What are the common presentations of abdominal disorders?
- Abdominal pain
What is meant by dyspepsia?
- Upper abdominal pain and bloating
- Chronic or recurrent pain or discomfort in the upper abdomen
What are the causes of dyspepsia?
- Chronic peptic ulcer disease
- Functional / non-ulcer
Some debate over this
What % of dyspepsia is functional / non-ulcer?
What is meant by functional / non-ulcer dyspepsia?
No functional problem found to account for symptoms
When is dyspepsia classified as functional?
When there is 3 months of dyspepsia with no structural causes found
What is the course of treatment for dyspepsia?
- Empirical acid suppression
- Non invasive H-pylori testing/eradication
- Early endoscopy
How common is abdominal pain?
Very common, 2% of all hospital admissions
What must be taken into consideration when a patient presents with abdominal pain?
That there are many causes, and it can be misleading, so we must therefore adopt a sensible approach
Is abdominal pain related to the small bowel intra- or extra-peritoneal?
Why is it important to question what embryological division abdominal pain related to the small bowel belongs to?
Because intra-peritoneal structures refer pain to shared areas of the abdominal wall
Where does the foregut refer pain to?
Up to the 2nd part of the duodenum to the epigastric area
Where does the midgut refer pain to?
Up to the distal third of the transverse colon to the peri-umbilical area
Where does the hindgut refer pain to?
What may cause foregut pain?
What kind of foregut pain is produced when caused by ulcers
Where does epigastric pain caused by ulcers commonly occur?
In the first part of the duodenum or lesser curve of the stomach
Where does pancreatitis cause pain?
- Epigastric pain
- Back pain (retroperitoneal structure)
Where do gallstones cause pain?
- Epigastric pain
- Can also get right upper quadrant (RUQ) pain
What is gallstones pain sometimes referred to as?
Why is referring to gallstones pain as colicky a slight misnomer?
Because the pain is fairly constant
What is midgut pain sometimes referred to as?
'Real' colicky pain
At what frequency is colicky pain in the small bowel?
Every 2-3 minutes
At what frequency is colicky pain in the large bowel?
Every 10-15 minutes
What are the symptoms of a small bowel obstruction?
- Abdominal distention
What may be shown on an x-ray of a small bowel obstruction?
- Central abdominal distended loops
- Circular folds extending the full width of the bowel lumen
What is the classic midgut pain scenario?
What may cause hindgut pain?
What % of intestinal obstructions are due to sigmoid volvuluses?
What happens in a sigmoid volvulus?
Twists in on itself or its mesentery, causing a bowel obstruction and interruption to blood supply