W8: Acute Abdominal Pain (Clinical) Flashcards
(71 cards)
1
Q
Less than how many days classifies as acute abdominal pain?
A
less than 10 days
2
Q
Less than how many days classifies as acute abdominal pain?
A
less than 10 days
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
4
Q
List 5 rare causes of abdominal pain?
A
- ruptured/syptomatic AAA
- IBD
- DKA
- ischaemic gut
- basal pneumonia
5
Q
What are three types of abdominal pain?
A
- parietal
- visceral
- extra-abdominal
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
7
Q
What is important when asking about vomiting?
A
- colour e.g. green/yellow bile
- consistency e.g. coffee grounds
- smell
8
Q
What are some signs of abdominal pain on examination?
A
- guarding
- Rosvig’s sign
- rebound tenderness
- localised peritonism
9
Q
How does general peritonitis present on abdo examination?
A
abdo is “board-like”
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
11
Q
List 5 rare causes of abdominal pain?
A
- ruptured/syptomatic AAA
- IBD
- DKA
- ischaemic gut
- basal pneumonia
12
Q
What are three types of abdominal pain?
A
- parietal
- visceral
- extra-abdominal
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
14
Q
What is important when asking about vomiting?
A
- colour e.g. green/yellow bile
- consistency e.g. coffee grounds
- smell
15
Q
What are some signs of abdominal pain on examination?
A
- guarding
- Rosvig’s sign
- rebound tenderness
- localised peritonism
16
Q
How does general peritonitis present on abdo examination?
A
abdo is “board-like”
17
Q
Where is parietal pain localised to in terms of the dermatomes?
A
the dermatome above the site of the stimulus
18
Q
Where are visceral receptors found? (4 places)
A
- serosal surface
- mesentery
- within intestinal muscle
- mucosa of hollow organ
19
Q
What 3 stimuli do visceral receptors respond to?
A
- distension
- inflammation
- ischaemia
20
Q
What fibres transmit visceral pain?
A
-C fibres
21
Q
Whereabouts in the abdomen is pain felt when caused by organs in the foregut? (e.g. stomach, pancreas)
A
middle
22
Q
Whereabouts in the abdomen is pain felt when caused by organs in the midgut? (e.g. small intestine)
A
Supra-pubic
23
Q
Whereabouts in the abdomen is pain felt when caused by organs in the hindgut? (e.g. colon)
A
lower abdomen
24
Q
Where are somato-parietal pain receptors found? (3 places)
A
- parietal peritoneum
- muscle
- skin
25
Through what kind of fibres is pain transmitted in somato-parietal pain?
myelinated A delta fibres
26
Where is somato-parietal pain transmitted to?
specific dorsal root ganglia
27
List 4 potential causes of left hypochondriac pain.
- gastric ulcer
- duodenal ulcer
- pancreatitis
- biliary colic
28
List 5 potential causes of epigastric pain.
- stomach ulcer
- epigastric hernia
- pancreatitis
- gallstones
- heartburn/indigestion
29
List 3 potential causes of right hypochondriac pain.
- gallstones
- stomach ulcer
- pancreatitis
30
What is the physiological explanation for referred pain?
When organs share common nerve pathway
31
Give an example of referred pain in acute abdominal pain.
Gallbladder pain can sometimes be felt in right shoulder tip
32
What 3 relieving factors should be considered when taking history in acute abdominal pain?
- painkillers
- heat
- cold compress
33
What 3 aggravating factors should be considered when taking history in acute abdominal pain?
- coughing
- sneezing
- movement
34
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
35
List 4 potential causes of left hypochondriac pain?
- gastric ulcer
- duodenal ulcer
- pancreatitis
- biliary colic
36
List 5 potential causes of epigastric pain?
- stomach ulcer
- epigastric hernia
- pancreatitis
- gallstones
- heartburn/indigestion
37
List 3 potential causes of right hypochondriac pain?
- gallstones
- stomach ulcer
- pancreatitis
38
List 4 potential causes of right lumbar pain.
- lumbar hernia
- urine infection
- kidney stones
- constipation
39
List 5 potential causes of umbilical pain.
- pancreatitis
- stomach ulcer
- IBD (small bowel)
- umbilical hernia
- early appendicitis
40
List 4 potential causes of left lumbar pain.
- constipation
- kidney stones
- diverticular disease
- IBD
41
List 3 potential causes of left iliac pain.
- diverticular disease
- gynae pelvic pain
- inguinal hernia
42
List 5 potential causes of hypogastric pain.
- pelvic gynae pain
- urine infection
- IBD
- appendicitis
- diverticular disease
43
List 4 potential causes of right iliac pain.
- appendicitis
- constipation
- inguinal hernia
- gynae pelvic pain
44
What blood vessel supplies the foregut?
coeliac axis
45
What blood vessel supplies the midgut?
superior mesenteric artery
46
What blood vessel supplies the hindgut?
inferior mesenteric artery
47
Where can ureteral obstruction present in males as referred pain?
ipsilateral testicle
48
What is the mneumonic for radiopaque foreign bodies.
- BATCHIPS
- Barium
- Antihistamines
- Tricyclic antidepressants
- Chloral hydrate, cocaine, calcium
- Heavy metals
- Iodine
- Phenothiazine, potassium
- Slow release
49
What can cause absent bowel sounds? (3)
- ileus
- obese patients
- peritonitis
50
What is the significance of tinkling bowel sounds?
Indicates fluid obstruction
51
What are three causes of back pain?
- ruptured AAA
- pancreatitis
- renal tract disease
52
What is constant pain a sign of and colicky pain a sign of?
- constant pain -> inflammation
| - colicky -> blocked "tube"
53
What is initial management in acute abdo pain?
- ABC
- analgesia and nausea treatment
- give oxygen
- give fluids
- urinalysis
54
What is Cullen's Sign and what is it a sign of?
- Periumbilical bruising
| - sign of pancreatitis
55
What is stercoral perforation?
Perforation of the colon due to faecal impaction wearing away at the wall of the colon
56
What is erythema ab igne caused by?
Someone holding a hot water bottle to their abdo
57
What investigations should be carried out?
- FBC, U&Es, LFTs, CRP, Ca, Lactate
- Serum Amylase
- pregnancy test
- x-ray
- CT
- Ultrasound
58
In what 3 circumstances is an abdominal x-ray useful for?
- obstruction
- colitis
- perforation
59
What are 2 causes that must be ruled out in acute pancreatitis?
- acute pancreatitis
| - ruptured AAA
60
How does perforated duodenal ulcer often present on x-ray?
free air under the diaphragm
61
How does perforated duodenal ulcer present on examination?
board-like rigidity
62
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
63
What is stercoral perforation?
Perforation of the colon due to
64
List 5 colon emergencies.
- toxic colitis
- obstruction
- volvulus
- acute diverticulitis
- perforation
65
What is the initial management of volvulus?
decompress using rigid sigmoidoscope
66
What is the initial management of acute presentation of malignancy causing bowel obstruction?
stent or operate
67
What is the initial management of Diverticulitis?
spectrum from antibiotics to Hartmann's procedure
68
What is Hartmann's Procedure?
-Removal of the sigmoid, (leave rectum) and attach a colostomy bag
69
What is the name of the classification system used for Diverticulitis?
-Hinchey classification
70
What are the four stages in Hinchey Classification?
1. paracolic abscess
2. pelvic abscess
3. purulent peritonitis
4. faecal peritonitis
71
Peritonitis from Kumar CLarker
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