W8: Acute Abdominal Pain (Clinical) Flashcards
Less than how many days classifies as acute abdominal pain?
less than 10 days
Less than how many days classifies as acute abdominal pain?
less than 10 days
List some common causes of abdominal pain.
- acute appendicitis
- intestinal obstruction
- perforated ulcer
- pancreatitis
- gallstone
- diverticular disease of colon
- trauma
- NSAP - Non specific abdominal pain
- Urological
- gynae
- IBS
- infections
List 5 rare causes of abdominal pain?
- ruptured/syptomatic AAA
- IBD
- DKA
- ischaemic gut
- basal pneumonia
What are three types of abdominal pain?
- parietal
- visceral
- extra-abdominal
What are some common associated symptoms in abdominal pain?
- burping
- absence of passing wind
- nausea/vomiting
- fever
- heartburn/indigestion
- change in bowel habit
- PR blood/mucous
What is important when asking about vomiting?
- colour e.g. green/yellow bile
- consistency e.g. coffee grounds
- smell
What are some signs of abdominal pain on examination?
- guarding
- Rosvig’s sign
- rebound tenderness
- localised peritonism
How does general peritonitis present on abdo examination?
abdo is “board-like”
List some common causes of abdominal pain.
- acute appendicitis
- intestinal obstruction
- perforated ulcer
- pancreatitis
- gallstone
- diverticular disease of colon
- trauma
- NSAP - Non specific abdominal pain
- Urological
- gynae
- IBS
- infections
List 5 rare causes of abdominal pain?
- ruptured/syptomatic AAA
- IBD
- DKA
- ischaemic gut
- basal pneumonia
What are three types of abdominal pain?
- parietal
- visceral
- extra-abdominal
What are some common associated symptoms in abdominal pain?
- burping
- absence of passing wind
- nausea/vomiting
- fever/chills
- heartburn/indigestion
- change in bowel habit
- PR blood/mucous
- malaise
- weight loss
What is important when asking about vomiting?
- colour e.g. green/yellow bile
- consistency e.g. coffee grounds
- smell
What are some signs of abdominal pain on examination?
- guarding
- Rosvig’s sign
- rebound tenderness
- localised peritonism
How does general peritonitis present on abdo examination?
abdo is “board-like”
Where is parietal pain localised to in terms of the dermatomes?
the dermatome above the site of the stimulus
Where are visceral receptors found? (4 places)
- serosal surface
- mesentery
- within intestinal muscle
- mucosa of hollow organ
What 3 stimuli do visceral receptors respond to?
- distension
- inflammation
- ischaemia
What fibres transmit visceral pain?
-C fibres
Whereabouts in the abdomen is pain felt when caused by organs in the foregut? (e.g. stomach, pancreas)
middle
Whereabouts in the abdomen is pain felt when caused by organs in the midgut? (e.g. small intestine)
Supra-pubic
Whereabouts in the abdomen is pain felt when caused by organs in the hindgut? (e.g. colon)
lower abdomen
Where are somato-parietal pain receptors found? (3 places)
- parietal peritoneum
- muscle
- skin
Through what kind of fibres is pain transmitted in somato-parietal pain?
myelinated A delta fibres
Where is somato-parietal pain transmitted to?
specific dorsal root ganglia
List 4 potential causes of left hypochondriac pain.
- gastric ulcer
- duodenal ulcer
- pancreatitis
- biliary colic
List 5 potential causes of epigastric pain.
- stomach ulcer
- epigastric hernia
- pancreatitis
- gallstones
- heartburn/indigestion
List 3 potential causes of right hypochondriac pain.
- gallstones
- stomach ulcer
- pancreatitis
What is the physiological explanation for referred pain?
When organs share common nerve pathway
Give an example of referred pain in acute abdominal pain.
Gallbladder pain can sometimes be felt in right shoulder tip
What 3 relieving factors should be considered when taking history in acute abdominal pain?
- painkillers
- heat
- cold compress
What 3 aggravating factors should be considered when taking history in acute abdominal pain?
- coughing
- sneezing
- movement
What are pain characteristic differences in acute vs chronic abdo pain?
- acute tends to be sudden onset, sharp, intense and localised
- chronic tends to be gnawing, aching, diffuse
List 4 potential causes of left hypochondriac pain?
- gastric ulcer
- duodenal ulcer
- pancreatitis
- biliary colic
List 5 potential causes of epigastric pain?
- stomach ulcer
- epigastric hernia
- pancreatitis
- gallstones
- heartburn/indigestion
List 3 potential causes of right hypochondriac pain?
- gallstones
- stomach ulcer
- pancreatitis
List 4 potential causes of right lumbar pain.
- lumbar hernia
- urine infection
- kidney stones
- constipation
List 5 potential causes of umbilical pain.
- pancreatitis
- stomach ulcer
- IBD (small bowel)
- umbilical hernia
- early appendicitis
List 4 potential causes of left lumbar pain.
- constipation
- kidney stones
- diverticular disease
- IBD
List 3 potential causes of left iliac pain.
- diverticular disease
- gynae pelvic pain
- inguinal hernia
List 5 potential causes of hypogastric pain.
- pelvic gynae pain
- urine infection
- IBD
- appendicitis
- diverticular disease
List 4 potential causes of right iliac pain.
- appendicitis
- constipation
- inguinal hernia
- gynae pelvic pain
What blood vessel supplies the foregut?
coeliac axis
What blood vessel supplies the midgut?
superior mesenteric artery
What blood vessel supplies the hindgut?
inferior mesenteric artery
Where can ureteral obstruction present in males as referred pain?
ipsilateral testicle
What is the mneumonic for radiopaque foreign bodies.
- BATCHIPS
- Barium
- Antihistamines
- Tricyclic antidepressants
- Chloral hydrate, cocaine, calcium
- Heavy metals
- Iodine
- Phenothiazine, potassium
- Slow release
What can cause absent bowel sounds? (3)
- ileus
- obese patients
- peritonitis
What is the significance of tinkling bowel sounds?
Indicates fluid obstruction
What are three causes of back pain?
- ruptured AAA
- pancreatitis
- renal tract disease
What is constant pain a sign of and colicky pain a sign of?
- constant pain -> inflammation
- colicky -> blocked “tube”
What is initial management in acute abdo pain?
- ABC
- analgesia and nausea treatment
- give oxygen
- give fluids
- urinalysis
What is Cullen’s Sign and what is it a sign of?
- Periumbilical bruising
- sign of pancreatitis
What is stercoral perforation?
Perforation of the colon due to faecal impaction wearing away at the wall of the colon
What is erythema ab igne caused by?
Someone holding a hot water bottle to their abdo
What investigations should be carried out?
- FBC, U&Es, LFTs, CRP, Ca, Lactate
- Serum Amylase
- pregnancy test
- x-ray
- CT
- Ultrasound
In what 3 circumstances is an abdominal x-ray useful for?
- obstruction
- colitis
- perforation
What are 2 causes that must be ruled out in acute pancreatitis?
- acute pancreatitis
- ruptured AAA
How does perforated duodenal ulcer often present on x-ray?
free air under the diaphragm
How does perforated duodenal ulcer present on examination?
board-like rigidity
What is toxic colitis, how does it present and what is it a complication of?
- acute distension of the colon
- abdominal pain, bloating, fever, abdo tenderness, tachycardia, dehydration
- usually complication of IBD
What is stercoral perforation?
Perforation of the colon due to
List 5 colon emergencies.
- toxic colitis
- obstruction
- volvulus
- acute diverticulitis
- perforation
What is the initial management of volvulus?
decompress using rigid sigmoidoscope
What is the initial management of acute presentation of malignancy causing bowel obstruction?
stent or operate
What is the initial management of Diverticulitis?
spectrum from antibiotics to Hartmann’s procedure
What is Hartmann’s Procedure?
-Removal of the sigmoid, (leave rectum) and attach a colostomy bag
What is the name of the classification system used for Diverticulitis?
-Hinchey classification
What are the four stages in Hinchey Classification?
- paracolic abscess
- pelvic abscess
- purulent peritonitis
- faecal peritonitis
Peritonitis from Kumar CLarker
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