Differentials for acute presentations - Abdominal pain

Question 1

What are life threatening causes of acute abdominal pain?

Answer 1

• Peritonitis
• AAA
• Ischaemic bowel
• Medical causes (DKA, Pneumonia, MI, Addisonian crisis)

Question 2

How would you explore acute abdominal pain?

Answer 2

SOCRATES

Question 3

What would you want to ask about on systemic enquiry in someone with acute abdominal pain?

Answer 3

• How patient feels
• Fever
• Gastro - nausea, vomiting, bowel habit, blood/malaena, weight loss
• Urological - dysuria, urinary frequency
• Gynae - LMP, PV discharge, contraception, chance of pregnancy

Question 4

What would you as about on PMH in someone with acute abdominal pain?

Answer 4

• Happened before
• Other medical conditions
• Previous surgery - particularly abdominal

Question 5

What would you want to ask about on social history?

Answer 5

• Smoking
• Alcohol

Question 6

What would you look for on examinaion in someone with acute abdominal pain?

Answer 6

• Inspect - movement with resps, grey turners/cullen’s sign, scars
• Guarding/rebound tenderness
• Murphy’s/Rovsig’s sign
• Liver/spleen/kidneys/AAA
• Hernias
• Percussion tenderness
• Bowel sounds
• External genetalia/PR if indicated

Question 7

What bloods would you want to do in someone with acute abdominal pain?

Answer 7

• FBC
• U+E’s
• CRP
• LFTs
• Amylase
• INR/G&S
• Cap glucose
• Mg2+/PO4-
• VBG

Question 8

What bedside tests would you consider doing in someone with acute abdominal pain?

Answer 8

• NEWS
• ECG
• Urine dipstick
• Urine BHCG

Question 9

What imaging sould you consider doing in someone with acute abdominal pain?

Answer 9

• Erect CXR
• AXR
• Fast Scan
• USS/CT abdo/pelvis

Question 10

What structured approach would you take to determining what investigations you are going to do in someone with acute abdominal pain?

Answer 10

• Bloods/Bedside
• Orifices
• X-rays/Imaging
• ECG
• Specific tests

Question 11

What are surgical causes of acute abdominal pain?

Answer 11

• Peritonitis/perforation
• Ruptured AAA
• Appendicitis
• Gallstone disease
• Acute pancreatitis
• Diverticulitis
• Renal colic
• Bowel obstruction
• Acute mesenteric ischaemia
• Testicular torsion
• Ischaemic colitis
• Volvulus
• Strangulated hernia
• Meckels diverticulum
• Mesenteric adenitis
• Adhesions
• Hepatic abscess
• Psoas abscess

Question 12

What are medical causes of acute abdominal pain?

Answer 12

• Gastritis
• Peptic ulcer
• Pyelonephtritis
• Gastroenteritis
• COnstipation
• Crohn’s Disease/UC
• MI
• Pneumonia
• SC crisis
• DKA
• IBS
• Budd-chiari syndrome
• Addisonian crisis
• Hypercalcaemia
• Acute intermittent porphyria
• Hepatitis

Question 13

What are gynaecological causes of Acute abdominal pain?

Answer 13

• Ectopic pregnancy
• Ovarian Torsion
• Acute salpingitis/PID
• Ovarian cyst rupture
• Pregnancy
• Fitz-hugh-curtis syndrome
• Endometriosis