meant by the term ‘peritonitic’?
Inflammation of the peritoneum by a noxious substance.
What is meant by the term ‘rebound tenderness’?
Pain when releasing pressure from palpation (a sign of peritonism).
What is ‘guarding’?
Involuntary tensing of the abdominal wall muscle on palpation (a sign of local peritonism if in one quadrant only).
What is meant by the term ‘rigid abdomen’?
Involuntary guarding in all four quadrants (a sign of general peritonitis).
Which type of cell in the stomach secretes hydrochloric acid?
Parietal cells
What is the role of G cells in the stomach?
They secrete the hormone gastrin.
What type of cells in the stomach produce pepsinogen?
Chief cells
What abdominal structures arise from the embryological midgut?
Organs from the duodenum (distal to entrance of common bile duct) to junction of proximal 2/3 of transverse colon with distal 1/3.
Where is pain from abdominal structures of each embryological origin felt? (3)
Foregut - epigastrium (initially - can localise later on)
Midgut - umbilical region
Hindgut - hypogastric (suprapubic) region
What abdominal structures arise from the embryological foregut? (6)
Oesophagus, stomach, pancreas, liver, gallbladder, and duodenum (proximal to entrance of common bile duct).
What abdominal structures arise from the embryological hindgut?
Distal 1/3 of transverse colon to upper part of anal canal.
What is the limit for acceptable weekly alcohol consumption for a man?
Less than 14 units per week.
What is Grey-Turner’s sign?
Ecchymosis (bruising) in either flank.
What is Cullen’s sign?
Visible periumbilical ecchymosis (bruising)
What are ‘caput medusae’?
Periumbilical varices that branch out from the umbilicus, that occur with portal hypertension from liver cirrhosis.
What is Murphy’s sign?
Pain in the Right Upper Quadrant from local peritonism due to acute cholecystitis.
What is Rovsing’s sign?
Pain felt in the right iliac fossa during palpation of the left iliac fossa, due to local peritonism from acute appendicitis.
What abdominal signs are indicative of internal haemorrhage?
Cullen’s Sign and Grey-Turner’s Sign
What causes of internal haemorrhage can cause abdominal signs? (3)
Acute pancreatitis, splenic rupture or perforated peptic ulcer disease.
Why do peptic ulcers not cause guarding?
There is no peritonism.
What is involved in a Nissen fundoplication?
A laparoscopic surgery offered to control symptoms of GORD, where the fundus of the stomach is wrapped around the lower oesophagus to reinforce the lower oesophageal sphincter.
What are the indications for surgery for gastroesophageal reflux disease (GORD)? (3)
Failure of medical therapy (either through efficacy or side effects)
Desire to discontinue medical therapy
Presence of a hiatus hernia
What red flag symptoms do you need to ask about in a patient with dyspepsia? (6)
Anaemia (lethargy, breathlessness)
Loss of weight
Anorexia
Recent onset/progressive symptoms
Malaena and haematemesis
Swallowing difficulty (dysphagia)
[ALARMS]
What are the NICE criteria for a direct access upper GI endoscopy for suspected cancer? (2)
Individual with dysphagia OR age > 55 with weight loss and any of the following: upper abdominal pain, reflux, or dyspepsia.
What is the most common histological type of gastric cancer?
Adenocarcinoma
What is linitis plastica?
A rare type of gastric adenocarcinoma where there is ‘thickening’ of the stomach wall, seen when adenocarcinoma spreads primarily through the musculature of the stomach wall.
What does the TNM staging system mean in the context of gastric adenocarcinoma?
T - how far the tumour has grown into the stomach wall
N - degree of lymph node spread
M - presence of metastases
What are the appropriate investigations required for gastric adenocarcinoma? (5)
-Upper GI endoscopy
-Minimum of 6 biopsies taken during the endoscopy
-Initial staging CT thorax, abdomen and pelvis
-Discussion at local upper GI cancer MDT
-If tumour is potentially resectable, a staging laparoscopy is performed, and perioperative chemotherapy is given.
What is a peptic ulcer?
A break in the mucosal lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer) - this disruption extends into the submucosa or muscularis propria and is usually more than 5mm in diameter.
What tests can confirm successful H. pylori eradication? (3)
Urea breath test, faecal antigen testing, and endoscopy (rapid urease test, histology and culture)
What is involved in triple therapy for treatment of H. pylori infection?
Treatment with a PPI and two different antibacterials.
What signs and symptoms may a patient with peptic ulcer perforation present with? (5)
-Rigid abdomen (indicative of generalised peritonitis secondary to florid bowel contents in the peritoneal cavity)
-Sudden onset of epigastric pain (before becoming more generalised in nature)
-Distention
-Nausea
-Vomiting.
What investigations are diagnostic for gastric perforation? (2)
Erect chest x-ray (will show air under diaphragm indicative of perforation in around 60% of patients)
If clinical features of perforation but normal CXR, CT scan required to confirm diagnosis (98% sensitive)
What is the standard management for a perforated gastric ulcer? (4)
-Laparotomy to repair perforation (usually by patching omentum over perforation)
-Washout of enteric contents from peritoneal cavity
-H. pylori eradication therapy
-Investigation for more sinister causes of perforation (such as cancer)
What is the main cause of a distended abdomen following surgery?
A postoperative ileus - a functional bowel obstruction resulting from any noxious insult to the bowel; usually resolves within a week.
