Podcast
Questions and Answers
What is the abbreviation for acute abdominal pain?
What is the abbreviation for acute abdominal pain?
AAP
What is the primary cause of visceral pain?
What is the primary cause of visceral pain?
Parietal pain is localized to the dermatome above the site of the stimulus.
Parietal pain is localized to the dermatome above the site of the stimulus.
True
What is the most common cause of generalized abdominal pain?
What is the most common cause of generalized abdominal pain?
Signup and view all the answers
What condition is often associated with right lower quadrant (RLQ) pain in young patients?
What condition is often associated with right lower quadrant (RLQ) pain in young patients?
Signup and view all the answers
Loin pain can be caused by muscle strain.
Loin pain can be caused by muscle strain.
Signup and view all the answers
Overlying tenderness or underlying surgical disease can impact the accuracy of diagnosing acute abdominal pain.
Overlying tenderness or underlying surgical disease can impact the accuracy of diagnosing acute abdominal pain.
Signup and view all the answers
Atypical presentations of acute abdominal pain are uncommon, affecting only 15% of cases.
Atypical presentations of acute abdominal pain are uncommon, affecting only 15% of cases.
Signup and view all the answers
True colic is characterized by a baseline of no pain.
True colic is characterized by a baseline of no pain.
Signup and view all the answers
Stabbing pain is a characteristic feature of aortic aneurysms (AAA).
Stabbing pain is a characteristic feature of aortic aneurysms (AAA).
Signup and view all the answers
Burning or boring pain is a common symptom associated with peptic ulcer disease (PUD).
Burning or boring pain is a common symptom associated with peptic ulcer disease (PUD).
Signup and view all the answers
What two conditions are often associated with gnawing pain?
What two conditions are often associated with gnawing pain?
Signup and view all the answers
Previous episodes of acute abdominal pain (AP) are a significant consideration in the assessment of a patient with current AP.
Previous episodes of acute abdominal pain (AP) are a significant consideration in the assessment of a patient with current AP.
Signup and view all the answers
Observation is an important component of the physical exam for acute abdominal pain.
Observation is an important component of the physical exam for acute abdominal pain.
Signup and view all the answers
What is the main purpose of checking for hernia sites during palpation of the abdomen?
What is the main purpose of checking for hernia sites during palpation of the abdomen?
Signup and view all the answers
Rebound tenderness is a reliable indicator of peritonitis, having a low false-negative rate.
Rebound tenderness is a reliable indicator of peritonitis, having a low false-negative rate.
Signup and view all the answers
Tenderness that is out of proportion to the examination is a key finding that can be suggestive of mesenteric ischemia or acute pancreatitis.
Tenderness that is out of proportion to the examination is a key finding that can be suggestive of mesenteric ischemia or acute pancreatitis.
Signup and view all the answers
Cullen's sign is a bluish discoloration around the umbilicus and is associated with retroperitoneal hemorrhage.
Cullen's sign is a bluish discoloration around the umbilicus and is associated with retroperitoneal hemorrhage.
Signup and view all the answers
Kehr's sign, severe left shoulder pain, can be a sign of splenic rupture or ectopic pregnancy rupture.
Kehr's sign, severe left shoulder pain, can be a sign of splenic rupture or ectopic pregnancy rupture.
Signup and view all the answers
What is the specific area of tenderness associated with McBurney's sign?
What is the specific area of tenderness associated with McBurney's sign?
Signup and view all the answers
Murphy's sign, an abrupt interruption of inspiration on palpation of the right upper quadrant, is a sign of acute cholecystitis.
Murphy's sign, an abrupt interruption of inspiration on palpation of the right upper quadrant, is a sign of acute cholecystitis.
Signup and view all the answers
The iliopsoas sign is elicited by hyperextension of the right hip, which causes abdominal pain and is indicative of appendicitis.
The iliopsoas sign is elicited by hyperextension of the right hip, which causes abdominal pain and is indicative of appendicitis.
Signup and view all the answers
The obturator's sign, characterized by internal rotation of the right hip causing abdominal pain, is another sign suggestive of appendicitis.
The obturator's sign, characterized by internal rotation of the right hip causing abdominal pain, is another sign suggestive of appendicitis.
Signup and view all the answers
Grey-Turner's sign, a discoloration of the flanks, is typically caused by retroperitoneal hemorrhage.
Grey-Turner's sign, a discoloration of the flanks, is typically caused by retroperitoneal hemorrhage.
Signup and view all the answers
The chandelier sign, where manipulation of the cervix causes the patient to lift their buttocks off the table, is indicative of pelvic inflammatory disease.
The chandelier sign, where manipulation of the cervix causes the patient to lift their buttocks off the table, is indicative of pelvic inflammatory disease.
Signup and view all the answers
Rovsing's sign is a positive finding when palpation of the left lower quadrant causes pain in the right lower quadrant, suggestive of appendicitis.
Rovsing's sign is a positive finding when palpation of the left lower quadrant causes pain in the right lower quadrant, suggestive of appendicitis.
Signup and view all the answers
The absence of bowel sounds in the abdomen can only be confirmed after listening for at least 2 minutes.
The absence of bowel sounds in the abdomen can only be confirmed after listening for at least 2 minutes.
Signup and view all the answers
A bruit in the epigastrium can be suggestive of a potential abdominal aortic aneurysm.
A bruit in the epigastrium can be suggestive of a potential abdominal aortic aneurysm.
Signup and view all the answers
Tenderness, induration, mass, and frank blood are findings that can be observed during a rectal examination.
Tenderness, induration, mass, and frank blood are findings that can be observed during a rectal examination.
Signup and view all the answers
The myth that rebound tenderness is a reliable indicator of peritonitis has been proven by clinical studies, suggesting that it is not as accurate of a sign as previously thought.
The myth that rebound tenderness is a reliable indicator of peritonitis has been proven by clinical studies, suggesting that it is not as accurate of a sign as previously thought.
Signup and view all the answers
Administration of analgesics prior to surgical consultation can actually improve the accuracy of diagnosing acute abdominal pain.
Administration of analgesics prior to surgical consultation can actually improve the accuracy of diagnosing acute abdominal pain.
Signup and view all the answers
When assessing a patient with acute abdominal pain, the initial management focuses primarily on stabilizing their condition, not necessarily on a firm diagnosis.
When assessing a patient with acute abdominal pain, the initial management focuses primarily on stabilizing their condition, not necessarily on a firm diagnosis.
Signup and view all the answers
A low threshold for seeking senior help is encouraged in the management of acute abdominal pain.
A low threshold for seeking senior help is encouraged in the management of acute abdominal pain.
Signup and view all the answers
A complete blood count (FBC) is a highly sensitive test that can accurately pinpoint the specific cause of acute abdominal pain.
A complete blood count (FBC) is a highly sensitive test that can accurately pinpoint the specific cause of acute abdominal pain.
Signup and view all the answers
Clotting tests can be helpful in assessing patients with acute pancreatitis, sepsis, disseminated intravascular coagulation (DIC), or liver disease.
Clotting tests can be helpful in assessing patients with acute pancreatitis, sepsis, disseminated intravascular coagulation (DIC), or liver disease.
Signup and view all the answers
Plain X-rays are often the first and most reliable imaging modality for diagnosing acute abdominal pain.
Plain X-rays are often the first and most reliable imaging modality for diagnosing acute abdominal pain.
Signup and view all the answers
Laparoscopy has been proven to reduce the risk of unnecessary laparotomy and can be a valuable tool for resolving the diagnostic dilemma of non-specific abdominal pain.
Laparoscopy has been proven to reduce the risk of unnecessary laparotomy and can be a valuable tool for resolving the diagnostic dilemma of non-specific abdominal pain.
Signup and view all the answers
While plain X-rays have limited utility in diagnosing acute abdominal pain, they are still helpful for detecting bowel obstruction or perforation.
While plain X-rays have limited utility in diagnosing acute abdominal pain, they are still helpful for detecting bowel obstruction or perforation.
Signup and view all the answers
Early diagnostic laparoscopy is favored over CT scanning because it is less invasive, has a lower risk profile, and can provide a definitive diagnosis.
Early diagnostic laparoscopy is favored over CT scanning because it is less invasive, has a lower risk profile, and can provide a definitive diagnosis.
Signup and view all the answers
Study Notes
Acute Abdominal Pain (AAP) Definition
- AAP is the presentation of previously undiagnosed abdominal pain
- Lasting for 1/52 or less
- Prior to a clinical encounter in 1st or 2nd care
Introduction
- Over 1000 causes of acute abdominal pain exist
- Non-specific acute abdominal pain (SAP) accounts for 34%
- Acute appendicitis accounts for 28%
- Acute cholecystitis makes up 10%
- Small bowel obstruction (SBO) accounts for 4%
- Perforated peptic ulcer (PU) accounts for 3%
- Pancreatitis makes up 3%
- Diverticular disease accounts for 2%
- Other causes account for 13%
- Admission rates are 20-40%
- Initial diagnosis is inaccurate in 50-65% of cases
Pathophysiology
- Visceral pain arises from distention, inflammation, or ischemia in hollow or solid organs
- Location of this pain is rooted in the organ's embryonic development:
- Foregut to epigastrium
- Midgut to umbilicus
- Hindgut to the hypogastric region
- Parietal pain is localized to the dermatome above the stimulating site
- Referred pain produces symptoms (e.g., tenderness) but not signs
Generalized Acute Abdominal Pain (AP)
- Perforation
- Abdominal Aortic Aneurysm (AAA)
- Acute pancreatitis
- Diabetes Mellitus (DM)
- Bilateral pleurisy
Central Acute Abdominal Pain (AP)
- Early appendicitis
- Small bowel obstruction (SBO)
- Acute gastritis
- Acute pancreatitis
- Ruptured AAA
- Mesenteric thrombosis
Epigastric Pain
- Peptic ulcer disease (PUD)
- Esophagitis
- Acute pancreatitis
- AAA
Right Upper Quadrant (RUQ) Pain
- Gallbladder disease
- Peptic ulcer disease (PUD)
- Acute pancreatitis
- Pneumonia
- Subphrenic abscess
Left Upper Quadrant (LUQ) Pain
- Gastrointestinal issues (GI)
- Pneumonia
- Acute pancreatitis
- Spontaneous splenic rupture
- Acute perinephritis
- Subphrenic abscess
Suprapubic Pain
- Acute urinary retention
- Urinary tract infections (UTIs)
- Cystitis
- Pelvic inflammatory disease (PID)
- Ectopic pregnancy
- Diverticulitis
Right Iliac Fossa (RIF) Pain
- Acute appendicitis
- Mesenteric adenitis (young patients)
- Perforated peptic ulcer disease (PUD)
- Diverticulitis
- Pelvic inflammatory disease (PID)
- Salpingitis
- Ureteric colic
- Meckel's diverticulum
- Ectopic pregnancy
- Crohn's disease
- Biliary colic (low-lying gallbladder)
Loin Pain
- Muscle strain
- Urinary tract infections (UTIs)
- Renal stones
- Pyelonephritis
Left Iliac Fossa (LIF) Pain
- Diverticulitis
- Constipation
- Irritable bowel syndrome (IBS)
- Pelvic inflammatory disease (PID)
- Rectal cancer (Ca)
- Ulcerative colitis (UC)
- Ectopic pregnancy
Limitations
- Limitations arise from the relationship between overlying tenderness and an underlying surgical pathology.
- 35% of intra-operative diagnoses exhibit atypical presentations.
Key Points on History Taking
- Site of pain
- Nature and character of pain
- Duration of pain
- Intensity of pain
- Precipitating and relieving factors
- Associated symptoms
Classification by Nature of Pain
- Colicky pain: Baseline of no pain in true colic, IBS, bowel obstruction
- Nagging and Grumbling pain: Biliary colic, Cholecystitis, PID, UTI
- Stabbing pain: AAA
- Burning or boring pain: PUD, esophagitis
- Gnawing pain: Pancreatitis, pancreatic cancer
Associated Symptoms
- Fever
- Genitourinary issues
- Gynecological issues
- Vascular issues
Past Medical History (PMH)
- Previous episodes of AAP
- Investigations
- Operations
- Chronic disease
- Immunosuppression
- Medications (NSAIDs)
Physical Examination
-
General Observations (OBS): Important for assessment
- Posture: Bending forward (chronic pancreatitis), jaundice (common bile duct (CBD) obstruction), dehydration (peritonitis, small bowel obstruction)
-
Inspection:
- Abdomen: Scaphoid or flat (peptic ulcer), distended (ascites or intestinal obstruction), visible peristalsis (thin or malnourished patient with obstruction)
-
Palpation:
- Check for hernia sites
- Tenderness
- Rebound tenderness
- Guarding (involuntary spasm of muscles during palpation)
- Rigidity (abdominal muscles tense and board-like-indicates peritonitis)
- Local right iliac fossa tenderness (acute appendicitis, acute salpingitis)
- Low-grade, poorly localized tenderness (intestinal obstruction)
- Tenderness out of proportion to examination (mesenteric ischemia, acute pancreatitis)
- Flank tenderness (perinephric abscess, retrocecal appendicitis)
- Specific Signs: Cullen's sign, Kehr's sign, McBurney's sign, Murphy's sign, iliopsoas sign, obturator's sign, Gray-Turner's sign, chandelier sign, Rovsing's sign
-
Auscultation:
- Bowel sounds (BS) absent or present, high-pitched, hyperactive, or tinkling
- Bruit in epigastrium
- PR Examination: Tenderness, induration, mass, frank blood
- PV Examination: Bleeding, discharge, cervical motion tenderness, adnexal masses or tenderness, uterine size or contour
Initial Management
- Initial assessment: Very ill (resuscitation, help), stable (couple hours), reasonably well (investigations)
- ABCDE approach for emergencies
- Resuscitation and analgesia (opioid IV)
- Full monitoring
- Seeking senior help (low threshold)
Investigations
- Blood tests: FBC, Hb, WCC, amylase (pancreatitis), U&Es, LFTs, clotting, glucose, G&S (cross-match if necessary), ABG, ECG, cardiac enzymes
- Urinalysis: Cheap, readily available, useful with clinical scenario, microscopic urinalysis (MSU)
- Pregnancy test
- Radiology: Erect/supine CXR, x-ray studies, Ultrasound (?gynæ pathology), CT KUB/IVU (renal/ureteric colic)
- Plain X-rays: Limited utility in evaluation of AAP (low diagnostic yield, misleading incidental findings, no impact on management—exception: bowel obstruction/perforation)
- CT scanning: 1st-line imaging for AAP, modern CT quicker with thin sections
- Laparoscopy: Early laparoscopy can improve accuracy, prompt management, and reduce unnecessary laparotomy.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Test your knowledge on the causes, diagnosis, and pathophysiology of acute abdominal pain. This quiz covers the various types and statistics related to AAP, including common conditions like appendicitis and pancreatitis. Prepare to deepen your understanding of this critical medical topic.
