Presentation on theme: "acute abdominal pain How to approach a patient with Andrew McGovern"— Presentation transcript:
1 acute abdominal pain How to approach a patient with Andrew McGovern Brighton and Sussex Medical School
2 Introduction Plan Epidemiology Common causes History and examination InvestigationsCase exampleEpidemiologyAbdominal pain present in 10% of hospital admissions.1/3 of these require surgical intervention.
4 Pain History SOCRATES Site – has the pain moved? Character – visceral, somatic, colicRadiation- pain in retroperitoneal structures radiates to the back- Loin to groin in ureteric colicAssociated symptomsGI symptoms: nausea, vomiting bleeding- also GU symptoms and cardiopulmonary symptomsSeverity – elderly patients have increased pain threshold/reduced visceral sensation.
5 Other history Fever Recent travel Past surgical and medical history Psychiatric disordersMenstrual and gynaecological history
6 Examination Abdominal examination Vitals – HR, RR, BP, Temperature General appearance – jaundiced, anaemia, nutritional statusCheck for signs of dehydrationCardiorespiratory examinationAbdominal examinationInspection – scars, distensionPalpation - hernial orificesPercussionAuscultation – high pitched tinklingbowel sounds
7 Examination Special signs Murphy’s sign – cholecystitis Cullen’s Sign – pancreatitisGrey-Turner’s sign– pancreatitis, ruptured AAA, RTARectal and pelvic examination
8 Investigations General investigations FBC, ESR – ↓Hb in peptic ulcer disease, malignancy. ↑WCC in infective/inflammatory disease.U&E – ↑urea/creatinine in renal conditions. Electrolyte disturbance in D&V.LFTs – abnormal in cholangitis and hepatitis.Amylase – ↑↑ in acute pancreatitis. ↑ in perforated peptic ulcer or infarcted bowel.MSUCXR – Gas under diaphragm in perforation. Pneumonia.AXR – Dilated bowel – IBD, obstruction. Sentinel loop – pancreatitis, appendicitis. Renal stones, etc.USS
9 Case History Examination Mr G: 62 year old male with gradual onset of severe epigastric pain.ExaminationBP 132/79 SaO2 98% on air HR 78/minPatient comfortable at rest.Heart sounds normal: I + II + OChest clearAbdomen soft – tender in RUQ, Murphy’s +veno palpable masses, no organomegally,BS present
10 Case Investigations Diagnosis Treatment Bloods – CRP 28 [NR <5] AXR – normalUSS – thickened GB wall, stones and pericholecystic fluid.DiagnosisAcute cholecystitisTreatmentNBM, pain relief, antibiotics, cholecystectomy within 72h.