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INVESTIGATIONS IN THE
CASE OF ABDOMINAL PAIN
IN GENERAL…..
EXAMINATION OF FAECES
• 1   MACROSCOPY

    a] large, loose,bulky,frothy & offensive –
 malabsorption

      b] greasy - steatorrhoea
•      c] blood & mucus – dysentery, ulerative
    colitis, CA rectum

•     d] clay coloured – obstructive jaundice

•     e] dark – hemolytic jaundice
•   f] black & tarry – upper GI bleed

•   g] fresh blood – lower GI bleed
2 MICROSCOPY

3 CHEMICAL EXAMINATION

   a] occult blood
   b] faecal fat estimation
   c] faecal nitrogen
EXAMINATION OF VOMITUS

A] undigested food – gastric outlet obstruction



B] faecal odour - gastrocolic fistula , intestinal
  obstruction
ASCITIC FLUID EXAMINATION


• 1 APPEARANCE

   1 haemorrhagic – malignant ascites

    2 purulent – pyogenic peritonitis
3 straw coloured - tuberculous peritonitis

4 milky – chylous ascites
• 2 OTHER TESTS

A] serum ascites albumin gradient

    HIGH (>1.1g/dl)-portal hypertension

   LOW (<1.1g/dl)- TB peritonitis, malignancy,
 hypoprotinemia..
GASTRIC ACID STUDY
• 3.7 +/- 2.1 mEq/L , in males
• 2.2 +/- 1.7 mEq/L , in females



  low output = gastric ulcer, CA

  raised      = duodenal ulcer, Z.E syndrome
RADIOLOGY
• 1 PLAIN RADIOGRAPH

Indications: a) a/c abdominal emergencies
             b) to delineate radio opaque calculi
             c) to detect organomegaly
Features :

# Soft tissues

# Radio opaque calculi
   Foreign bodies , Calcified lymph nodes ,
  Phleboliths , Calcification along aorta / its
  branches
# bowel obstruction, paralytic ileus – gas &
 multiple fluid levels

# bowel perforation – gas seen under
 diaphragm – erect picture
• 2 CONTRAST STUDIES

Indications : a) anatomical abnormalities
              b) abnormalities in motility
• BARIUM SWALLOW  oesophagus

• BARIUM MEAL  stomach & small intestine

• BARIUM ENEMA  large intestine
• DOUBLE CONTRAST TECHNIQUE

   gastric ulcer frm carcinoma

    duodenal ulcer [ulcer crater ]
ULTRASOUND
•  insensitive to intestinal lesions


• ascites, local collections of fluid

•  pancreatic lesions
ENDOSCOPY
SIGMOIDOSCOPY   = lesions upto splenic
  flexure



COLONOSCOPY     = large intestinal
 lesions
OTHERS
• 1- CT Trs, Abscess, fluid, nodes

• 2- MRI

• 3- LAPAROSCOPY peritoneum- inspected
  directly
ACUTE ABDOMEN
1
•          PAIN



•     SYMPTOMS & SIGNS OF PERITONITIS-
    guarding & rebound tenderness with rigidity
•   ADEQUATE RESUSCITATION




•    LAPAROTOMY
2
•       PAIN


•      NO CLEAR EVIDENCE OF PERITONITIS



•     BLOOD TESTS [S.amylase inc. = A/C
    Pancreatits]
no diagnosis


 ERECT CHEST X RAY [free air under diaphragm
  = perforation ]
       no free air


ABDOMINAL X RAY [dilated loops of bowel =
 intestinal obstruction ]

       no abnormality
•     ULTRASOUND [ gall stone & thickened gall
    bladder wall = Cholecystitis ]
           no abnormality


•      CONTRAST RADIOLOGY [ Perforation &
    Pseudo obstruction ]

            no abnormality
•      CT SCAN [ Pancreatitis, Abscess, Aortic
    aneurism ] & ANGIOGRAPHY [ Mesenteric
    ischemia ]

           no diagnosis has been revealed


• DIAGNOSTIC LAPAROTOMY
CHRONIC/ RECURRENT ABDOMINAL
             PAIN
• 1 ENDOSCOPY & ULTRASOUD --

    1) epigastric pain
    2)dyspepsia
     3) symptoms sugg. of GB d/s
• 2 COLONOSCOPY

    1) pts wt altered bowel habits
    2) rectal bleeding
    3) features of obstuction of colon
• 3 ANGIOGRAPHY

      1) pain provoked by food - pt wt
 atherosclerosis - indicate Mesenteric Ischemia
• 4- young pts - pain relieved by defaecation,
  bloating & alternating bowel habit

     - irritable bowel syndrome------

      -SIMPLE INVESTIGATIONS ENOUGH
[bld count, faecal calprotectin & sigmoidoscopy]
• 5 US, CT, FAECAL ELASTASE

     1) pts wt upper abdominal pain
 radiating to back

            == pancreatitis [alcohol abuse
 history]
• 6 investigation for renal / ureteric stone by
  ABDOMINAL X RAY,,, US,,, I/V UROGRAPHY

         1) pts -- recurrent attacks of pain in the
  loin radiating to flanks + urinary symptoms
7 * repeated neg investigations
  * vague symptoms
  * past h/o psychiatric disturbances

  === PAIN PSYCHOLOGICAL IN ORIGIN

 === REVIEW & DISCUSSION WT Pt.
THANK YOU….

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Investigating Abdominal Pain: A Guide to Common Tests and Examinations

  • 1. INVESTIGATIONS IN THE CASE OF ABDOMINAL PAIN
  • 3. EXAMINATION OF FAECES • 1 MACROSCOPY a] large, loose,bulky,frothy & offensive – malabsorption b] greasy - steatorrhoea
  • 4. c] blood & mucus – dysentery, ulerative colitis, CA rectum • d] clay coloured – obstructive jaundice • e] dark – hemolytic jaundice
  • 5. f] black & tarry – upper GI bleed • g] fresh blood – lower GI bleed
  • 6. 2 MICROSCOPY 3 CHEMICAL EXAMINATION a] occult blood b] faecal fat estimation c] faecal nitrogen
  • 7. EXAMINATION OF VOMITUS A] undigested food – gastric outlet obstruction B] faecal odour - gastrocolic fistula , intestinal obstruction
  • 8. ASCITIC FLUID EXAMINATION • 1 APPEARANCE 1 haemorrhagic – malignant ascites 2 purulent – pyogenic peritonitis
  • 9. 3 straw coloured - tuberculous peritonitis 4 milky – chylous ascites
  • 10. • 2 OTHER TESTS A] serum ascites albumin gradient HIGH (>1.1g/dl)-portal hypertension LOW (<1.1g/dl)- TB peritonitis, malignancy, hypoprotinemia..
  • 11. GASTRIC ACID STUDY • 3.7 +/- 2.1 mEq/L , in males • 2.2 +/- 1.7 mEq/L , in females low output = gastric ulcer, CA raised = duodenal ulcer, Z.E syndrome
  • 12. RADIOLOGY • 1 PLAIN RADIOGRAPH Indications: a) a/c abdominal emergencies b) to delineate radio opaque calculi c) to detect organomegaly
  • 13. Features : # Soft tissues # Radio opaque calculi Foreign bodies , Calcified lymph nodes , Phleboliths , Calcification along aorta / its branches
  • 14. # bowel obstruction, paralytic ileus – gas & multiple fluid levels # bowel perforation – gas seen under diaphragm – erect picture
  • 15. • 2 CONTRAST STUDIES Indications : a) anatomical abnormalities b) abnormalities in motility
  • 16. • BARIUM SWALLOW  oesophagus • BARIUM MEAL  stomach & small intestine • BARIUM ENEMA  large intestine
  • 17. • DOUBLE CONTRAST TECHNIQUE gastric ulcer frm carcinoma  duodenal ulcer [ulcer crater ]
  • 18. ULTRASOUND •  insensitive to intestinal lesions • ascites, local collections of fluid •  pancreatic lesions
  • 19. ENDOSCOPY SIGMOIDOSCOPY = lesions upto splenic flexure COLONOSCOPY = large intestinal lesions
  • 20. OTHERS • 1- CT Trs, Abscess, fluid, nodes • 2- MRI • 3- LAPAROSCOPY peritoneum- inspected directly
  • 22. 1 • PAIN • SYMPTOMS & SIGNS OF PERITONITIS- guarding & rebound tenderness with rigidity
  • 23. ADEQUATE RESUSCITATION • LAPAROTOMY
  • 24. 2 • PAIN • NO CLEAR EVIDENCE OF PERITONITIS • BLOOD TESTS [S.amylase inc. = A/C Pancreatits]
  • 25. no diagnosis ERECT CHEST X RAY [free air under diaphragm = perforation ] no free air ABDOMINAL X RAY [dilated loops of bowel = intestinal obstruction ] no abnormality
  • 26. ULTRASOUND [ gall stone & thickened gall bladder wall = Cholecystitis ] no abnormality • CONTRAST RADIOLOGY [ Perforation & Pseudo obstruction ] no abnormality
  • 27. CT SCAN [ Pancreatitis, Abscess, Aortic aneurism ] & ANGIOGRAPHY [ Mesenteric ischemia ] no diagnosis has been revealed • DIAGNOSTIC LAPAROTOMY
  • 29. • 1 ENDOSCOPY & ULTRASOUD -- 1) epigastric pain 2)dyspepsia 3) symptoms sugg. of GB d/s
  • 30. • 2 COLONOSCOPY 1) pts wt altered bowel habits 2) rectal bleeding 3) features of obstuction of colon
  • 31. • 3 ANGIOGRAPHY 1) pain provoked by food - pt wt atherosclerosis - indicate Mesenteric Ischemia
  • 32. • 4- young pts - pain relieved by defaecation, bloating & alternating bowel habit - irritable bowel syndrome------ -SIMPLE INVESTIGATIONS ENOUGH [bld count, faecal calprotectin & sigmoidoscopy]
  • 33. • 5 US, CT, FAECAL ELASTASE 1) pts wt upper abdominal pain radiating to back == pancreatitis [alcohol abuse history]
  • 34. • 6 investigation for renal / ureteric stone by ABDOMINAL X RAY,,, US,,, I/V UROGRAPHY 1) pts -- recurrent attacks of pain in the loin radiating to flanks + urinary symptoms
  • 35. 7 * repeated neg investigations * vague symptoms * past h/o psychiatric disturbances === PAIN PSYCHOLOGICAL IN ORIGIN === REVIEW & DISCUSSION WT Pt.