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