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Abdominal Pain

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  • 1. Abdominal Pain JohnThompson MS FRCSED FRCS Consultant Surgeon
  • 2. “The general rule can be laid down that the majority of severe abdominal pains which ensue in patients who have been previously fairly well, and which last as long as six hours, are caused by conditions of surgical import”. Zachary Cope,1881-1974
  • 3. History  Nature of pain/severity  Onset  Duration and evolution  Site/radiation  Exacerbating and relieving factors
  • 4. History  Don’t miss anything  Abdominal symptoms  Urinary symptoms  Cardiovascular risks  Chest symptoms  It’s not always in the abdomen
  • 5. Examination  General appearance  Observations (no value judgements)  Don’t hold back on analgesia (but beware junkies/Munchausen Syndrome)  Look, listen then feel  Guarding, rebound and Rovsing’s sign  Repeated observation (MICLO)
  • 6. Don’t forget “medical” causes  Lower lobe pneumonia  Inferior MI  Hypercalcaemia  Psychiatric
  • 7. Investigations  Urine for…..?  FBC for…..?  Amylase for…..?  CRP for…..?  Lactate for….?  X-Rays for….?
  • 8. Investigations  Urine for…..?  FBC for…..?  Amylase for…..?  CRP for…..?  Lactate for….?  X-Rays for….?
  • 9. Chest X Ray  Sub-diaphragmatic gas  Mediastinal widening  Lung mass  Pulmonary oedema
  • 10. Chest X Ray  Sub-diaphragmatic gas  Mediastinal widening  Lung mass  Pulmonary oedema
  • 11. Abdominal X-Ray: Air  In dilated bowel  In biliary tree  In Gallbladder  On both sides of bowel wall  With fluid level  Fluid levels (gastric, multiple, single)
  • 12. AXR: Calcification  Around pancreas  In line of ureter  Next to vertebrae  Right upper quadrant  Left upper quadrant
  • 13. Ultrasound  FAST scan in emergency  Gallstones/pancreatitis /cholangitis  AAA  Appendicitis  Gynae
  • 14. Laparoscopy  ….. AND BIOPSY!  Useful in younger female  Take the appendix out and tell the patient  Perforated duodenal ulcer  ?Perforated colon (controversial)
  • 15. CT scanning  RAAA  Trauma  Pancreatitis  Elderly with possible malignancy
  • 16. MRI?
  • 17.  A bit of embryology……
  • 18. Vomiting  Once or twice intermittent  Huge vomit infrequently then relief  Frequent small volume  Unremitting  Nature of vomitus
  • 19.  Never let the skin stand between you and a diagnosis!