4th year Gastroenterology Lectures Abdominal pain

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4th year Gastroenterology LecturesAbdominal
pain

• Yasir M Khayyat
• MBcHB,FRCPC,FACP
• Assistant Professor of Medicine

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Objectives of approach to abdominal pain

• Pain mechanisms involved pathways.
• Recognize the appropriate analysis of abdominal
  pain and consistently apply it.
• Understand the differential diagnosis of
  abdominal pain by location and patient setting.
• Apply the necessary investigations pertinent to
  the presenting abdominal pain

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Pain afferent transmission

• Sensory neuroreceptors ( mucosa ,muscularis ) of
  hollow organs.
• Myelinated A delta fibers ( skin, muscles ) sharp
  ,precise pain.
• Unmyelinated C fibers. ( dull,burning,poorly
  localized ,more gradual onset and longer duration
  type of pain )

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Clinical Assessment
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Abdominal Pain Analysis
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Differential Diagnosis of Abdominal Pain by site

• Think also of non
• Abdominal organs
• Heart
• Lungs
• Spine
• Metabolic
• Aorta

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• Basic principles
• Introduce yourself
• Know what system or disease type you are
  evaluating
• Write down
• Be brief and focused

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Physical examination

• General appearance- breathing pattern- position
  in bed- posture- degree of discomfort-facial
  expression.
• Vital signs Temp-Tachycardia-hypotension
• Lung pneumonia
• Abdomen ( I/P/P/A )
• Elicits peritonitis by light gentle palpation,
  shaking the bed, deep breath, cough

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Laboratory investigations

• CBC and Differential
• Urinalysis
• serum electrolytes ,BUN
• Glucose concentration.
• Pregnancy test ( serum/urine)
• LFT, Amylase/Lipase ( upper abdominal pain).

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Radiologic Evaluation

• Plain Abdominal series ( supine/erect )? ?gas
• Abdominal US check for solid organs,doppler
  technology to evaluate vascular organs.
• CT abdomen check inflammatory neoplastic
  trauma.

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Other diagnostic tests

• Peritoneal lavageTrauma ,? hemoperitoneum
• Laproscopy
• Exploratory laprotomy.

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Special circumstances for abdominal pain

• Extremes of age
• Pregnancy the uterus displaces the organs and
  does not allow precise abdominal examination.the
  common causes are appendicitis-cholecystitis-pyelo
  nephritis-adnexal problems.
• Immunocompromised host with two usual causes of
  abdominal pain

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• Immunocompromised host
• Usual causes of abdominal pain
• Special causes Neutropenic enterocolitis-drug
  induced pancreatitis- GVHD-pnumatosis
  intestinalis- CMV infection- Fungal infection)
• ICU patient
• No history available.
• Rely on CT scan of the abdomen.
• Acalculous cholecystitis- stress ulcer.