Investigations in the case of abdominal pain
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INVESTIGATIONS IN THE CASE OF ABDOMINAL PAIN
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IN GENERAL…..
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EXAMINATION OF FAECES
• 1 MACROSCOPY a] large, loose,bulky,frothy & offensive –
malabsorption
b] greasy - steatorrhoea
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• c] blood & mucus – dysentery, ulerative colitis, CA rectum
• d] clay coloured – obstructive jaundice
• e] dark – hemolytic jaundice
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• f] black & tarry – upper GI bleed
• g] fresh blood – lower GI bleed
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2 MICROSCOPY
3 CHEMICAL EXAMINATION
a] occult blood b] faecal fat estimation c] faecal nitrogen
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EXAMINATION OF VOMITUS
A] undigested food – gastric outlet obstruction
B] faecal odour - gastrocolic fistula , intestinal obstruction
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ASCITIC FLUID EXAMINATION
• 1 APPEARANCE 1 haemorrhagic – malignant ascites 2 purulent – pyogenic peritonitis
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3 straw coloured - tuberculous peritonitis
4 milky – chylous ascites
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• 2 OTHER TESTS
A] serum ascites albumin gradient HIGH (>1.1g/dl)-portal hypertension LOW (<1.1g/dl)- TB peritonitis, malignancy,
hypoprotinemia..
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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
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RADIOLOGY
• 1 PLAIN RADIOGRAPH
Indications: a) a/c abdominal emergencies b) to delineate radio opaque calculi c) to detect organomegaly
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Features :
# Soft tissues
# Radio opaque calculi Foreign bodies , Calcified lymph nodes ,
Phleboliths , Calcification along aorta / its branches
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# bowel obstruction, paralytic ileus – gas & multiple fluid levels
# bowel perforation – gas seen under diaphragm – erect picture
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• 2 CONTRAST STUDIES
Indications : a) anatomical abnormalities b) abnormalities in motility
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• BARIUM SWALLOW oesophagus
• BARIUM MEAL stomach & small intestine
• BARIUM ENEMA large intestine
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• DOUBLE CONTRAST TECHNIQUE
gastric ulcer frm carcinoma
duodenal ulcer [ulcer crater ]
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ULTRASOUND
• insensitive to intestinal lesions
• ascites, local collections of fluid
• pancreatic lesions
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ENDOSCOPY
SIGMOIDOSCOPY = lesions upto splenic flexure
COLONOSCOPY = large intestinal lesions
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OTHERS
• 1- CT Trs, Abscess, fluid, nodes
• 2- MRI
• 3- LAPAROSCOPY peritoneum- inspected directly
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ACUTE ABDOMEN
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1• PAIN
• SYMPTOMS & SIGNS OF PERITONITIS- guarding & rebound tenderness with rigidity
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• ADEQUATE RESUSCITATION
• LAPAROTOMY
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2 • PAIN
• NO CLEAR EVIDENCE OF PERITONITIS
• BLOOD TESTS [S.amylase inc. = A/C Pancreatits]
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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
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• ULTRASOUND [ gall stone & thickened gall bladder wall = Cholecystitis ]
no abnormality
• CONTRAST RADIOLOGY [ Perforation & Pseudo obstruction ]
no abnormality
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• CT SCAN [ Pancreatitis, Abscess, Aortic aneurism ] & ANGIOGRAPHY [ Mesenteric ischemia ]
no diagnosis has been revealed
• DIAGNOSTIC LAPAROTOMY
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CHRONIC/ RECURRENT ABDOMINAL PAIN
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• 1 ENDOSCOPY & ULTRASOUD --
1) epigastric pain 2)dyspepsia 3) symptoms sugg. of GB d/s
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• 2 COLONOSCOPY
1) pts wt altered bowel habits 2) rectal bleeding 3) features of obstuction of colon
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• 3 ANGIOGRAPHY
1) pain provoked by food - pt wt atherosclerosis - indicate Mesenteric Ischemia
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• 4- young pts - pain relieved by defaecation, bloating & alternating bowel habit
- irritable bowel syndrome------ -SIMPLE INVESTIGATIONS ENOUGH [bld count, faecal calprotectin & sigmoidoscopy]
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• 5 US, CT, FAECAL ELASTASE
1) pts wt upper abdominal pain radiating to back
== pancreatitis [alcohol abuse history]
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• 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
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7 * repeated neg investigations * vague symptoms * past h/o psychiatric disturbances
=== PAIN PSYCHOLOGICAL IN ORIGIN
=== REVIEW & DISCUSSION WT Pt.
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THANK YOU….