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General practice 2023 > Murtagh - Abdominal pain > Flashcards

Murtagh - Abdominal pain Flashcards

1
Q

inflammatory causes of acute abdomen

A

inflammatory bowel disease
appendicitis
cholecystitis
hepatitis
pancreatitis
salpingitis (Fallopian tubes)
diverticulitis

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2
Q

causes of acute abdomen caused by perforation

A

perforated duodenal ulcer
perforated gastric ulcer
faecal peritonitis
biliary peritonitis
appendicitis

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3
Q

obstructive causes of acute abdomen

A

biliary colic
acute small bowel obstruction
acute large bowel obstruction
ureteric colic
acute urinary retention
intestinal infarction

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4
Q

heamorragic causes of acute abdomen

A

ruptured ectopic pregnancy
ruptured spleen or liver (haemoperitoneum)
ruptured ovarian cyst
ruptured abdominal aortic aneurysm

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5
Q

causes of acute abdomen related to torsion (ischaemia)

A

sigmoid volvolus
torsion ovarian cyst
torsion of testes

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6
Q

what is the most likely cause of severe colicky midline umbilical abdominal pain with distension and vomiting

A

SBO

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7
Q

what is the most likely cause of midline lower abdominal pain with distention and vomiting

A

large bowel obstruction

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8
Q

name something that must be considered in an elderly patient presenting with severe abdominal pain with a background of arteriosclerotic disease or AF, or following MI

A

mesenteric artery occlusion

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9
Q

‘probability diagnosis’ for acute abdominal pain

A

acute gastroenteritis
acute appendicitis
mittelschmerz/dysmenorrhea
irritable bowel syndrome
biliary colic/renal colic

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10
Q

serious cardiovascular disorders ‘not to be missed’ for acute abdomen presentation

A

myocardial infarction
ruptured AAA
dissecting aneurysm aorta
mesenteric artery occlusion/ischaemia

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11
Q

severe infections ‘not to be missed’ in acute abdomen presentations

A

acute salpingitis
peritonitis/spontaneous bacterial peritonitis
ascending cholangitis
intra-abdominal abscess

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12
Q

other ‘serious disorders not to be missed’ for acute abdomen

A

pancreatitis
ectopic pregnancy
small bowell obstruction/strangulated hernia
sigmoid volvolus
perforated viscus
neoplasia (large or small bowel obtstruction)

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13
Q

pitfalls often missed in acute abdomen

A

acute appendicitis
myofascial tear
pulmonary causes - pneumonia or pulmonary embolism
faecal impaction (elderly)
herpes zoster

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14
Q

rare causes of acute abdomen

A

porphyria
lead poisoning
henoch-schonlein purpura
haemochromatosis
haemoglobinuria
Addison disease

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15
Q

seven masquerades checklist for acute abdomen

A

depression
diabetes (ketoacidosis)
drugs (especially narcotics)
anaemia (sickle cell)
endocrine disorder (thyroid storm, Addison)
spinal dysfunction
UTI (including urosepsis)

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16
Q

for acute abdomen - is the patient trying to tell me something?

A

consider munchausen syndrome, sexual dysfunction and abdominal stress

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17
Q

probability diagnosis of chronic abdomen

A

irritable bowel syndrome
diverticular disease
mittelschmerz/dysmenorrhea
peptic ulcer/gastritis

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18
Q

serious disorders not to be missed in chronic abdomen

A

cardiovascular - mesenteric artery ischaemia or AAA
neoplasia
- bowel/stomach cancer
- pancreatic cancer
- ovarian tumours
severe infections
- hepatitis
- recurrent PID

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19
Q

pitfalls often missed for chronic abdomen

A

adhesions
appendicitis
food allergies
lactase deficiency
constipation/faecal impaction
chronic pancreatitis
crohns disease
endometriosis
diverticulitis

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20
Q

rare causes of chronic abdomen

A

tropical infections eg. hydatids, melioidoses, malaria, strongyloides
uraemia
lead poisoning
porphyria
sickle cell anaemia
hypercalcaemia
Addisons disease

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21
Q

seven masquerades checklist for chronic abdomen

A

depression
drugs
andocrine disorder (Addisons disease)
spinal dysfunction
UTI

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22
Q

for chronic abdomen - is the patient trying to tell me something?

A

consider hypochondriasis, anxiety, sexual dysfunction, munchausen syndrome

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23
Q

misdiagnosis of ectopic pregnancy may cause

A

rapid hypovolaemic shock

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24
Q

misdiagnosis of ruptured AAA may cause

A

rapid hypovolaemic shock

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25
Q

misdiagnosis of gangrenous appendix may cause

A

peritonitis/pelvic abscess

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26
Q

misdiagnosis of perforated ulcer may lead to

A

peritonitis

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27
Q

misdiagnosis of obstructed bowel may lead to

A

gangrene

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28
Q

what is a common cause of acute abdomen in children

A

mesenteric adenitis

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29
Q

red flags to ask about in history taking for the acute abdominal pain patient

A

collapse on the toilet
lightheadedness
ischameic heart disease
progressive vomiting pain, distention
menstural abnormalities
malignancy
lack of flatus

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30
Q

signs to look out for in the acute abdomen presenting patient

A

pallor and sweating
hypotension
atrial fibrillation or tachycardia
fever
prostration
rebound tenderness and guarding
decreased urine output

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31
Q

early appendicitis presents typically as

A

centraal abdominal pain that shifts to the right iliac fossa some 4-6 hours later
can cause diarrhoea with abdominal pain, especially if a pelvic appendix

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32
Q

in what populations might appendicitis present atypically

A

elderly, in children, pregnancy and in those taking steroids

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33
Q

disaccharidase deficiencies

A

eg. lactase deficiency
associated with cramping and abdominal pain, which may be severe
follows hours after the ingestion of milk and is accompanied by the passage of watery stool

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34
Q

how might herpes zoster present

A

in the elderly patient with unilateral abdominal pain in the dermatomal distribution

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35
Q

causes of abdominal pain, frequency and dysuria other than UTI

A

cause could also be diverticulitis, pelvic appendicitis, salpingitis or a ruptured ectopic pregnancy

36
Q

drugs to consider as a cause of abdominal pain

A

alcohol
antibiotics
aspirin
corticosteroids
cytotoxic agents
tricyclic antidepressants
iron preparations
nicotine
NSAIDs/COX-2 inhibitors
sodium valproate
phenytoin

37
Q

for a patient with AF you should consider

A

mesenteric artery obstruction

38
Q

for a patient with tachycardia you should consider

A

sepsis and volume depletion

39
Q

for a patient with taahypnoea you should consider

A

sepsis, pneumonia, acidosis

40
Q

for a patient with pallor and shock you should consider

A

acute blood loss

41
Q

for a patient with absent bowel sounds you should consider

A

diffuse sepsis, ileum, mechanical obstruction (advanced)

42
Q

for distension, you should consider

A

six Fs
fat, fluid, flatus, faeces, fetus, frightening growths

43
Q

for hypertympany, you should consider

A

indicates mechanical obstruction

44
Q

haemoglobin may identify

A

anaemia with chronic blood loss
eg. peptic ulcer, cancer, oesophagitis

45
Q

blood film may indicate

A

abnormal red blood cells with sickle cell disease

46
Q

WCC may indicate

A

leucocytosis with appendicitis
acute pancreatitis
mesenteric adenitis
cholecystitis (especially with empyema)
pyelonephritis

47
Q

ESR indicates

A

raised with cancer, crohns disease, abscess, but non-specific test

48
Q

CRP may indicate

A

preferable to ESR
use in diagnosing and monitoring infection, inflammation eg. pancreatic

49
Q

liver function tests may indicate

A

hepatobiliary disorder

50
Q

serum amylase and/or lipase may indicate

A

if raised to greater than three times the normal upper level then pancreatitis is most likely
also raised partially with most intra-abdominal disasters (e.g. ruptured ectopic pregnancy, perforated peptic ulcers, ruptured empyema of gall bladder, ruptured aortic aneurysm)

51
Q

faecal elastase may indicate

A

chronic pancreatitis

52
Q

pregnancy tests may indicate

A

for susppected ectopic
urina and serum bHCG

53
Q

blood in urine sample may indicate

A

ureteric colic (stone or blood clot), urinary infection

54
Q

white cells in urine sample may indicate

A

urinary infection, appendicitis (bladder irritation)

55
Q

bile pigments in urine sample may indicate

A

gall bladder disease

56
Q

porphobilinogen in the urine sample may indicate

A

porphyria
(add ehrlich aldehyde agent)

57
Q

ketones in the urine sample may indicate

A

diabetic ketoacidosis

58
Q

air in the urine sample is called

A

pneumaturia

59
Q

pneumaturia may indicate

A

fistula (eg. diverticulitis, other pelvic abscess, pelvic cancer)

60
Q

faecal blood may indicate

A

mesenteric artery occlusion, intussusception (recurrant jelly), colon cancer, diverticulitis, crowns disease and ulcerative colitis

61
Q

what might you look for on an x-ray abdomen

A
  • kidney/ureteric stones (70% opaque)
  • biliary stones (10-30% opaque)
  • air in the biliary tree
  • calcified aortic aneurysm
  • marked distension sigmoid - sigmoid volvolus
  • distended bowel with fluid level: bowel obstruction
  • enlarged caecum with large bowel obstruction
  • blurred right psoas shadow: appendicitis
  • coffee bean sign: volvulus
  • a sentinel loop of gas in left upper quadrant (LUQ): acute pancreatitis
62
Q

a distended bowel with fluid level on x-ray indicates

A

bowel obstruction

63
Q

a blurred high psoas shadow on x-ray indicates

A

appendicitis

64
Q

a coffee bean sign on x-ray indicates

A

volvolus

65
Q

a sentinel loop of gas in the upper left quadrant indicates

A

acute appendicitis

66
Q

what are you looking for on a chest x-ray

A

perforated ulcer

67
Q

an ultrasound is most useful for

A

hepatobiliary system,
kidneys and female pelvis

68
Q

what should you look for on an ultrasounds

A

gallstones
ectopic pregnancy
pancreatic pseudocyst
aneurysm aorta/dissecting aneurysm
hepatic metastases and abdominal tumours
thickened appendix
parabolic collection

69
Q

an ultrasound might be affected by

A

gas shadows

70
Q

a CT scan is good for

A

gives good survey of abdominal organs including masses and fluid collection

71
Q

what are you looking for on CT scan

A

pancreatitis (acute and chronic)
undiagnosed peritoneal inflammation (best)
trauma
diverticulitis
leaking aortic aneurysm
retroperitoneal pathology
appendicitis (especially with oral contrast)

72
Q

ERCP might show

A

bile duct obstruction and pancreatic disease

73
Q

a contrast enhanced x-ray might be useful for

A

e.g. gastrograffin meal
diagnosis of bowel leakage

74
Q

HIDA or DIDA nuclear sign is used for

A

diagnosis of acute cholecystitis
this is useful when US is unhelpful

75
Q

other investigations for abdominal presentations

A

IVP
barium enema
MRI
ECG
endoscopy upper GI
sigmoidoscopy and colonoscopy

76
Q

what does this stuff look like on plain x-ray?

A
77
Q

early severe vomiting indicates

A

severe obstruction of the GIT

78
Q

what is colicky pain

A

rhythmic pain with regular spasms of recurring pain building to a climax and then fading

79
Q

what is true colic?

A

true colic is ureteric colic
biliary colic and kidney colic are not ‘true colics’

80
Q

epigastric pain usually arises from

A

usually arises from the disorders of the embryologic foregut
eg. oesophagus, stomach and duodenum, hepatobiliary structures, pancreas and spleen

81
Q

if the pain moves from the epigrastrium to the right

A

gall bladder and liver

82
Q

if the pain moves from the peigastrium to the left

A

spleen

83
Q

periumbilical pain usually arises from

A

usually arises from disorders of the embryologic midgut

84
Q

supreppubic pain usually arises from

A

disorders of the embryologic hindgut

85
Q

pain from visceral mechanoreceptors

A

triggered by intestinal distention or tension on mesentery or blood vessels
diffuse and poorly localised pain

86
Q

pain from parietal peritoneal nociceptors

A

triggered by mechanical, thermal and chemical stimuli
pain is experienced directly at the site of insult

General practice 2023 (49 decks)

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