Download Causes of acute central abdominal pain

Some Important Notes
On Clinical Surgery
Collected by :
Dr.Soran M.Gharih
Cause of mass in the right iliac fossa:
1.Appendicitis
2. tuberculosis
3.carcinoma of caecum
4. crohn's disease
5.iliac lymphadenopathy
6. iliac artery aneurysm
7. psoas abscess
8. chondrosarcoma of the ilium
9. tumor in an undescended testis
10. actinomycosis
11. ruptured epigastric artery
For left iliac fossa delete the first three causes and insert
diverticulitis and carcinoma of colon.
Common causes of enlargement of kidney:
1. hydronephrosis
2. pyonephrosis
3.perinephric abscess
4. malignant disease (hypernephroma and nephroblastoma)
5. solitary cysts
6. polycyic disease
7. hpertrophy
Some causes of pathological lymhadenopathy:
Generalized:
• viral: EBV, CMV,HIV
• bacterial: brucellosis, syphilis
• protozoal: toxoplasmosis
• neoplastic: lymohoma, acute or chronic lymphocytic leukemia
CLL , ALL
• others: RA, SLE, sarcoidosis
Localized:
. infective: acute or chronic including viral bacterial, and other
agents
•neoplastic :secondary metastatic, primary hematological including
Hodgkin's and non Hodgkin's lymphoma
Differential diagnosis of the swollen limb:
1-non-vascular or lymphatic
* General disease state:cardiac failure , liver failure,
hypoproteinemia , hypothyroidism (myxedema), allergic diseases
including,angioedema, and idiopathic cyclic edema.immobility and
lower limb dependency.
*Local disease processes: ruptured Baker's cyst, Myositis
ossificans, bony or soft tissue tumors, arthritis hemiarthrosis, calf
muscle hernatoma, achiles tendon rupture
*Retroperitoneal fibrosis:
*Gigantistm
Drugs:corticosteroids , estrogen , progestagen , MAOI ,
phenylbutazone, methyldopa ,hydralazine, nifedipine
*Trauma
*Obesity
2-venous:
*Deep venous thrombosis:
*Post thrombotic syndrome
*Varicose veins :not simple primary varicose vein
*KlippeI Trenauray syndrome
*External venous compression: pelvic or abdominal tumors gravid
uterus, retroperitoneal fibrosis
3-arteriaI:
*ischemic reperfusion following lower limb revascularization for
acute and chronic ischemia
*arteriovenous malformation
*aneurysm : popliteal, femoral, false aneurysm following trauma
Causes of superficial thrombophlebitis
1.varicose veins
2.occult carcinoma: bronchus,pancreas. stomach, lymphoma
3.thromboangitis obliterans (Buerger's disease)
4.polycythemia
5.polyarteritis
6.iatrogenic : intravenous injection and injuries
7.idiopathic
Common causes of hair loss:
1.local
• male balding
• alopecia aerate
•skin infections
2. general:
*hypothyroidism
*cytotoxic drugs
*hypopituitarism
*iron deficiency
*severe illness.
Causes of ptosis:
1.inflammation
2.tumors
3.excessive eyelid skin
4.muscle weakness (myopathy and myasthenia)
5. third nerve palsy
Causes of swelling of the chest wall
1. bony hard:
• secondary carcinoma
• chondroma
• osteoma
• exostosis
• meyloma
2. fluctuant:
• tuberculous abscess of rib or LN
• empyema necessitas
• infectcd hematoma
3. pulsatile
• eroding aortic aneurysm
Causes of swelling of salivary gland:
1. acute infection:
• viral (mumps)
• bacterial (staphylococcus)
2.duct obstruction
3.sialectasis (chronic _infection)
4.tumor
5. sarcoidosis (Mlkulickz's syndrome)
6.Sjogren'syndrome
Causes of swelling of the jaw:
1.infections
•dental abscess
• acute osteomyelitis
• actinomycosis
2. cysts
• denogenerus cyst
• cystic tumors
3. neoplasma
benign:
• fibrous dysplasia
• giant cell granuloma
• odutogenic tumorsadaniantinoma
malignant:
*osteogenic sarcoma
*malignant lymphorna (Burkitt's tumor)
*secondary tumors
Causes of cervical lymphadenopathy:
1. infection
• non specific
• glandular fever
•tuberculosis
•syphilis
• toxoplasmosis
• cat scratch fever
2.metastatic tumor
*from head, neck, chest an abdomen
3.primary reticulosis
*lymphoma
• lymphomasarcoma
• reticulosarcoma
4.sarcoidosis
Causes of solitary nodule in the thyroid:
I. dominant nodule in multinodular goiter
2. hemorrhage into nodule
3. adenoma
4. carcinoma(papillary or follicular)
5. enlargement of the whole of one lobe (usually Hashimoto's
disease)
Causes of massive enlargement of the breast:
1.benign hypertrophy (usually bilateral)
2. giant fibroadenoma
3.phylloides tumor
4.sarcoma
5.colloid carcinoma
6. filarial elephantiasis
The differences between eczema and paget's disease of the
nipple
eczema
Paget's disease
bilateral
unilateral
Commonly occurs at lactation
Occurs at menopause
itches
Does not itch
vesicles
No vesicles
Nipple intact
Nipple may be destroyed
No lumps
May be an underlying lump
The varieties of mastitis:
1. Neonatal (caused by maternal hormones)
2. milk engorgement during lactation
3. diffuse infection during lactation
4. mumps
Breast changes of pregnancy
I. fullness and pricking sensation
2. enlargement
3. distended subcutaneous veins
4. increased nipple and areolar pigmentation
5. circumareolar pigmentation
6. hypertrophy of subareolar sebaçeous glands(montgomery's
tubercies)
7. a clear expressible secretion (colostrums)
The causes of a solid single mass in one side of the scrotum
1. tumor
2. orchitis
3. ematocele
4. gumma
5. epididymoorchitis (when the epididymis large and the testis is
small)
The differential diagnosis of inguinal hernia:
1. femoral hernia
2. vaginal hydrocele
3. hydrocele of the cord or the canal of Nuck
4. undescended testis
5. lipoma of the cord
The differential diagnosis of femoral hernia:
I. inguinal hernia
2. enlarged lymph gland
3. saphenovarix
4. ectopic testis
5. psoas abscess
6. psoas bursa
7. lipoma
The differential diagnosis of a lump in the groin
I. inguinal hernia
2. femoral hernia
3. enlarged lymph gland
4. saphenovarix
5. ectopic testis
6. femoral aneurysm
7. hydrocele of the cord or hydrocele of the canal of Nuck
8. lipoma of the cord
9. psoas bursa
10. psoas abscess
Causes of discharge from the umbilicus
1. congenital
*intestinal Fistula
• patent urachus
• umbilical adenoma
2. acquired
1. umbilical granuloma
2. dermatitis
3. ompholith (umbilical concretion)
4.fistula (intestinal)
5. secondary carcinoma
6. endometriosis
The common conditions that present with acute upper
abdominal pain
1.esophagitis
2. boerhaave s syndrome
3.acute gastritis
4.perforated peptic ulcer
5.acute cholecystitis
6. gall stone and biliary colic
7.acute pancreatitis
The common conditions that present with chronic upper
abdominal pain
1. chronic peptic ulceration
2. carcinoma of the stomach
3.chronic cholecystitis
4.chronic pancreatitis
5.liver metastasis
6.splenomegaly
Causes of acute central abdominal pain
1.meckle's diverticulitis
2. acute gastroenteritis
3.inflammatory bowel disease
4.yersisnia ileitis
5. typhoid
6. tuberculosis
7. urinary tract infection
The causes of chronic central abdominal pain
1. crohn's disease
2. tuberculosis
3. radiation bowel damage
4 tumors of the small bowel
5. recurrent adhesive obstruction
6. ischemia of the small bowel
7. endometriosis .
The causes of the generalized abdominal pain
1. irritable bowel syndrome
2. recurrent adhesive obstruction
3. mesenteric ischemia
4. carcinomatosis
5.chronic constipation
6.radiation damage
7.retroperitoneal damage
8.retroperitoneal tumors
9.endometriosis
10.pelviureteric junction obstruction
11.lumbar spine pain
12.retroperitoneal fibrosis.
13.psychsomatic
The causes of acute and chronic lower abdominal pain
1. appendicitis
2. crohn’s disease
3. carcinoma of the caecum and right colon
4. diverticular disease
5. carcinoma of the left colon and rectum
6. bladder outflow obstruction
7.interstitial and irradiation cystitis
8. pelvic inflammatory disease
The cardinal symptoms of intestinal obstruction
1.pain
2.vomiting
3.distension
4.absolute constipation
The sources of intraabdominal hemorrhage
1.ruptured abdominal aortic aneurysm
2. ruptured spleen
3. ruptured ectopic pregnancy
4.ruptured ovarian cyst
5.hemorrhage from liver adenoma
6.ruptured visceral aneurysm (splenic, hepatic and mesenteric)
7. torn mesentery
8.retroperitoneal hemorrhage (over anticoagulation)
The causes of hematemesis and melena
1. chronic peptic ulceration
2. acute gastric erosions (aspirin, phenylbutazone, steroids, trauma
especially burns)
3. carcinaoma of the stomach
4. esophageal varices
5. purpura
6. hemophilia
Causes of enlargement of kidney:
1. distension of the pelvicaliceal system
2. space occupying lesions:
• single (cyst, abscess, and tumor)
•multiple (polvcystic disease)
3. compensatory hypertrophy
Causes of abdominal distesion
1.fetus
2. flatus
3. faeces
4. fat
5. fluid (ascites, encysted)
6. large solid tumors:
• fibroids
• enlarged liver
• enlarged spleen
• polycystic kidneys
• retroperitoneal sarcomata
Conditions which present with rectal bleeding
1.
• blood mixed with stool : carcinoma of colon
• blood streaked on stool: carcinoma of rectum
• blood after defecation :hemorrhoids
• blood and mucus : colitis
. blood alone diverticular disease
• melaena : peptic ulceration
2. bleeding with pain: fissure, or carcinoma of colon , proctitis
caused by schistosomiasi
Diagnosis of anal conditions which present with anal pain
1. pain alone:
• fissure (pain after defecation)
• proctalgia fugax (pain spontaneously at night)
• anoreetal abscess
2.pain and bleeding fissure
3. pain and a lump:
•perianal hematoma
• anorectal abscess
4. pain, lump and beeding:
•prolapsed hemorrhoids
•carcinoma of the anal canal
• prolapsed rectal polyp or carcinoma
•ptolapsed rectum
Anal conditions which present with lump
1. a lump with no other symptoms:
• anal warts
•skin tags.
2. a lump and pain:
• perianal hematoma
3. a lump, pain and bleeding:
• prolapsed hemorrhoids
• carcinoma Of anal canal
• prolapsed rectal polyp or carcinoma
• prolapsed rectum
The causes of pruritis ani
1. mucous discharge from the anus caused by
• hemorrhoids
• polyps
•skin tags
• condylomata
• fissure
•. fistula
• carcinoma of anus
2. vaginal discharge caused by
•trichomonas vaginitis
•monilia vaginitis
•cervicitis
• gonorrhea
3. skin diseases caused by
•
tinea cruris
•
fungal infections
•
infection in diabetics
4. parasites
• threadworm
5. fecal soiling
•poor hygiene
• incontinence
• diarrhea
6. psychoneurosis
Causes of pericoccygeal swelling
1. pilonidal sinus
2. postanal dermoid cyst
3. chondroma
4. sacroccygeal teratoma
Causes of fecal incontinence
1. diarrhea
2. fecal impaction
3. nerve damage
4. sphincter muscle damage
5. dementia
In This series :
Preparing the following practical books :
1- Clinical Orthopedic.
2- Clinical Gynecology .
3- Clinical ENT .
4- Clinical psychiatry .
5- Clinical Neurology ( History taking & Physical
Examination In neurology)
6- 52 Cases in Clinical pediatric .
7- History taking and physical examination in surgery .
8- The most important subject for 4,5, 6th stages that you
have to know before the exam .
9- OSCE exam for 6th stage .
10- ECG Interpretation.
11- Common abdominal signs and symptoms .
12- Theory exam Of previous years for 6 th stage
13- History taking and physical examination in Medicine
14- Collection Of Physiology exam of previous years for
second stage medical students.
Preparing the following practical books for newly graduated
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(Rotator) : About how to learn the routine of treating patient in
All department in hospital :
1-Medical emergency & Case Management in CCU.
2-Surgical emergency .
3- Pediatric emergency & Case Management in premature
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4- Obstetrical & Gynecological emergency.
5-Assessing and Management of patients in Primary health
care & the most important medications used daily
6-ECG Interpretation.