1. Abdominal Pain
JohnThompson MS FRCSED FRCS
Consultant Surgeon

2. “The general rule can be laid down that the
majority of severe abdominal pains which
ensue in patients who have been previously
fairly well, and which last as long as six hours,
are caused by conditions of surgical import”.
Zachary Cope,1881-1974

3. History
 Nature of pain/severity
 Onset
 Duration and evolution
 Site/radiation
 Exacerbating and relieving factors

4. History
 Don’t miss anything
 Abdominal symptoms
 Urinary symptoms
 Cardiovascular risks
 Chest symptoms
 It’s not always in the abdomen

5. Examination
 General appearance
 Observations (no value judgements)
 Don’t hold back on analgesia (but beware
junkies/Munchausen Syndrome)
 Look, listen then feel
 Guarding, rebound and Rovsing’s sign
 Repeated observation (MICLO)

6. Don’t forget “medical”
causes
 Lower lobe pneumonia
 Inferior MI
 Hypercalcaemia
 Psychiatric

7. Investigations
 Urine for…..?
 FBC for…..?
 Amylase for…..?
 CRP for…..?
 Lactate for….?
 X-Rays for….?

8. Investigations
 Urine for…..?
 FBC for…..?
 Amylase for…..?
 CRP for…..?
 Lactate for….?
 X-Rays for….?

9. Chest X Ray
 Sub-diaphragmatic gas
 Mediastinal widening
 Lung mass
 Pulmonary oedema

10. Chest X Ray
 Sub-diaphragmatic gas
 Mediastinal widening
 Lung mass
 Pulmonary oedema

11. Abdominal X-Ray: Air
 In dilated bowel
 In biliary tree
 In Gallbladder
 On both sides of bowel
wall
 With fluid level
 Fluid levels (gastric,
multiple, single)

12. AXR: Calcification
 Around pancreas
 In line of ureter
 Next to vertebrae
 Right upper quadrant
 Left upper quadrant

13. Ultrasound
 FAST scan in
emergency
 Gallstones/pancreatitis
/cholangitis
 AAA
 Appendicitis
 Gynae

14. Laparoscopy
 ….. AND BIOPSY!
 Useful in younger
female
 Take the appendix out
and tell the patient
 Perforated duodenal
ulcer
 ?Perforated colon
(controversial)

15. CT scanning
 RAAA
 Trauma
 Pancreatitis
 Elderly with possible
malignancy

16. MRI?

18.  A bit of embryology……

30. Vomiting
 Once or twice intermittent
 Huge vomit infrequently then relief
 Frequent small volume
 Unremitting
 Nature of vomitus

36.  Never let the skin stand between you and a
diagnosis!