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GI > W8: Acute Abdominal Pain (Clinical) > Flashcards

W8: Acute Abdominal Pain (Clinical) Flashcards

1
Q

Less than how many days classifies as acute abdominal pain?

A

less than 10 days

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2
Q

Less than how many days classifies as acute abdominal pain?

A

less than 10 days

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3
Q

List some common causes of abdominal pain.

A
  • acute appendicitis
  • intestinal obstruction
  • perforated ulcer
  • pancreatitis
  • gallstone
  • diverticular disease of colon
  • trauma
  • NSAP - Non specific abdominal pain
  • Urological
  • gynae
  • IBS
  • infections
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4
Q

List 5 rare causes of abdominal pain?

A
  • ruptured/syptomatic AAA
  • IBD
  • DKA
  • ischaemic gut
  • basal pneumonia
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5
Q

What are three types of abdominal pain?

A
  • parietal
  • visceral
  • extra-abdominal
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6
Q

What are some common associated symptoms in abdominal pain?

A
  • burping
  • absence of passing wind
  • nausea/vomiting
  • fever
  • heartburn/indigestion
  • change in bowel habit
  • PR blood/mucous
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7
Q

What is important when asking about vomiting?

A
  • colour e.g. green/yellow bile
  • consistency e.g. coffee grounds
  • smell
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8
Q

What are some signs of abdominal pain on examination?

A
  • guarding
  • Rosvig’s sign
  • rebound tenderness
  • localised peritonism
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9
Q

How does general peritonitis present on abdo examination?

A

abdo is “board-like”

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10
Q

List some common causes of abdominal pain.

A
  • acute appendicitis
  • intestinal obstruction
  • perforated ulcer
  • pancreatitis
  • gallstone
  • diverticular disease of colon
  • trauma
  • NSAP - Non specific abdominal pain
  • Urological
  • gynae
  • IBS
  • infections
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11
Q

List 5 rare causes of abdominal pain?

A
  • ruptured/syptomatic AAA
  • IBD
  • DKA
  • ischaemic gut
  • basal pneumonia
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12
Q

What are three types of abdominal pain?

A
  • parietal
  • visceral
  • extra-abdominal
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13
Q

What are some common associated symptoms in abdominal pain?

A
  • burping
  • absence of passing wind
  • nausea/vomiting
  • fever/chills
  • heartburn/indigestion
  • change in bowel habit
  • PR blood/mucous
  • malaise
  • weight loss
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14
Q

What is important when asking about vomiting?

A
  • colour e.g. green/yellow bile
  • consistency e.g. coffee grounds
  • smell
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15
Q

What are some signs of abdominal pain on examination?

A
  • guarding
  • Rosvig’s sign
  • rebound tenderness
  • localised peritonism
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16
Q

How does general peritonitis present on abdo examination?

A

abdo is “board-like”

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17
Q

Where is parietal pain localised to in terms of the dermatomes?

A

the dermatome above the site of the stimulus

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18
Q

Where are visceral receptors found? (4 places)

A
  • serosal surface
  • mesentery
  • within intestinal muscle
  • mucosa of hollow organ
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19
Q

What 3 stimuli do visceral receptors respond to?

A
  • distension
  • inflammation
  • ischaemia
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20
Q

What fibres transmit visceral pain?

A

-C fibres

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21
Q

Whereabouts in the abdomen is pain felt when caused by organs in the foregut? (e.g. stomach, pancreas)

A

middle

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22
Q

Whereabouts in the abdomen is pain felt when caused by organs in the midgut? (e.g. small intestine)

A

Supra-pubic

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23
Q

Whereabouts in the abdomen is pain felt when caused by organs in the hindgut? (e.g. colon)

A

lower abdomen

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24
Q

Where are somato-parietal pain receptors found? (3 places)

A
  • parietal peritoneum
  • muscle
  • skin
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25
Q

Through what kind of fibres is pain transmitted in somato-parietal pain?

A

myelinated A delta fibres

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26
Q

Where is somato-parietal pain transmitted to?

A

specific dorsal root ganglia

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27
Q

List 4 potential causes of left hypochondriac pain.

A
  • gastric ulcer
  • duodenal ulcer
  • pancreatitis
  • biliary colic
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28
Q

List 5 potential causes of epigastric pain.

A
  • stomach ulcer
  • epigastric hernia
  • pancreatitis
  • gallstones
  • heartburn/indigestion
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29
Q

List 3 potential causes of right hypochondriac pain.

A
  • gallstones
  • stomach ulcer
  • pancreatitis
30
Q

What is the physiological explanation for referred pain?

A

When organs share common nerve pathway

31
Q

Give an example of referred pain in acute abdominal pain.

A

Gallbladder pain can sometimes be felt in right shoulder tip

32
Q

What 3 relieving factors should be considered when taking history in acute abdominal pain?

A
  • painkillers
  • heat
  • cold compress
33
Q

What 3 aggravating factors should be considered when taking history in acute abdominal pain?

A
  • coughing
  • sneezing
  • movement
34
Q

What are pain characteristic differences in acute vs chronic abdo pain?

A
  • acute tends to be sudden onset, sharp, intense and localised
  • chronic tends to be gnawing, aching, diffuse
35
Q

List 4 potential causes of left hypochondriac pain?

A
  • gastric ulcer
  • duodenal ulcer
  • pancreatitis
  • biliary colic
36
Q

List 5 potential causes of epigastric pain?

A
  • stomach ulcer
  • epigastric hernia
  • pancreatitis
  • gallstones
  • heartburn/indigestion
37
Q

List 3 potential causes of right hypochondriac pain?

A
  • gallstones
  • stomach ulcer
  • pancreatitis
38
Q

List 4 potential causes of right lumbar pain.

A
  • lumbar hernia
  • urine infection
  • kidney stones
  • constipation
39
Q

List 5 potential causes of umbilical pain.

A
  • pancreatitis
  • stomach ulcer
  • IBD (small bowel)
  • umbilical hernia
  • early appendicitis
40
Q

List 4 potential causes of left lumbar pain.

A
  • constipation
  • kidney stones
  • diverticular disease
  • IBD
41
Q

List 3 potential causes of left iliac pain.

A
  • diverticular disease
  • gynae pelvic pain
  • inguinal hernia
42
Q

List 5 potential causes of hypogastric pain.

A
  • pelvic gynae pain
  • urine infection
  • IBD
  • appendicitis
  • diverticular disease
43
Q

List 4 potential causes of right iliac pain.

A
  • appendicitis
  • constipation
  • inguinal hernia
  • gynae pelvic pain
44
Q

What blood vessel supplies the foregut?

A

coeliac axis

45
Q

What blood vessel supplies the midgut?

A

superior mesenteric artery

46
Q

What blood vessel supplies the hindgut?

A

inferior mesenteric artery

47
Q

Where can ureteral obstruction present in males as referred pain?

A

ipsilateral testicle

48
Q

What is the mneumonic for radiopaque foreign bodies.

A
  • BATCHIPS
  • Barium
  • Antihistamines
  • Tricyclic antidepressants
  • Chloral hydrate, cocaine, calcium
  • Heavy metals
  • Iodine
  • Phenothiazine, potassium
  • Slow release
49
Q

What can cause absent bowel sounds? (3)

A
  • ileus
  • obese patients
  • peritonitis
50
Q

What is the significance of tinkling bowel sounds?

A

Indicates fluid obstruction

51
Q

What are three causes of back pain?

A
  • ruptured AAA
  • pancreatitis
  • renal tract disease
52
Q

What is constant pain a sign of and colicky pain a sign of?

A
  • constant pain -> inflammation

- colicky -> blocked “tube”

53
Q

What is initial management in acute abdo pain?

A
  • ABC
  • analgesia and nausea treatment
  • give oxygen
  • give fluids
  • urinalysis
54
Q

What is Cullen’s Sign and what is it a sign of?

A
  • Periumbilical bruising

- sign of pancreatitis

55
Q

What is stercoral perforation?

A

Perforation of the colon due to faecal impaction wearing away at the wall of the colon

56
Q

What is erythema ab igne caused by?

A

Someone holding a hot water bottle to their abdo

57
Q

What investigations should be carried out?

A
  • FBC, U&Es, LFTs, CRP, Ca, Lactate
  • Serum Amylase
  • pregnancy test
  • x-ray
  • CT
  • Ultrasound
58
Q

In what 3 circumstances is an abdominal x-ray useful for?

A
  • obstruction
  • colitis
  • perforation
59
Q

What are 2 causes that must be ruled out in acute pancreatitis?

A
  • acute pancreatitis

- ruptured AAA

60
Q

How does perforated duodenal ulcer often present on x-ray?

A

free air under the diaphragm

61
Q

How does perforated duodenal ulcer present on examination?

A

board-like rigidity

62
Q

What is toxic colitis, how does it present and what is it a complication of?

A
  • acute distension of the colon
  • abdominal pain, bloating, fever, abdo tenderness, tachycardia, dehydration
  • usually complication of IBD
63
Q

What is stercoral perforation?

A

Perforation of the colon due to

64
Q

List 5 colon emergencies.

A
  • toxic colitis
  • obstruction
  • volvulus
  • acute diverticulitis
  • perforation
65
Q

What is the initial management of volvulus?

A

decompress using rigid sigmoidoscope

66
Q

What is the initial management of acute presentation of malignancy causing bowel obstruction?

A

stent or operate

67
Q

What is the initial management of Diverticulitis?

A

spectrum from antibiotics to Hartmann’s procedure

68
Q

What is Hartmann’s Procedure?

A

-Removal of the sigmoid, (leave rectum) and attach a colostomy bag

69
Q

What is the name of the classification system used for Diverticulitis?

A

-Hinchey classification

70
Q

What are the four stages in Hinchey Classification?

A
  1. paracolic abscess
  2. pelvic abscess
  3. purulent peritonitis
  4. faecal peritonitis
71
Q

Peritonitis from Kumar CLarker

A

get info

GI (29 decks)

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