Presentation is loading. Please wait.

Presentation is loading. Please wait.

acute abdominal pain How to approach a patient with Andrew McGovern

Similar presentations

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
Investigations Case example Epidemiology Abdominal pain present in 10% of hospital admissions. 1/3 of these require surgical intervention.

3 Causes Diffuse RUQ/LUQ RUQ LUQ RLQ LLQ RLQ/LLQ Acute pancreatitis DKA
Gastroenteritis Intestinal obstruction Peritonitis Mesenteric ischaemia RUQ/LUQ Acute pancreatitis Lower lobe pneumonia Myocardial ischaemia RUQ Cholecystitis Biliary colic Hepatitis Hepatic abscess LUQ Gastritis Splenic rupture/abscess RLQ Appendicitis Caecal diverticulitis Meckel’s diverticulitis LLQ Sigmoid diverticulitis RLQ/LLQ IBD Renal stones Cystitis Endometriosis Ruptured ectopic pregnancy Incarcerated hernias Psoas abscess

4 Pain History SOCRATES Site – has the pain moved?
Character – visceral, somatic, colic Radiation - pain in retroperitoneal structures radiates to the back - Loin to groin in ureteric colic Associated symptoms GI symptoms: nausea, vomiting bleeding - also GU symptoms and cardiopulmonary symptoms Severity – elderly patients have increased pain threshold/reduced visceral sensation.

5 Other history Fever Recent travel Past surgical and medical history
Psychiatric disorders Menstrual and gynaecological history

6 Examination Abdominal examination Vitals – HR, RR, BP, Temperature
General appearance – jaundiced, anaemia, nutritional status Check for signs of dehydration Cardiorespiratory examination Abdominal examination Inspection – scars, distension Palpation - hernial orifices Percussion Auscultation – high pitched tinkling bowel sounds

7 Examination Special signs Murphy’s sign – cholecystitis Cullen’s Sign
– pancreatitis Grey-Turner’s sign – pancreatitis, ruptured AAA, RTA Rectal 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. MSU CXR – 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. Examination BP 132/79 SaO2 98% on air HR 78/min Patient comfortable at rest. Heart sounds normal: I + II + O Chest clear Abdomen soft – tender in RUQ, Murphy’s +ve no palpable masses, no organomegally, BS present

10 Case Investigations Diagnosis Treatment Bloods – CRP 28 [NR <5]
AXR – normal USS – thickened GB wall, stones and pericholecystic fluid. Diagnosis Acute cholecystitis Treatment NBM, pain relief, antibiotics, cholecystectomy within 72h.

Download ppt "acute abdominal pain How to approach a patient with Andrew McGovern"

Similar presentations

Ads by Google