GIT GUT - Abdominal Pain Flashcards
Differential Diagnoses of Abdominal Pain
- Reflux esophagitis with sliding hernia
- PUD
- Gallstone/PUD
- Pancreatic Pseudocyst
- Acute Pancreatitis
- Pancreatic Cancer
- Cholelithiasis - Biliary colic
- Cholelithiasis + Mittelschermz
- Acute cholecystitis
- Acute cholangitis
- Cholangitis - Post cholecystectomy
- Hepatic cancer
- Mesenteric ischemia
- Diverticulosis
- Diverticulitis
- Ruptured Diverticulitis
- Colon cancer
- Ureteric Colic
- Benign Prostatic Hyperplasia
Probability diagnosis Acute gastroenteritis Acute appendicitis Mittelschmerz/dysmenorrhoea Irritable bowel syndrome Biliary colic/renal colic Peptic ulcer
Serious disorders not to be missed Vascular: •myocardial infarction (esp. inferior) •splenic infarction •ruptured AAA •dissecting aneurysm aorta •mesenteric artery occlusion
Cancer:
•of bowel with large or small bowel obstruction
Infection: •acute cholecystitis •acute salpingitis •peritonitis/spontaneous bacterial peritonitis •ascending cholangitis •intra-abdominal abscess
Other:
•pancreatitis
•ectopic pregnancy
•small bowel obstruction/strangulated hernia
•sigmoid volvulus
•perforated viscus (esp. perforated peptic ulcer)
Pitfalls (often missed) Acute appendicitis (atypical) Myofascial tear/muscle wall pain Pulmonary causes: •pneumonia •pulmonary embolism Faecal impaction (elderly) Acute diverticulitis Herpes zoster Acute hepatitis Inflammatory bowel disease
Rarities: •porphyria •lead poisoning •haemochromatosis •haemoglobinuria •Addison disease
Masquerades checklist Depression Diabetes (ketoacidosis) Drugs (e.g. NSAIDS, iron tablets, narcotics, cytotoxics) Anaemia (sickle cell) Spinal dysfunction (referred) UTI (inc. urosepsis)
Is the patient trying to tell me something?
May be very significant.
Consider Munchausen syndrome, sexual dysfunction and abnormal stress
Abdominal Pain - Key History
Key history
Pain has to be analysed according to the usual SOCRATES features. In respect to associated symptoms and signs, special attention has to be paid to anorexia, nausea or vomiting, micturition, bowel function, menstruation and drug intake
Abdominal Pain - Key PE
Key examination A useful checklist is: •general appearance •oral cavity •vital parameters incl. temperature, pulse •abdominal examination: inspection, auscultation, palpation and percussion (in that order) •rectal examination •inguinal region •vaginal examination (if appropriate) •urine analysis
Abdominal Pain - Key Investigation
Key investigations
- FBE
- ESR/CRP
- Serum lipase or amylase
- Urine MC
- LFTs
- H. pylori tests
- Faecal blood
Consider:
•imaging including plain X-ray, ultrasound, IVU, CT scan and others according to suspected conditions•upper GI endoscopy
Abdominal Pain - Diagnostic Tips
Diagnostic tips
•Upper abdominal pain is caused by lesions of the upper GIT.
•Lower abdominal pain is caused by lesions of the lower GIT or pelvic organs.
•Early severe vomiting indicates a high obstruction of the GIT.
•Acute appendicitis features a characteristic ‘march’ of symptoms:
- pain → anorexia, nausea → vomiting.
