Abdominal Pain Clinical Reasoning

Front 1

'Crampy' Wave pain is called what? Describe its properties.

Back 1

Colic pain. Caused by contractions/distension.

Front 2

What pain lasts minutes to hours?

Back 2

Renal
Labour
Oesophageal

Front 3

What pains are dull?

Back 3

Ischaemic
Labour
Bladder/Large Bowel/Uterine

Front 4

Describe SI pain

Back 4

sharp, crampy, central spasms

Front 5

Describe Biliary Pain

Back 5

relating to the bile duct
RUQ to Back
lasts hours.
Constant + severe

Front 6

Describe Renal Pain

Back 6

Constant
Very Severe
Loin to groin
(lasts hour)

Front 7

Describe Ischaemic Pain

Back 7

Dull
Severe
Symptoms are worse than signs

Front 8

Describe Oesophageal Pain

Back 8

Sharp
Constant
Severe

Front 9

Describe an intussusception

Back 9

One bit of bowel gets telescoped into another. Ie it slides into another bit from a LESION
causes OBSTRUCTION

Front 10

Describe an Adhesion

Back 10

Acute inflammation of serosal surface of bowel. THEN THE FIBRINOUS EXUDATE binds between tissues

Front 11

Describe a Volvulus:

Back 11

Twisting of bowel loop around mesentery. Obstruction + strangulation

Front 12

Hernias

Back 12

Portions of bowel protrude into outpuching of the peritoneum.
Bowel gets trapped.
Inguinal, femoral, ubilical, abdominal wall.

Front 13

Describe:
bowel obstruction
pseudo-obstruction
what do they present as?

Back 13

Caused by hernia/adhesion/intusspecion/volvulus/foreign thing/cancer.
Pseudo-obstruction: impaired motility caused by ischaemia/infarction. PARALYTIC ILEUS
frequent abdominal pain post prandially. also relief via vomiting.

Front 14

What causes transmural infarction?

Back 14

Compromise of the major blood vessels.

Front 15

What causes mucosal/submucosal infarction?

Back 15

Hypoperfusion (ie shock or atherosclerotic narrowing)

Front 16

Ischaemic Bowel Disease presentation

Back 16

Abdominal pain + variable tenderness + nausea + vomiting + maybe bloody diarrhoea. Weight loss. USUALLY AN OLD PERSON.

Front 17

Complications of a bowel obstruction?

Back 17

Dehydration: hypovolemia. Substances released from static luminal contents cause more secretion of fluid.

Infarction:
strangulation or impaired venous draining leading to congestion/haemorrhage. eventually compromises arterial flow.

Front 18

Diverticulitis Presentation?

Back 18

firstly, it happens with people over 70 (ie over 50%).
most are asymptomatic
complication are acute inflammation
bleeding

Front 19

Acute appendicitis Stages:

Back 19

Early focal
Acute suppurative (ie pus forming)
Gangrenous
Perforated

Front 20

Acute appendicitis Clinical Signs:

Back 20

Initially periumbilical abdominal pain (visceral)
RLQ (inflammation of parietal peritoneum overlying the appendix)
Anorexia Vomiting Nausea Malaise
Mild FEVER or TACHYCARDIIA

Front 21

Complications from appendicitis?

Back 21

Perforation:
neutrophils release lysosomal contents making necrosis. bacterial infection from bacterial. transmural necrosis leads to perforation.

Front 22

Crohn's Disease
Morphology Macro + Micro

Back 22

Macro:
Skip leasions
Thickening ot eh wall
Mucosal Ulceration
Cobblestone Appearance of the Mucosa
Serosal Vasocongestion

MICRO:
patchy transmural inflammation
non-necrotising granulomas common
acute inflammation: oedema + mucosal ulceration when active

Front 23

Crohn's Disease Clinical Presentation

Back 23

Intermittent attacks: diarrhoea + fever + crampy abdominal pain
Perianal fissures
Weight loss

Front 24

Crohn's Disease Complications

Back 24

Anaemia (blood loss or b12 or fe or folate def)
Malabsorption of specific nutrients/vitamins
Bowel perforation
Fistulas to other organs
Bowel obstruction
Carcinoma

Front 25

UC:
morphology
macro
micro

Back 25

MACRO:
no skip lesions
reddened ulcerated mucosa
pseudo-polyps (as actual mucosa is dead)
No or minimal thickening of the wall
mucosal atophy

Micro:
acute/chronic inflammation of the mucosa +/- submucosa
superficial ulceration
no granulomas

Front 26

UC:
clinical presentation

Back 26

Intermittent ttacks/bloody/mucoid diarrhoea/crampy abdominal pain/fever
weight loss

Front 27

Complications of UC

Back 27

anaemia.
dehydration
toxic megacolon
carcinoma moreso than CD

Front 28

Visceral Pain
Stimuli:

Back 28

3 Major ones
Mechanical: stretching/distention
Chemical Receptors: respond to inflammation (bradykinin) due to infection/bile problems etc
Ischaemia: vasoactive agents such as K/lactate/H

so the crushing or cutting of the gut does not produce pain

Front 29

Parietal pain: quality
stimuli:

Back 29

well localised, sudden onset, sharp.
stimuli:
anything causing irritation

Front 30

referred pain theory is called

Back 30

convergence projection hypothesis

Front 31

Abdominal Pain diagnosis:
immediate
rapid
gradual
ONSET

Back 31

immediate:
perforation/ischaemia/rupture

rapid (mins):
biliary colic renal colic small bowel obstruction

gradual (hrs)
gastritis, appendicitis, cholecystitis

Front 32

define: guarding

Back 32

voluntary/involuntary spasm of abdominal wall musculature

Front 33

Signs of parietal peritonitis:

Back 33

severe tenderness
guarding
rigidity
rebound tenderness
absent bowel sounds

Front 34

Acute abdomen

Back 34

sudden onset.
4 types:
steady w peritonitis:
appendicitis/diverticulitis/haemorrhage/perforation

steady w/o peritonitis:
cholecystitis, tumour infiltration, abscess, ischaemia. bowel ischaemia without rupture

intermittant with distention:
bowel obstruction

intermittent without distention
gastroenteritis, IBD

Front 35

distension is also called

Back 35

swelling

Front 36

gastroenteritis definition

Back 36

Gastroenteritis is defined as vomiting or diarrhea due to infection of the small or large bowel.

Front 37

bowel obstruction investigations:

Back 37

x-ray or ct scan (to see the obstruction

Front 38

Bowel Obstruction Clinical Sign:

Back 38

Loud + high pitched bowel sound

Front 39

Findings of an Abdominal Exam for appendicitis:

Back 39

Psoas sign (pain on extension of right thigh (retroperitoneal retrocaecal appendix)

Obturator Sign: Pain on internal rotation of right thigh (pelvic appendix)

Dunphy's Sign = increased pain with coughing.

Rosvings Sign (cross tenderness)

Front 40

Investigations For Abdominal Pain

Back 40

CBC: Inflammation increases WBC count. WBC shift to the left?

Urinalysis (kidney function + UTI diagnostic tool)
looking for colour + appearancce + ion + electrolyte +pH + GLUCOSE (WHICH SHOULD BE FILTERED OUT BY KIDNEY)

Ultrasound (for ectopic Pregnancy)

Pregnancy Test (for ectopic pregnancy)

Colonoscopy/Sigmoidoscopy for crohns

Front 41

Nervous Supply of the Bowel

Back 41

Extrinsic:
Brain + Spinal Cord

Intrinsic:
Submucousa + Myenteric Plexus (circular/longitudinal)

Front 42

Define Peristalsis

Back 42

Intrinsic, automatic bowel contraction (proximal to distal)

Physiological: MMC

Pathological: intense contractions to overcome obstruction/irritation

Front 43

Retro-Caecal Appendix

Back 43

Shown by pain on rectal exam.

Front 44

Fever/Anorexia/Nausea is caused by

Back 44

cytokines in the systemic circulation

Front 45

Chronic inflammation is characterised by:

Back 45

Lymphocytes + persistance of tissue damaging agent

Front 46

define: pyogenic. what type of bacteria cause this?

Back 46

pus-forming (all gram -ve bacteria in the bowel)

Front 47

Cause of liver disesase?

Back 47

Portal HTN: trans location of bacteria from increased permeability.

Front 48

Why is an abscess formation good?

Back 48

It prevents further infection and can be drained.

Front 49

How is the omentum the policeman?

Back 49

Fibrinolysis: walls off infection.