Epigastric pain (oxford clin cases) Flashcards
What does epigastric pain that has spread to involve the whole abdomen suggest?
Peritonitis
What does epigastric pain that has spread to involve the chest indicate?
Cardiac pathology eg IHD or ACS (MI etc)
Where is biliary pain usually? Where else can it be?
Usually RUQ but can present as purely epigastric pain too
What does very sudden onset epigastric pain suggest pathologically?
Perforation eg of a duodenal ulcer or Boerhaave’s
How long does pain from acute pancreatitis take to develop to maximal intensity?
10-20 mins
How long does pain from biliary colic take to develop to maximal intensity?
10-20 mins
How long does pain from acute cholecystitis take to develop to maximal intensity?
Hours
How long does pain from pneumonia take to develop to maximal intensity?
Hours
What character will cardiac pain have?
Crushing or tightness
What character will pain from peptic ulcer be?
Sharp and burning
What character will pain from gastritis be?
Sharp and burning
What character will pain from duodenitis be?
Sharp or burning
What character will pain from pancreatitis be?
Deep and boring
Where may epigastric pain from pancreatitis radiate to?
To the back
What position will relieve pain from pacreatitis?
Sitting forward
How can you differentiate epigastric pain that has a pulmonary cause eg basal pneumonia, pulmonary embolus, pneumothorax, pericarditis?
It will be worse when a patient breathes deeply (pleuritic pain)
It may involve the shoulder tip (diaphragmatic involvement irritates the phrenic nerve)
What might a cough associated with epigastric pain suggest?
GORD (stomach acid irritates the vocal chords)
If the cough is acute and the patient is producing sputum it may be basal pneumonia
What might a cough associated with epigastric pain suggest?
GORD (stomach acid irritates the vocal chords)
If the cough is acute and the patient is producing sputum it may be basal pneumonia
When someone presents with epigastric pain, what may you discover in their family history and what does this suggest?
They may have a family history of cardiac disease and so their pain may be cardiac related
There are also some hereditary factors that may increase someone’s risk of having pancreatitis
What will lower lobe consolidation on an erect chest radiograph suggest if a patient presents with epigastric pain?
Basal pneumonia
What is the best imaging method for those with abdominal pain?
Ultrasound or CT
What imaging modality is not helpful for those with abdominal pain most of the time? In what situations will it actually be helpful?
Abdominal radiograph
Only useful when looking for foreign bodies or to look for bowel dilation
What must you always consider a possibility when someone has epigastric pain/ heartburn?
Myocardial infarction
What are red flags to refer someone to endoscopy?
Persistent vomitting Chronic GI bleeding Weight loss Progressive dysphagia Iron deficiency anaemia Epigastric mass Over 55 with persistent recent onset dyspepsia, reflux and GI pain alongside weight loss
