Session 11 - Signs and Symptoms of Abdominal Disorders

Question 1

Give four common presentations for abdominal disorders

Answer 1

Dyspepsia
Abdominal Pain
Constipation
Dysphagia

Question 2

Define dyspepsia

Answer 2

Upper abdominal pain

Question 3

Give four causes of dyspepsia

Answer 3

o Chronic peptic ulcer disease
o GORD
o Malignancy
o Functional/non ulcer

Question 4

What is functional dyspepsia?

Answer 4

60% of dyspepsia

No functional problem found to account for symptoms - 3 months of dyspepsia with no structural causes found

Question 5

What are the three main actions when someone presents with dyspepsia?

Answer 5

o Empirical acid suppression
o Non invasive H-pylori testing/eradication
o Early endoscopy

Question 6

How common is abdominal pain as a presentation?

Answer 6

2% of all admissions

Question 7

What is the first thing you need to do when thinking about abdominal pain?

Answer 7

Localise it

Question 8

How do you localise abdominal pian?

Answer 8

Is it intra-peritoneal/extra-peritoneal?

What embryological division does it belong to?

Question 9

WHat are the three embryological divisions of the abdomen and where does pain localise?

Answer 9

 Foregut – Up to 2nd part of Duodenum - Epigastric area
 Midgut – Up until the distal third of the transverse colon - Peri-umbilical
 Hindgut – Supra-pubic

Question 10

Give three causes of foregut pain

Answer 10

o Ulcers-epigastric pain
 Commonly in the first part of the duodenum / lesser curve of the stomach
o Pancreatits – Epigastric pain, back pain (retroperitoneal structure)
o Gallstones – Epigastric pain, can also get Right Upper Quadrant (RUQ) pain. Often refered to as colicky pain (slight misnomer as the pain fairly constant).

Question 11

Give two examples of causes of midgut pain

Answer 11

‘Real’ colicky pain
o Small bowel – Every 2-3 minutes
o Large bowel – Every 10-15 mins

Question 12

Give four signs and symptoms of small bowel obstruction

Answer 12

o	Vomiting (fairly early feature)
o	Abdominal distension
o	Xray may show 
	central abdominal distended loops
	Circular folds (extending the full width of the bowel lumen)

Question 13

Give one cause of hindgut pain

Answer 13

Sigmoid volvulus

Question 14

What is a sigmoid volvulus?

Answer 14

Causes 8% of all intestinal obstruction

Twists on itself or its mesentery, causing bowel obstruction and an interrupted blood supply

Question 15

What is anorexia?

Answer 15

Loss of appetite

Question 16

Give five causes of anorexia

Answer 16

o	Subjectively unpleasant food or surroundings
o	Anxiety
o	Anger/fear
o	Symptom of a physical disorder
o	Symptom of a psychological disorder

Question 17

Give five physical causes of anorexia

Answer 17

	Cancer (in particular GI tract)
	Chemotherapy/certain Antibiotics
	Pregnancy
	Depression
	Endocrine disorders

Question 18

What do you need to distinguis between when asking about weight loss?

Answer 18

Intentional or unintentional?

More than a 5% unintentional weight loss should be investigated

Question 19

What is nausea?

Answer 19

Subjective sensation of needing toi vomit

Question 20

Give four causes of nausea

Answer 20

o Food poisoning (Staphlococcal, salmonella, E-coli)
o Gastroenteritis (viral- Norwalk)
o Cholecystitis
o Appendicitis

Question 21

HOw is constipation classified?

Answer 21

Defecate less than 3 times a week - Change in bowel habit more important

Question 22

Give four causes of constipation

Answer 22

Diet
Medication
Dehydration
Immobility

Question 23

Why is a good history necessary for diarrhoea?

Answer 23

Many causes which change depending on the time and place of onset

Question 24

What are five categories of diarrhoea?

Answer 24

o	Secretory (Infection)
o	Osmotic (Lactose intolerance)
o	Abnormal Intestinal Motility (Thyrotoxicosis, IBS)
o	Exudative (Colitis, Cancer)
o	Malabsorption (Pancreatic enzyme/Bile Salt Deficiency)

Question 25

What is dyspagia?

Answer 25

o Difficulty swallowing (solids and liquids) | o Differentiate from painful swallowing (Odynophagia)

Question 26

What are two broad categories of dysphagia?

Answer 26

Difficulty initating swallow | Food sticking in oesophagus

Question 27

Give five causes of bleeding from oesophagus (haematemesis)

Answer 27

``` o Acute/chronic peptic ulcer o Mallory-Weiss tear  Tear in oesophagus from repetitive retching o Oesophageal/Gastric Varices o Erosive Oesophagitis o Gastric/Oesophageal cancer ```

Question 28

Give six causes of rectal bleeding

Answer 28

``` o Angiodysplasia  Vascular malformation of the gut blood vessels o Diverticular disease o Colonic carcinoma o Haemorrhoids/Anal fissure o Inflammatory Bowel Disease o Massive upper GI bleed  Malaena ```

Question 29

Give course for hepatic portal vein so superior vena cava

Answer 29

Hepatic portal vein -> Left gastric vein-> Oesophageal veins -> Azygous vein -> Upper extremities vein > SVC

Question 30

Give five causes of abdominal distension

Answer 30

``` The five F's o Fat o Fluid o Faeces o Flatus o Foetus ```

Question 31

Give three cause sof fluid ascites

Answer 31

Liver fialure Portal hypertension Cancer

Question 32

Give two causes of flatulus

Answer 32

Aerophagia (air swallowing) | Gas production in gut