History Pack - Abdominal Pain Flashcards
A patient presents with right sided abdo pain , just below ribs - what are your differentials?
- Cholecystitis
- Cholangitis
- acute hepatitis
- gastric / duodenal ulcer
- pancreatitis
Describe SOCRATES for cholecystitis?
Site - RUQ below ribs
Onset - sudden and lasts for 2-3 hours.
Character - during atttack pain present all the time. intensity increases then subsides. COLICKY PAIN - restless, unable to find comfortable position.
Radiation - around side up to right shoulder.
Associated symptoms -
- feel hot and feverish.
- bowel changes : Constipated.
- No change in colour of stool. No change in urine.
- Belching.
- loss of appetite. weight loss.
- Jaundice ?
Timing - suddenly after fatty food.
Exacerbating / relieving factors : paracetamol / codeine not affective. Fatty food makes it worse.
Severity: 10/10 at its worse
What further investigations would you do in a patient presenting with cholecystitis?
- USS (shows gallstones, thickened gallbladder wall)
Bloods - raised WCC, CRP raised, slightly raised LFTs
What examination sign will be positive in cholecystitis?
Murphy’s sign
What is the difference between cholecystitis and cholangitis?
Cholangitis is infection of the bile duct usually associated with gallstone obstruction.
Cholecystitis is inflammation of the gallbladder due to gallstones.
What are the differentials for biliary colic?
- IBD (spasm of hepatic flexure)
- carcinoma of right side ofc colon
- renal colic
- atypical peptic ulcer
- pancreatitis
A patient presents with a aching, gnawing pain that goes through to his back - what are your differentials?
- Duodenal Ulcer
- Pancreatitis
A patient presents with pain just below the sternum and slightly to the right. It is made worse by drinking alcohol, it is seems to occur one hour before meals and has begun to wake him up at night ?
Duodenal ulcer
Duodenal Ulcer SOCRATES?
Site - below sternum just to the right.
Onset: - previous discomfort in area now pain.
Character : gnawing, aching, burning.
Radiating : goes through to back.
Associated symptoms:
- malaena?
- chane in bowels - no
- weight loss - no
- nausea
- vomiting infrequent but can relieve pain
Timing : one hour before meals, wakes pt up at night.
Exacerbating/relieving factors:
- worsened by alcohol
- not helped by eating
- helped by drinking milk
- milk of magnesia helps initially
Severity :
- 7/10
What further investigations would you request for a duodenal ulcer?
- how does invx for patients under 55 differ from older patients?
- H.pylori test (in under 55yrs, if positive start therapy without further indication)
- endoscopy (older patients exclude cancer with biopsies)
What are the complications of H.Pylori infection?
- Inflammation (gastritis)
- Peptic ulcer (duo and gastric)
- Gastric cancer
What can a patient do that strongly suggests peptic ulcer disease?
- point with one finger to site of pain strongly suggests peptic ulcer disease.
What are the symptoms of advanced gastric cancer?
- epigastric pain
(difficult to tell apart from peptic ulcer as it may be relieved by food and antacids) - nausea / vomiting
- loss of appetite
- weight loss
- dysphagia ( if fundus involved)
- anaemia ( occult blood loss)
What skin conditions are often associated with gastric cancer?
- dermatomyositis
- acanthosis nigricans
a patient presents with cough, chest pain and SOB -what are your differentials?
Cardiac:
- heart failure
Resp:
- COPD exacerbation (green sputum)
- Pneumonia (rusty sputum)
- tumour (bright red sputum)
- TB (fever + night sweats)
What are the causes of haemoptysis?
Neoplastic
Infective:
- TB
- bronchiectasis
- bronchitis
- chronic abscess
- aspergillosis
Vascular:
- lung infarct (PE)
- Vasculitis
Interstitial:
- fibrosis
- sarcoidosis
- goodpasture’s syndrome
aorto-pulmonary fistula
warfarin excess
What is good pastures syndrome?
- autoimmune disease in which antibodies attack the basement membranes in lungs and kidneys leading to bleeding.
What are the associated symptoms for headache?
- nausea / vomiting
- rash
- fever
- blurred / double vision
- loss of consciousness
- neck stiffness
- caffeine
How might a DVT present ?
SOCRATES?
Site - calf pain
Onset - after long flight, surgery, immobility.
Character - continual, heavy ache in leg and feeling tight.
Radiation - none
Associated symptoms : swollen, hot, red
(chest pain, SOB - if progreessed to PE)
Timing: pain is consistently the same despire sitting with legs up
Exacerbating/relieving factors -
Severity : 4/10, difficulty moving about house. weight bare?
How would you differentiate DVT from cellulitis?
Cellulitis - fever and rigors, well demarcated, red, swollen, tender area.
DVT - swollen, hot , red, ache, calf
