SOCRATES

Question 1

most common dioagnoses?

Answer 1

Question 2

Epigastric organs?

Answer 2

stomach, duodenum, pancreas, liver, heart, diaphragm, gallbladder, lung bases.

Question 3

Site of pain?

Answer 3

Pain that’s spread from the epigastium to the whole abdo is likely peritonitis from a perforated GI tract.

Pain spread from epi to chest is likely cardiac.

Biliary disease may present with purely epigastric pain.

Question 4

Onset of pain?

Answer 4

Very sudden - perforation (duodenal ulcer or boerhaaves) or MI.

10-20mins - acute pancreatitis and biliary colic.

Hours - Inflammatory processes like acute cholecystitis or pneumonia.

Question 5

Character of pain?

Answer 5

Crushing/tightness - cardiac.

Sharp/burning - peptic ulcers, gastritis, and doudenitis.

Deep/boring - pancreatitis.

Question 6

Radiation of pain?

Answer 6

Back pain – pancreatitis, leaking AAA and sometimes peptic ulcers.

Shoulder tip pain due to irritation of the phrenic nerve – diaphragmatic involvement from basal pneumonia or subphrenic abscess.

Jaw/neck/arm – Cardiac.

Retrosternal chest pain – oesophagitis or myocardial ischaemia.

Question 7

Attenuating factors?

Answer 7

Acute pancreatitis – sitting forward relieves pain.

Question 8

Timing?

Answer 8

Self-limiting over timescales of 6-8hrs – Biliary colic, peptic ulcer disease, gastritis, duodenitis and non-ulcer dyspepsia. (biliary colic has constant pain for duration of attack). Epigastric pain made worse by exercise is cardiac.

Question 9

Exacerbating factors (movement, deep breathing, fatty meals)?

Answer 9

Movement – pain of intra-abdo origin and peritonitis.

Deep breathing – basal pneumonia, pulmonary embolus, pneumothorax, pericarditis.

Fatty meals – triggering self limiting pain is biliary colic.

Question 10

Severity?

Answer 10

Not severe – uncomplicated peptic ulcer disease, gastritis, duodenitis and non-ulcer dyspepsia.

Severe – pancreatitis, perforated peptic ulcers, MI.