INVESTIGATIONS IN THE CASE OF ABDOMINAL PAIN

IN GENERAL…..

EXAMINATION OF FAECES

• 1 MACROSCOPY a] large, loose,bulky,frothy & offensive –

malabsorption

b] greasy - steatorrhoea

• c] blood & mucus – dysentery, ulerative colitis, CA rectum

• d] clay coloured – obstructive jaundice

• e] dark – hemolytic jaundice

• f] black & tarry – upper GI bleed

• g] fresh blood – lower GI bleed

2 MICROSCOPY

3 CHEMICAL EXAMINATION

a] occult blood b] faecal fat estimation c] faecal nitrogen

EXAMINATION OF VOMITUS

A] undigested food – gastric outlet obstruction

B] faecal odour - gastrocolic fistula , intestinal obstruction

ASCITIC FLUID EXAMINATION

• 1 APPEARANCE 1 haemorrhagic – malignant ascites 2 purulent – pyogenic peritonitis

3 straw coloured - tuberculous peritonitis

4 milky – chylous ascites

• 2 OTHER TESTS

A] serum ascites albumin gradient HIGH (>1.1g/dl)-portal hypertension LOW (<1.1g/dl)- TB peritonitis, malignancy,

hypoprotinemia..

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

RADIOLOGY

• 1 PLAIN RADIOGRAPH

Indications: a) a/c abdominal emergencies b) to delineate radio opaque calculi c) to detect organomegaly

Features :

# Soft tissues

# Radio opaque calculi Foreign bodies , Calcified lymph nodes ,

Phleboliths , Calcification along aorta / its branches

# bowel obstruction, paralytic ileus – gas & multiple fluid levels

# bowel perforation – gas seen under diaphragm – erect picture

• 2 CONTRAST STUDIES

Indications : a) anatomical abnormalities b) abnormalities in motility

• BARIUM SWALLOW oesophagus

• BARIUM MEAL stomach & small intestine

• BARIUM ENEMA large intestine

• DOUBLE CONTRAST TECHNIQUE

gastric ulcer frm carcinoma

duodenal ulcer [ulcer crater ]

ULTRASOUND

• insensitive to intestinal lesions

• ascites, local collections of fluid

• pancreatic lesions

ENDOSCOPY

SIGMOIDOSCOPY = lesions upto splenic flexure

COLONOSCOPY = large intestinal lesions

OTHERS

• 1- CT Trs, Abscess, fluid, nodes

• 2- MRI

• 3- LAPAROSCOPY peritoneum- inspected directly

ACUTE ABDOMEN

1• PAIN

• SYMPTOMS & SIGNS OF PERITONITIS- guarding & rebound tenderness with rigidity

• ADEQUATE RESUSCITATION

• LAPAROTOMY

2 • PAIN

• NO CLEAR EVIDENCE OF PERITONITIS

• BLOOD TESTS [S.amylase inc. = A/C Pancreatits]

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

• ULTRASOUND [ gall stone & thickened gall bladder wall = Cholecystitis ]

no abnormality

• CONTRAST RADIOLOGY [ Perforation & Pseudo obstruction ]

no abnormality

• CT SCAN [ Pancreatitis, Abscess, Aortic aneurism ] & ANGIOGRAPHY [ Mesenteric ischemia ]

no diagnosis has been revealed

• DIAGNOSTIC LAPAROTOMY

CHRONIC/ RECURRENT ABDOMINAL PAIN

• 1 ENDOSCOPY & ULTRASOUD --

1) epigastric pain 2)dyspepsia 3) symptoms sugg. of GB d/s

• 2 COLONOSCOPY

1) pts wt altered bowel habits 2) rectal bleeding 3) features of obstuction of colon

• 3 ANGIOGRAPHY

1) pain provoked by food - pt wt atherosclerosis - indicate Mesenteric Ischemia

• 4- young pts - pain relieved by defaecation, bloating & alternating bowel habit

- irritable bowel syndrome------ -SIMPLE INVESTIGATIONS ENOUGH [bld count, faecal calprotectin & sigmoidoscopy]

• 5 US, CT, FAECAL ELASTASE

1) pts wt upper abdominal pain radiating to back

== pancreatitis [alcohol abuse history]

• 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

7 * repeated neg investigations * vague symptoms * past h/o psychiatric disturbances

=== PAIN PSYCHOLOGICAL IN ORIGIN

=== REVIEW & DISCUSSION WT Pt.

THANK YOU….