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Year 3 - Medicine and Surgery book > Epigastric Pain > Flashcards

Epigastric Pain Flashcards

1
Q

What are the ddx for acute epigastric pain

*must be excluded asap

A 
Acute pancreatitis*
Perforated peptic ulcer*
Gastritis/duodenitis
Peptic ulcer disease
Biliary colic
Acute cholecystitis
Ascending cholangitis*
Myocardial infarction*
AAA rupture*
Mesenteric ischaemia*
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2
Q

What kind of site of pain would be consistent with peritonitis from a perforated GI tract

A

Pain spreads from epigastrium to involve rest of abdomen

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3
Q

Very sudden onset epigastric pain suggests?

A

Perforation of a viscus

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4
Q

Pain from acute pancreatitis and biliary colic develops maximal intensity over what time period

A

10-20 mins

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5
Q

How long do inflammatory processes e.g. acute cholecystitis or pneumonia take to peak?

A

Hours

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6
Q

“Sharp, burning” pain indicates what pathology?

A

Peptic ulcers, gastritis, duodenitis

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7
Q

Deep, “boring” pain indicates what pathology?

A

Pancreatitis

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8
Q

Ruptured AAA, pancreatitis and occasionally peptic ulcers may cause pain to radiate where?

A

Back

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9
Q

Shoulder-tip pain may arise from irritation of the phrenic nerve, suggesting involvement of the diaphragm. What pathologies may this be consistent with

A

Basal pneumonia or subphrenic abscess

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10
Q

Retrosternal chest pain indicates what pathology?

A

Oesophagitis / MI

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11
Q

Patients with acute pancreatitis may find that doing what relieves their pain?

A

Sitting forwards

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12
Q

In patients with peritonitis and intra-abdominally originating pains, what makes the pain worse

A

Movement

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13
Q

If self-limiting pain is triggered by fatty meals, what pathology is this highly suggestive of?

A

Biliary colic

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14
Q

What symptoms should you ask about in patients with epigastric pain?

A
  1. N+V - small bowel obstruction may give colicky epigastric pain w N+V. Inferior MI irritating diaphragm may also cause vomiting.
  2. Fever? - infection (viral hepatitis, pneumonia) or widespread inflammation (i.e. peritonitis)
  3. Dyspepsia/waterbrash? - GORD/oesophagitis
  4. Stool changes? - pale stools = bile not reaching bowel. Steatorrhoea = pancreatic exocrine insufficiency or long-standing biliary disease
  5. Cough - may indicate basal pneumonia
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15
Q

In patients who have had biliary disease (e.g. gallstones) are prone to which complications?

A

Acute pancreatitis, acute cholecystitis and ascending cholangitis

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16
Q

Postprandial pain may signify what pathology

A

Mesenteric ischaemia

17
Q

Which drugs may predispose to peptic ulcer disease

A

NSAIDS, steroids, bisphosphonates.

NB steroids may mask signs of peritonism

18
Q

What drugs are linked with increased incidence of acute pancreatitis

A

Sodium valproate, steroids, thiazides, azathioprine

19
Q

What is alcohol a RF for?

What about smoking?

A

Alcohol - acute pancreatitis

Smoking - peptic ulcer disease, vascular causes

20
Q

Describe the position that someone with peritonitis adopts?

What about someone who has pancreatitis

A

Peritonitis - lie completely still and rigid - movement causes pain

Pancreatitis - patient sit/lie forwards

21
Q

Jaundice may be due to which causes? Name 3

A

Ascending cholangitis
Acute pancreatitis
Acute hepatitis (but this rarely causes pain)

22
Q

What is Grey-Turners sign and what does it indicate

A

Extravasated blood in retroperitoneum causes discolouration of umbilicus and flank.

May be seen in acute haemorrhagic pancreatitis

23
Q

What may guarding indicate?

A

Guarding with tenderness may suggest acute cholecystitis or mild pancreatitis.

Severe tenderness with guarding and rigidity may indicate peritonitis

24
Q

A central, laterally expansile, pulsatile mass suggests?

A

Ruptured AAA

25
Q

Which blood tests would you do in someone with epigastric pain?

A
  1. FBC - WCC, Hb (bleeding peptic ulcer). Neutrophilia is prognostic indicator in pancreatitis
  2. CRP
  3. Pancreatic amylase/lipase - slight increases = pancreatitis. Very high amylase (>1000)/lipase (>300) = acute pancreatitis
  4. Liver enzymes - high AST/ALT = hepatocyte damage. High ALP/GGT/Bilirubin - pathology in biliary tree or compression of biliary tree.
  5. Albumin
  6. U&Es, creatinine
  7. Ca - hypercalcaemia can cause pancreatitis. Pancreatitis can cause hypocalcaemia as pancreas gets saponificated. Low Ca is prognostic in pancreatitis.
  8. Glucose - indicates damage to pancreas (hyperglycaemia)
  9. ABG - ARDS is a complication of acute pancreatitis. If pt not hypoxic do VBG
  10. Troponin
26
Q

If ALP rises without corresponding GGT increase - what does this suggest?

A

Bone or placenta cause of problem - not liver.

27
Q

In a VBG, if there is elevated pH and lactate, what conditions does this indicate

A

Acute pancreatitis or peritonitis

28
Q

Loss of psoas muscle shadow indicates what?

A

AAA rupture

29
Q

When is it necessary to do a US?

A

If AAA rupture suspected

If acute pancreatitis is diagnosed, US can be useful to look for gallstones. If no gallstones, consider MRCP.

30
Q

Causes of acute pancreatitis? I GET SMASHED

A 
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps/HIV/Coxsackie
Autoimmune
Scorpion bites
Hyperlipidaemia/hypercalcaemia/hypothermia
ERCP
Drugs (sodium valproate, steroids, thiazides, azathioprine)

Gallstones and ethanol most common

31
Q

What scoring system is used to predict outcome of pancreatitis

A score of what is considered severe pancreatitis

A

Glasgow score

3 or more is severe pancreatitis. Less is mild

32
Q

If a patient has mild pancreatitis, and gallstones are the cause, what is done

A

Laparoscopic cholecystectomy

If severe pancreatitis, ERCP within 3 days

33
Q

A patient who smokes and drinks, with epigastric pain for a few weeks, no radiation of pain, burning pain, no water brash or vomiting, no change in pain on position, indicates what pathology

A

Peptic ulcer disease/gastritis/non-ulcer dyspepsia

Conservative management, if that fails then give PPIs fora month or H. pylori treatment.

H pylori most common cause of peptic ulcers

34
Q

Someone who has severe epigastric pain (10/10), long term NSAID use, significant alcohol consumption points to which diagnosis

A

Perforated peptic ulcer

35
Q

Absent bowel sounds, motionless patient and tenderness and guarding on palpation indicates what?

A

Peritonitis

36
Q

Low stool elastase indicates compromise of which organ?

A

Pancreas

Year 3 - Medicine and Surgery book (29 decks)

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