Gastro - Approach To Abdominal Pain-DB
Gastro - Approach To Abdominal Pain-DB
Gastro - Approach To Abdominal Pain-DB
Abdominal Pain
Dr Devinder Singh Bansi BM DM FRCP
Consultant Gastroenterologist
Imperial College Healthcare NHS Trust
What Do They Have?
As you go through this
presentation, think about each of
these cases:
An 18 mo old that suddenly
became inconsoleable from AP
while playing
A 20 yo man with 12 hours of
diffuse crampy AP that migrated to
RLQ that became sharp
78 yo woman with h/o chronic
steroid use with sudden sharp AP
and a rigid exam
Scale of the Problem
GI symptoms in primary care
7.1-9.6% of all primary consultations are with
regard to GI complaints
Functional dyspepsia: 12
GORD: 5.8
IBS: 10.5
Appendicitis 28%
Cholecystitis 10%
Small bowel obstruction 4%
Gynaecological 4%
Pancreatitis 3%
Renal colic 3%
Peptic ulcer 2%
Cancer 2%
No clinical diagnosis 34%
Immunocompromised
Infants
Abdominal Pain in the Elderly
Somatic
Sharp, lancinating
Well localized
Referred
Distant from site of generation
Symptoms, but no signs
Understanding the Types of
Abdominal Pain
Location, location, location
Organs and their corresponding
fiber entry to the spinal cord
C3-5 – liver, spleen, diaphragm
T5-9 – gallbladder, stomach,
O- onset
L- location
D- duration
C- character
A-alleviating/aggravating factors
associated symptoms
R- radiation
S- severity
History Taking for Abdominal
Pain Presentations
PMH
Similar episodes in past
Other medical problems that increase disease
likelihood of problems (ex: DM and gastroparesis)
PSH
Adhesions, hernias, tumors
MEDS
Abx, NSAIDS, acid blockers, etc
GYN/URO
LMP, bleeding, discharge
Social
Tob/EtoH/drugs/home situation/agenda
Physical Exam in Abdominal
Pain Presentations
General appearance
“Sick versus not sick”
Mobile versus still
“Doorway” impression
Vital signs
“That’s why they’re called vital”
Physical Exam in Abdominal
Pain Presentations
Inspection
Distention, scars, bruises
Auscultation
Present, hyper, or absent
Actually not that helpful!
Palpation
Often the most helpful part of exam
Tenderness versus pain
probabilities
Should not dramatically alter
Computed Tomography
Revolutionized acute care
Often better than we are!
Common Diagnoses by Quadrant
Management of
Abdominal Pain
Always right to start with ABC’s
IV access
Fluid administration
Antiemetics
Analgesics
Directed testing and imaging
Re-evaluations
Antibiotics
Consultants
Surgeons, OB/GYN, urologists,
cardiologists, etc
Now How About Those Cases