ABDOMINAL PAIN
TYPES OF ABDOMINAL PAIN <ul><li>Visceral </li></ul><ul><ul><li>originates in abdominal organs covered by peritoneum </li><...
Epigastric pain <ul><li>Intestinal causes </li></ul><ul><ul><ul><li>Duodenal ulcer </li></ul></ul></ul><ul><li>Non intesti...
Right lower Quadrant Pain <ul><li>Intestinal causes </li></ul><ul><ul><ul><li>Appendicitis </li></ul></ul></ul><ul><ul><ul...
Left Lower Quadrant Pain <ul><li>Intestinal causes </li></ul><ul><ul><ul><li>Diverticulitis </li></ul></ul></ul><ul><ul><u...
Periumbilical Pain <ul><ul><ul><li>Appendicitis  </li></ul></ul></ul><ul><ul><ul><li>Colitis- Transverse colon </li></ul><...
Diffuse Pain <ul><li>Intestinal causes </li></ul><ul><ul><ul><li>Gastroenteritis </li></ul></ul></ul><ul><ul><ul><li>Intes...
INVESTIGATIONS <ul><li>HISTORY </li></ul><ul><li>Onset </li></ul><ul><li>Qualitative description </li></ul><ul><li>Intensi...
<ul><li>PHYSICAL EXAMINATION </li></ul><ul><li>Inspection </li></ul><ul><li>Palpation </li></ul><ul><li>Percussion </li></...
<ul><li>LABORATORY TESTS </li></ul><ul><li>Complete blood count </li></ul><ul><li>Urine analysis </li></ul><ul><li>Additio...
<ul><li>DIAGNOSTIC STUDIES </li></ul><ul><li>Plain X-rays- chest and abdomen </li></ul><ul><li>Contrast studies - barium (...
Common Causes of Acute Abdomen  <ul><li>Appendicitis  </li></ul><ul><li>Acute diverticulitis </li></ul><ul><li>Perforation...
<ul><li>Appendicitis </li></ul><ul><ul><li>abdominal pain begins in periumbilical area, anorexia, nausea or vomiting </li>...
<ul><li>Acute diverticulitis </li></ul><ul><ul><li>most pts have h/o diverticula </li></ul></ul><ul><ul><li>mild to modera...
<ul><li>Perforation of an ulcer </li></ul><ul><ul><li>sudden onset of severe intense, steady epigastric </li></ul></ul><ul...
<ul><li>Intestinal obstruction </li></ul><ul><ul><li>sudden onset of crampy pain usually in umbilical area- vomiting occur...
Common Causes of Chronic Pain Abdomen <ul><li>Irritable bowel syndrome </li></ul><ul><li>Diverticulosis </li></ul><ul><li>...
<ul><li>Irritable bowel syndrome </li></ul><ul><li>Pain described as nonradiating, intermittent, crampy located lower abdo...
<ul><li>Diverticulosis </li></ul><ul><li>80% - 85% remain asymptomatic - found during investigations for other reasons </l...
<ul><li>Inflammatory bowel disease </li></ul><ul><li>Ulcerative colitis </li></ul><ul><li>Crohn’s disease </li></ul><ul><l...
<ul><li>Duodenal ulcer </li></ul><ul><li>Epigastric pain </li></ul><ul><li>Sharp, burning, aching, gnawing pain occurring ...
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Abdominal Pain Intestines

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Abdominal Pain Intestines

  1. 1. ABDOMINAL PAIN
  2. 2. TYPES OF ABDOMINAL PAIN <ul><li>Visceral </li></ul><ul><ul><li>originates in abdominal organs covered by peritoneum </li></ul></ul><ul><li>Parietal </li></ul><ul><ul><li>from irritation of parietal peritoneum </li></ul></ul><ul><li>Colic- spasmodic </li></ul><ul><ul><li>intermittent crampy pain </li></ul></ul>
  3. 3. Epigastric pain <ul><li>Intestinal causes </li></ul><ul><ul><ul><li>Duodenal ulcer </li></ul></ul></ul><ul><li>Non intestinal causes </li></ul><ul><ul><ul><li>Acute pancreatitis </li></ul></ul></ul><ul><ul><ul><li>Gastritis </li></ul></ul></ul><ul><ul><ul><li>GERD </li></ul></ul></ul>
  4. 4. Right lower Quadrant Pain <ul><li>Intestinal causes </li></ul><ul><ul><ul><li>Appendicitis </li></ul></ul></ul><ul><ul><ul><li>Amoebic typhlitis </li></ul></ul></ul><ul><ul><ul><li>Regional Enteritis </li></ul></ul></ul><ul><ul><ul><li>Small bowel obstruction </li></ul></ul></ul><ul><li>Non intestinal causes </li></ul><ul><ul><ul><li>Leaking Aneurysm </li></ul></ul></ul><ul><ul><ul><li>Ruptured Ectopic Pregnancy </li></ul></ul></ul><ul><ul><ul><li>PID </li></ul></ul></ul><ul><ul><ul><li>Torsion Ovarian Cyst </li></ul></ul></ul><ul><ul><ul><li>Torsion testis </li></ul></ul></ul><ul><ul><ul><li>Ureteral Calculi </li></ul></ul></ul><ul><ul><ul><li>Obstructed hernia </li></ul></ul></ul>
  5. 5. Left Lower Quadrant Pain <ul><li>Intestinal causes </li></ul><ul><ul><ul><li>Diverticulitis </li></ul></ul></ul><ul><ul><ul><li>Regional enteritis </li></ul></ul></ul><ul><li>Non intestinal causes </li></ul><ul><ul><ul><li>Leaking Aneurysm </li></ul></ul></ul><ul><ul><ul><li>Ruptured Ectopic pregnancy </li></ul></ul></ul><ul><ul><ul><li>PID </li></ul></ul></ul><ul><ul><ul><li>Torsion Ovarian Cyst </li></ul></ul></ul><ul><ul><ul><li>Torsion testis </li></ul></ul></ul><ul><ul><ul><li>Ureteral Calculi </li></ul></ul></ul><ul><ul><ul><li>Obstructed hernia </li></ul></ul></ul>
  6. 6. Periumbilical Pain <ul><ul><ul><li>Appendicitis </li></ul></ul></ul><ul><ul><ul><li>Colitis- Transverse colon </li></ul></ul></ul><ul><ul><ul><li>Gastroenteritis </li></ul></ul></ul><ul><ul><ul><li>Small bowel obstruction </li></ul></ul></ul>
  7. 7. Diffuse Pain <ul><li>Intestinal causes </li></ul><ul><ul><ul><li>Gastroenteritis </li></ul></ul></ul><ul><ul><ul><li>Intestinal Obstruction </li></ul></ul></ul><ul><ul><ul><li>Mesenteric Vein Thrombosis </li></ul></ul></ul><ul><li>Non intestinal causes </li></ul><ul><ul><ul><li>Generalized peritonitis </li></ul></ul></ul><ul><ul><ul><li>Acute Pancreatitis </li></ul></ul></ul><ul><ul><ul><li>Sickle Cell Crisis </li></ul></ul></ul><ul><ul><ul><li>Metabolic disturbances </li></ul></ul></ul><ul><ul><ul><li>Dissecting or Leaking Aortic Aneurysm </li></ul></ul></ul>
  8. 8. INVESTIGATIONS <ul><li>HISTORY </li></ul><ul><li>Onset </li></ul><ul><li>Qualitative description </li></ul><ul><li>Intensity </li></ul><ul><li>Frequency </li></ul><ul><li>Location - Does it go anywhere (referred)? </li></ul><ul><li>Duration </li></ul><ul><li>Aggravating and relieving factors </li></ul>
  9. 9. <ul><li>PHYSICAL EXAMINATION </li></ul><ul><li>Inspection </li></ul><ul><li>Palpation </li></ul><ul><li>Percussion </li></ul><ul><li>Auscultation </li></ul><ul><li>Rectal exam </li></ul><ul><li>Pelvic exam </li></ul>
  10. 10. <ul><li>LABORATORY TESTS </li></ul><ul><li>Complete blood count </li></ul><ul><li>Urine analysis </li></ul><ul><li>Additional depending on rule outs </li></ul><ul><ul><li>amylase, lipase, CRP, LFT </li></ul></ul>
  11. 11. <ul><li>DIAGNOSTIC STUDIES </li></ul><ul><li>Plain X-rays- chest and abdomen </li></ul><ul><li>Contrast studies - barium (upper and lower GI series) </li></ul><ul><li>Ultrasound </li></ul><ul><li>CT scanning </li></ul><ul><li>Endoscopy </li></ul><ul><li>Sigmoidoscopy, colonoscopy </li></ul>
  12. 12. Common Causes of Acute Abdomen <ul><li>Appendicitis </li></ul><ul><li>Acute diverticulitis </li></ul><ul><li>Perforation of an ulcer </li></ul><ul><li>Intestinal obstruction </li></ul>
  13. 13. <ul><li>Appendicitis </li></ul><ul><ul><li>abdominal pain begins in periumbilical area, anorexia, nausea or vomiting </li></ul></ul><ul><ul><li>followed by pain over RIF, low grade fever </li></ul></ul><ul><ul><li>tenderness over McBurney’s point </li></ul></ul><ul><ul><li>rebound tenderness, guarding </li></ul></ul>
  14. 14. <ul><li>Acute diverticulitis </li></ul><ul><ul><li>most pts have h/o diverticula </li></ul></ul><ul><ul><li>mild to moderate, colicky to steady, aching abdominal pain - usually LLQ </li></ul></ul><ul><ul><li>may have fever and leukocytosis </li></ul></ul><ul><ul><li>with obstruction bowel sounds hyperactive </li></ul></ul><ul><ul><li>tenderness over affected section of bowel </li></ul></ul>
  15. 15. <ul><li>Perforation of an ulcer </li></ul><ul><ul><li>sudden onset of severe intense, steady epigastric </li></ul></ul><ul><ul><li>pain with radiation to sides, back, or right shoulder </li></ul></ul><ul><ul><li>past h/o burning, gnawing pain worse with empty stomach </li></ul></ul><ul><ul><li>epigastric tenderness </li></ul></ul><ul><ul><li>rebound tenderness </li></ul></ul><ul><ul><li>abdominal muscle rigidity </li></ul></ul><ul><ul><li>tenderness in right lower quadrant </li></ul></ul>
  16. 16. <ul><li>Intestinal obstruction </li></ul><ul><ul><li>sudden onset of crampy pain usually in umbilical area- vomiting occurs early with small bowel and late with large bowel obstruction </li></ul></ul><ul><ul><li>hyperactive, high-pitched bowel sounds </li></ul></ul><ul><ul><li>fecal mass may be palpable </li></ul></ul><ul><ul><li>abdominal distention </li></ul></ul><ul><ul><li>empty rectum or ballooning of rectum </li></ul></ul>
  17. 17. Common Causes of Chronic Pain Abdomen <ul><li>Irritable bowel syndrome </li></ul><ul><li>Diverticulosis </li></ul><ul><li>Inflammatory bowel disease </li></ul><ul><li>Duodenal ulcer </li></ul>
  18. 18. <ul><li>Irritable bowel syndrome </li></ul><ul><li>Pain described as nonradiating, intermittent, crampy located lower abdomen </li></ul><ul><li>Usually worse 1-2 hrs after meals </li></ul><ul><li>Exacerbated by stress </li></ul><ul><li>Relieved by bowel movements </li></ul><ul><li>Does not interrupt sleep </li></ul><ul><ul><li>critical to diagnosis of IBS </li></ul></ul>
  19. 19. <ul><li>Diverticulosis </li></ul><ul><li>80% - 85% remain asymptomatic - found during investigations for other reasons </li></ul><ul><li>irregular defecation, intermittent abdominal pain, bloating, or excessive flatulence </li></ul><ul><li>change in stool - flattened or ribbon like </li></ul><ul><li>recurrent bouts of steady or crampy pain </li></ul><ul><li>may mimic IBS except older age </li></ul>
  20. 20. <ul><li>Inflammatory bowel disease </li></ul><ul><li>Ulcerative colitis </li></ul><ul><li>Crohn’s disease </li></ul><ul><li>Both have similar presentations </li></ul><ul><li>Abdominal pain may be only complaint and may have been intermittent for years </li></ul><ul><li>Abdominal pain and diarrhea present in most pts </li></ul><ul><li>Pain diffuse or localized to RLQ-LLQ </li></ul><ul><li>Cramping sensation - intermittent or constant </li></ul><ul><li>Tenesmus & fecal incontinence </li></ul><ul><li>Stools loose and/or watery - may have blood </li></ul><ul><li>Rectal bleeding common with colitis </li></ul><ul><li>Other complaints </li></ul><ul><ul><li>fatigue </li></ul></ul><ul><ul><li>weight loss </li></ul></ul><ul><ul><li>anorexia </li></ul></ul><ul><ul><li>fever, chills </li></ul></ul><ul><ul><li>nausea, vomiting </li></ul></ul><ul><ul><li>joint pains </li></ul></ul><ul><ul><li>mouth sores </li></ul></ul>
  21. 21. <ul><li>Duodenal ulcer </li></ul><ul><li>Epigastric pain </li></ul><ul><li>Sharp, burning, aching, gnawing pain occurring 1 - 3 hrs after meals or in middle of night </li></ul><ul><li>Pain relieved with antacids or food </li></ul><ul><li>Symptoms recurrent lasting few days to months </li></ul><ul><li>Weight gain not uncommon </li></ul>
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