Lower Abdo Pain Flashcards
Causes of right lumbar pain
Appendicitis Bowel obstruction in caecum Crohn’s disease Ruptured ectopic pregnancy Renal/ureteric stones Coeval volvulus Meckel’s Diverticulitis Perforated viscous Inguinal hernia
What is Meckel’s diverticulitis?
Congenital form of diverticulitis
What might cause left iliac pain?
UC and Crohn’s Sigmoid diverticulitis Testicular torsion constipation Leaking AAA Ruptured ectopic Ischaemic colitis Colon cancer (rarely)
What is a volvulus?
Looped bit of bowel
Key conditions that cause flank pain?
Pyelonephritis Nephrolithiasis (kidney stones) Ureteric colic (kidney stones in ureter Testicular torsion Perforated peptic ulcer Leaking AAA
OTher causes of flank pain
Renal cancer
Abscess
Basal pneumonia
Spinal causes of flank pain?
Fractures
metastasises
Disc prolapse
Gynaecological reasons for flank pain?
Ectopic pregnancy
OVarian torsion
Other abdo pathology causing flank pain?
Pancreatitis
Diverticulitis
Differentials for SUDDEN onset left/right iliac pain
Perforated viscous
Ureteric stones
Testicular torsion
Volvulus
SLow onset
UC/Crohn’s
Colicky right/left iliac pain?
Ureteric stones
Volvulus
Constant pain at right or left iliac pain?
Appendicitis - deep pain
Testicular torsion
Diverticulits is colicky then constant
What type of pain is UC or Crohn’s?
Crampy
Appendicitis radiation
Central to RIF
Ureteric stones radiation
Loin to groin
What exacerbates appendicitis?
Movement
Why must you ask about timing of last excretion?
Could indicated bowel obstruction
What might N& V suggest?
Appendicitis
Bowel obstruction
Testicular torsion
Ureteric stones
Fever might suggest
Appendicitis
DIverticulitis
UC
Crohn’s
Tinkling bowel sounds might suggest
Intestinal obstruction (e.g. volvulus)
Aphthous ulcers might suggest
Crohn’s
Weight loss might suggest
Crohn’s
UC
Lower urinary tract symptoms would suggest
Ureteric stones
Volvulus signs on X-RAY?
Coffe bean sign and fetus sign
Kidney stones - uni lateral or bi lateral
Uni lateral
Describe the type of pain in kidney stones
Gradual that becomes severe
Differentiate kidney stones and ureteric stone pain
COnstant pain - kidney stones
Colicky pain - ureteric stones because the ureters are trying to contract and end up spasming
Sharp pain would suggest
Ruptured AAA
Shooting pain would suggest
Nerve impingement
If the pain radiates down the leg, what would it suggest?
Pain down the leg from flank
Peritonitis might be caused by
Ruptured AAA
Perforated peptic ulcer
What makes ureteric colic better?
Nothing
If the pain is worse on activity, what might it suggest?
MSK
If the pain lasts may weeks?
MSK pain
Fevers associated with flank pain can be due to
Inflammation: pyelonephritis, appendicitis
Other form of sepsis: Psoas abscess
Malignancy
Dehydration as an associated symptom will be seen in
Kidney stones
Nausea and vomiting will be associated with
Visceral organs E.g. ureteric colic Biliary colic Appendicitis Testicular torsion
Ureteric obstruction is associated with
Hesitancy
Reduced flow
Dribbling and incomplete urination
UTI Is associated with
Urinary frequency increase
URgency
Dysuria
What preexisting conditions may be relevant to flank pain
Previous kidney stones Recurrent cystitis (UTI) Atherosclerotic disease Longstanding back pain Kidney disease e.g. polycystic kidney disease Having 1 kidney
IBD
Recurrent surgery
Recurrent stones predispose to what type of kidney stone?
Struvite stones produced by bacteria?
What drug hx is important ?
Acyclovir
Indinavir
Acetazolamide
Why are Acyclovir and Indinavir important
These antivirals may cause kidney stone formation
How can acetazolamide cause kidney stones
Pee more
Dehydration
Kidney stones
FH
IBD
COlon cancer
Kidney stones
Social hx - what do you ask?
Diet Exercise Occupation Stress Travel - sexual history esp if there’s a chance of pregnancy
