Monday, 18 July 2016

Approach to abdominal pain

**Red flags**

  • History
    • collapse at toilet 
    • lightheadedness
    • ischaemic heart disease 
    • progressive-vomiting pain, distension 
    • menstrual abnomalities
    • malignancy
  • Signs
    • Pallor and sweating 
    • Hypotension 
    • Atrial fibrillation or tachycardia
    • Fever
    • Prostration 
    • Rebound tenderness and guarding 
    • Decreased urine output
  • Key history
    • Dysphagia/odynophagia
    • Nausea/vomiting
    • Loss of appetite 
    • Reflux
    • Abdominal pain 
    • Abdominal distension 
    • Altered bowel habit
    • systemic symptoms: malaise/fatigue/jaundice/fever
Murtagh Triad
  • Pale child + severe colic + vomiting = acute intussusception
  • intense pain + pale and 'shocked' +/- back pain = ruptured AAA
  • Anxiety and prostration + intense central pain + profuse vomiting +/- bloody diarrhoea = mesenteric arterial occlusion 
  • Localised RIF pain + a/n/v + guarding = acute appendicitis 
  • Colicky central pain + vomiting + distension = SBO
  • Colicky pain + distension +/- vomiting = LBO
  • Sudden severe pain + anxious, still, 'grey', sweaty + deceptive improvement = perforated peptic ulcer
  • Intense pain (loin) --> groin + microscopic haematuria = ureteric colic
  • acute pain + left sided radiation + fever = acute diverticulitis

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