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Z Year3 Clinical Presentations > Right Upper Quadrant Pain > Flashcards

Right Upper Quadrant Pain Flashcards

1
Q

What are RUQ pain differentials for a youngish person gastro?

A
  1. Biliary colic
  2. Cholecystitis
  3. Duodenal cancer
  4. Pancreatitis
  5. Ascending cholangitis
  6. Gastric ulcer
  7. SBO
  8. Appendicitis
  9. Hepatitis
  10. Fitz-hugh-curtis syndrome
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2
Q

What are RUQ pain differentials for a youngish person non gastro?

A
  1. Basal pneumonia

2. Pyelonephritis

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3
Q

What questions do you need to ask about RUQ?

A
  1. Socrates

2. Symptoms other than pain e.g. fever, weight loss

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4
Q

What assoicated symptoms questions do you ask about and why?

A
  1. Last open their bowel or pass any flatus - absolute constipation obstruction
  2. Any change in stool recently - CBD obstructed (steatorrhea), Bleeding ulcer (melaena)
  3. Pregnancy - ectopic?
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5
Q

What signs do you look for on examination of RUQ pain?

A
  1. Jaundice
  2. Cullens or Greys sign
  3. Pulsatile laterally expansive central mass
  4. Murphy’s sign
  5. Peritonitis
  6. Signs of SBO
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6
Q

What would jaundice with RUQ pain suggest?

A
  1. choledocholithiasis
  2. asceding cholangitis
  3. acute pancreatitis
  4. pancreatic cancer
  5. cholagiocarinoma
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7
Q

What would cullen’s or grey turner’s sign with RUQ pain suggest?

A

acute haemorrhagic pancreatitis

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8
Q

What would a pulsatile laterally expansive central mass with RUQ pain suggest?

A

AAA

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9
Q

What is Murphy’s sign?

A
  1. palpate abdomen just below tip of right ninth costal cartilage
  2. apply pressure and ask patient to take a deep breath
  3. cause liver and gallbladder to descend and press against your finger
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10
Q

What conditions is Murphy’s sign super painful in?

A

cholecystitis

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11
Q

What would peritonitis show up as in examination with RUQ pain?

A
  1. lie still
  2. rigid and tender abdomen and guarding
  3. may be no bowel sounds
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12
Q

What are signs of SBO?

A
  1. distended abdomen
  2. absent or tinkling bowel sounds
  3. if bowel becomes strangulated signs of peritonitis would predominate
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13
Q

What blood tests are essential in RUQ pain

A
  1. FBC
  2. LFTs
  3. Bilirubin
  4. Serum lipase and amylase
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14
Q

What do you look for and why in FBC?

A
  1. Anaemia if chronic bleeding from ulcer

2. WCC high if inflammatory condition

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15
Q

What condition is serum lipase and amylase very high?

A

pancreatitis

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16
Q

What conditions is serum lipase and amylase slightly high in?

A
  1. bowel obstruction
  2. mesenteric ischaemia
  3. posteriorly perforated duodenal ulcer
  4. mumps
  5. pancreatic carcinoma
  6. opiate medication
17
Q

What does raised AST and ALT suggest?

A

damage to hepatocytes

18
Q

What does rasied ALP and GGT suggest?

A

obstruction of CBD

19
Q

What does elevated levels of unconjugated bilirubin suggest?

A

heamolytic anaemia, Gilberts syndrome - liver cannot conjugate bilirubin fast enough

20
Q

What does elevated levels of conjugated bilirubin suggest?

A

(liver working fine) - obstruction of bile flow in liver or outside of liver

21
Q

What imaging do you do for RUQ?

A
  1. CXR
  2. US of pancreas CBD and gallbladder
  3. AXR
22
Q

What do you look for in CXR and RUQ?

A
  1. Air under diaphgram suggest a perforated viscus e.g. gastric or duodenal ulcer
  2. Wide mediastinum and/or heart shadow; suggest aortic dissection
23
Q

What do you look for in US of RUQ pain?

A
  1. Thickened inflamed wall of gallbladder: cholecystits

2. Look for presenece/absence of gallstones, biliary sludge and presence of intra or extrahepatic duct dilation

24
Q

What do you look for in AXR for RUQ pain?

A

bowel obstruction or perforation: look for Rigler’s sign

25
Q

What is cholecystitis?

A

inflammation of gallbladder

26
Q

Why does pain for cholecystitis start as poorly localised?

A

Irritation of virsceral peritoneum in initial stages produced poorly localised midline epigastirc pain

27
Q

When does the pain in cholecystitis go into RUQ?

A

As irritation spreads outwards to parietal peritoneum pain becomes sharply localized to RUQ

28
Q

What can the inflammaed gallbladder irritate?

A

liver scapisle and diaphragm above it - referred pain to shoulder (right scapula) (C3,C4, C5)

29
Q

What sort of pain does cholecystitis cause?

A

Inflammed gallbladder irritates parietal perineum causing constant pain

30
Q

What is the initial management for cholecystitis?

A
  1. ABC
  2. History
  3. Full examination
  4. First line investigation
  5. Diagnosis
31
Q

What is the non-operative treatment of cholecystitis?

A
  1. Clear fluids
  2. IV fluids: to avoid or treat dehydration
  3. Analgesia
  4. Antibiotic
32
Q

What is the operative treatment of cholecystitis?

A

laparoscopic cholecystectomy

Z Year3 Clinical Presentations (37 decks)

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