Abdominal Pain Types and Analysis

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Questions and Answers

What is the characteristic of visceral pain in terms of localization?

Dull and sharp

Lateralized

Well localized

Poorly localized (correct)

Which type of abdominal pain is caused by irritation of the parietal peritoneum?

Referred pain

Psychogenic pain

Parietal pain (correct)

Visceral pain

Where is gallbladder pain typically referred to?

The left upper quadrant

The epigastrium

The tip of the shoulder and back (correct)

The flank

What is the significance of the site of abdominal pain in diagnosis?

It can give a clue about the diagnosis and cause of the pain Signup and view all the answers

Which of the following conditions is most likely to cause epigastric pain?

Pancreatitis Signup and view all the answers

What is the characteristic of psychogenic pain?

It is often associated with depression or somatization Signup and view all the answers

Where is the pain typically located in patients with left upper quadrant pain?

The left upper quadrant Signup and view all the answers

What is the significance of the SOCRATES questions in the analysis of abdominal pain?

They are used to analyze the characteristics of abdominal pain Signup and view all the answers

What is the primary characteristic of the pain in ureteric colic?

Colicky and radiation to the groin Signup and view all the answers

What is the primary factor in determining the need for surgery in treating acute abdomen?

Presence of peritonitis Signup and view all the answers

What is the primary purpose of an erect chest x-ray in the management of acute abdomen?

To detect any air under the diaphragm suggestive of perforation Signup and view all the answers

What is the primary indication for performing a full blood count in the management of acute abdomen?

To detect leukocytosis Signup and view all the answers

Which of the following is NOT a cause of chronic or recurrent abdominal pain?

Food poisoning Signup and view all the answers

What is the primary indication for colonoscopy in patients with abdominal pain?

Altered bowel habit Signup and view all the answers

What is the primary purpose of a CT scan in the management of acute abdomen?

To detect retroperitoneal collections or masses Signup and view all the answers

Which of the following is a neurological/locomotor cause of abdominal pain?

Radiculopathy Signup and view all the answers

What is the primary characteristic of the radiation pattern in peptic ulcer disease?

Radiation to the upper quadrants Signup and view all the answers

What is the primary investigation for patients with features suggestive of mesenteric ischemia?

Angiography Signup and view all the answers

What is the primary purpose of careful history and clinical exam in the management of acute abdomen?

To detect signs of peritonitis Signup and view all the answers

Which of the following is a psychogenic cause of abdominal pain?

Anxiety Signup and view all the answers

What is the primary indication for performing an ultrasound in the management of acute abdomen?

To detect renal or gall stones Signup and view all the answers

What should be looked for in patients with chronic or recurrent abdominal pain?

Signs of weight loss, fever, jaundice, or anemia Signup and view all the answers

What is the primary purpose of assessing the patient every 2-4 hours in the management of acute abdomen?

To detect any changes in condition that might alter diagnosis and treatment Signup and view all the answers

What is the primary approach to treating acute abdomen?

Dependent on the affected organ Signup and view all the answers

What is the typical characteristic of pain in intestinal obstruction?

Pain is colicky, with spasms that disappear between spasms Signup and view all the answers

Which of the following conditions is most likely to cause a gradual onset of abdominal pain?

Inflammation of the appendix Signup and view all the answers

What is the common feature of movements in patients with peritonitis?

Movements exacerbate the pain Signup and view all the answers

Which of the following is NOT a cause of right-iliac fossa pain?

Ureteric colic Signup and view all the answers

What is the approximate percentage of urgent admissions to general surgery units due to acute abdomen?

50% Signup and view all the answers

Which of the following is a cause of centralized abdominal pain?

Mesenteric ischemia Signup and view all the answers

What is the typical feature of abdominal pain in patients with pelvic inflammatory disease?

The pain is pelvic and associated with menstruation Signup and view all the answers

Which of the following conditions is NOT a cause of generalized abdominal pain?

Cholecystitis Signup and view all the answers

Study Notes

Abdominal Pain

Types of abdominal pain:
- Visceral pain: resulted from stretching, distension, contraction, and twisting of unpaired organs; felt usually in the midline; dull and poorly localized.
- Parietal pain: resulted from irritation of parietal peritoneum; well localized and lateralized; caused by infection, inflammation, and neoplasia.
- Referred pain: e.g., gallbladder pain referred to tip of shoulder and back; M.I. referred to epigastrium.
Analysis of abdominal pain using SOCRATES questions:
- Site of pain: provides clues about diagnosis and cause of pain.
- Onset: acute or chronic.
- Character and pattern: constant, colicky, sharp, or dull; intermittent or continuous.
- Radiation: e.g., peptic ulcer disease radiates to upper quadrants or back; gallbladder disease radiates to tip of right shoulder or back.
- Associated symptoms: weight loss, vomiting, altered bowel habit.
- Timing and duration: exacerbated and relieving factors; food, hunger, drugs, alcohol, posture, movement, defecation.
- Severity: affects diagnosis and treatment.

Causes of Abdominal Pain

Epigastric pain: pancreatitis, gastritis, duodenitis, peptic ulcer, biliary disease, aortic aneurysm.
Right upper quadrant pain: hepatitis, cholecystitis, biliary colic, peptic ulcer, subphrenic and periphrenic abscess, renal stone, pyelonephritis, colonic cancer.
Left upper quadrant pain: peptic ulcer, gastric or colonic cancer, splenic rupture, subphrenic or periphrenic abscess, renal stone, pyelonephritis.
Loin pain: renal colic, pyelonephritis, renal tumor, perinephritis, pain referred from vertebral column.
Left-iliac fossa pain: diverticulitis, volvulus, colon cancer, pelvic abscess, inflammatory bowel disease, hip pathology, renal colic, UTI, cancer of undescended testis, zoster, ectopic pregnancy, torsion of ovarian cyst, and salpingitis.
Right-iliac fossa pain: appendicitis, Crohn's ileitis, and all causes of left-iliac fossa pain (except diverticulitis).
Pelvic pain: urological (UTI, urine retention, bladder stone) and gynecological (menstruation, pregnancy, endometriosis, salpingitis, torsion of ovarian cyst) disorders.
Central pain: mesenteric ischemia, abdominal aneurysm, pancreatitis.
Generalized abdominal pain: gastroenteritis, irritable bowel syndrome, peritonitis.

Acute Abdomen

Accounts for about 50% of all urgent admissions to general surgery units.
Causes of acute abdomen:
- Inflammation: gradual onset, usually over hours, diffuse pain, localized pain with parietal peritoneum irritation.
- Perforation: sudden onset, severe, generalized peritonitis.
- Obstruction: colicky pain, spasms, patient writhes and doubles up.
Table 1: Causes of acute abdomen (inflammation, perforation, obstruction, and other rare causes).

Management of Acute Abdomen

Careful history and clinical examination (vital signs, abdominal exam, guarding, and rebound tenderness).
Investigations:
- Full blood count (leukocytosis).
- Urea and electrolytes (dehydration).
- Amylase (pancreatitis).
- X-ray (erect chest x-ray, plain abdominal x-ray, obstruction).
- Ultrasound (renal or gall stones, free fluid, intra-abdominal abscess).
- Contrast radiology (intestinal obstruction).
- CT scan (pancreatitis, retroperitoneal collections, masses, aortic aneurysm).
- Angiography (mesenteric ischemia).

Treatment of Acute Abdomen

Depends on affected organ (perforation, obstruction, inflammation).
Presence or absence of peritonitis affects spread of intervention and necessity of surgery.

Chronic or Recurrent Abdominal Pain

Causes include intestinal and extra-intestinal disorders (table 2).
Note patient's general behavior, mood, emotional state, signs of weight loss, fever, jaundice, or anemia.
Look for evidence of diseases affecting other structures, especially vertebral column, spinal cord, lungs, and cardiovascular system.
Table 2: Extra-intestinal causes of abdominal pain (retroperitoneal, psychogenic, neurological, drugs, metabolic, and hematological disorders).

Investigations for Chronic or Recurrent Abdominal Pain

Depend on clinical features found during history and clinical examination.
Endoscopy and US for gastric pain, dyspepsia, and symptoms suggestive of gallbladder disease.
Colonoscopy for altered bowel habit, rectal bleeding, or features suggestive of colonic obstruction.
Angiography for features suggestive of mesenteric ischemia.

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Description

Learn about the different types of abdominal pain, including visceral, parietal, and referred pain, and how to analyze them. Understand the causes and characteristics of each type of pain.