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Abdominal Pain Abdominal Pain Mr Colin Dibble Consultant in Emergency Medicine North Manchester General Hospital 1 Saturday, 24 January 2009 Contents Background Appendicitis Perforation Anatomy Obstruction Differential diagnosis PUD/Gastritis Approach: History, Biliary Disease Examination, Investigations Pancreatitis Some Specific Clinical Renal Disease Conditions: Inflammatory Bowel Disease 2 Saturday, 24 January 2009 Background •In last 12 months (Dec 07-08) at NMGH alone: •Abdo pain? cause: 1694 •Biliary Colic: 187 •Pancreatitis: 186 •PUD: 108 •Appendicitis?: 148 •Obstruction?: 103 •Most diagnoses clinical 3 Saturday, 24 January 2009 4 Saturday, 24 January 2009 Pectoralis major m. 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. Costal cartilage 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. Costal cartilage External oblique m. cut 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. Costal cartilage External oblique m. cut Internal oblique m. 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. Costal cartilage External oblique m. cut Internal oblique m. Rectus abdominus m. 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. Costal cartilage External oblique m. cut Internal oblique m. Rectus abdominus m. Inguinal ligament 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. Costal cartilage External oblique m. cut Internal oblique m. Rectus abdominus m. Inguinal ligament Common femoral v. 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. Costal cartilage External oblique m. cut Internal oblique m. Rectus abdominus m. Inguinal ligament Common femoral v. Cremasteric m. 4 Saturday, 24 January 2009 Pectoralis major m. Serratus anterior m. Latissimus dorsi m. Costal cartilage External oblique m. cut Internal oblique m. Rectus abdominus m. Inguinal ligament Common femoral v. Cremasteric m. Great saphenous v. 4 Saturday, 24 January 2009 5 Saturday, 24 January 2009 Transverse colon 5 Saturday, 24 January 2009 Transverse colon Left kidney 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum Inferior mesenteric a. 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum Inferior mesenteric a. IVC 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum Inferior mesenteric a. IVC Aorta bifurcation 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum Inferior mesenteric a. IVC Aorta bifurcation Ascending colon 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum Inferior mesenteric a. IVC Aorta bifurcation Ascending colon Caecum 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum Inferior mesenteric a. IVC Aorta bifurcation Ascending colon Caecum Appendix 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum Inferior mesenteric a. IVC Aorta bifurcation Ascending colon Caecum Appendix Sigmoid colon 5 Saturday, 24 January 2009 Transverse colon Left kidney Superior mesenteric a. Pancreas Duodenum Inferior mesenteric a. IVC Aorta bifurcation Ascending colon Caecum Appendix Sigmoid colon Rectum 5 Saturday, 24 January 2009 6 Saturday, 24 January 2009 Stomach 6 Saturday, 24 January 2009 Stomach Liver 6 Saturday, 24 January 2009 Stomach Liver Gallbladder 6 Saturday, 24 January 2009 Stomach Liver Gallbladder Epiploic foramen of Winslow leading to lesser sac 6 Saturday, 24 January 2009 Stomach Liver Gallbladder Epiploic foramen of Winslow leading to lesser sac Spleen 6 Saturday, 24 January 2009 Stomach Liver Gallbladder Epiploic foramen of Winslow leading to lesser sac Spleen Pancreas 6 Saturday, 24 January 2009 Stomach Liver Gallbladder Epiploic foramen of Winslow leading to lesser sac Spleen Pancreas Hepatic flexure 6 Saturday, 24 January 2009 Stomach Liver Gallbladder Epiploic foramen of Winslow leading to lesser sac Spleen Pancreas Hepatic flexure Transverse colon 6 Saturday, 24 January 2009 Stomach Liver Gallbladder Epiploic foramen of Winslow leading to lesser sac Spleen Pancreas Hepatic flexure Transverse colon Greater omentum 6 Saturday, 24 January 2009 Splenic vein 7 Saturday, 24 January 2009 Spleen Splenic vein 7 Saturday, 24 January 2009 Spleen Left kidney Splenic vein 7 Saturday, 24 January 2009 Spleen Left kidney Right kidney Splenic vein 7 Saturday, 24 January 2009 Spleen Left kidney Right kidney Aorta Splenic vein 7 Saturday, 24 January 2009 Spleen Left kidney Right kidney Aorta Splenic vein Inferior vena cava 7 Saturday, 24 January 2009 Spleen Left kidney Right kidney Aorta Splenic vein Inferior vena cava Pancreas 7 Saturday, 24 January 2009 Spleen Left kidney Right kidney Aorta Splenic vein Inferior vena cava Pancreas Duodenum 7 Saturday, 24 January 2009 Spleen Left kidney Right kidney Aorta Splenic vein Inferior vena cava Pancreas Duodenum Greater omentum 7 Saturday, 24 January 2009 Spleen Left kidney Right kidney Aorta Splenic vein Inferior vena cava Pancreas Duodenum Greater omentum Stomach 7 Saturday, 24 January 2009 8 Saturday, 24 January 2009 Gallbladder 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v Superior mesenteric v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v Superior mesenteric v Inferior mesenteric v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v Superior mesenteric v Inferior mesenteric v Left colic v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v Superior mesenteric v Inferior mesenteric v Left colic v Descending colon 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v Superior mesenteric v Inferior mesenteric v Left colic v Descending colon Iliocoliv v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v Superior mesenteric v Inferior mesenteric v Left colic v Descending colon Iliocoliv v Ilium 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v Superior mesenteric v Inferior mesenteric v Left colic v Descending colon Iliocoliv v Ilium Superior rectal v 8 Saturday, 24 January 2009 Gallbladder Paraumbilical v Cystic v Right & Left gastric v Hepatic portal v Splenic v Superior mesenteric v Inferior mesenteric v Left colic v Descending colon Iliocoliv v Ilium Superior rectal v Inferior rectal v 8 Saturday, 24 January 2009 9 Saturday, 24 January 2009 Oesophagus 9 Saturday, 24 January 2009 Oesophagus Liver 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon Inferior duodenum 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon Inferior duodenum Transverse colon 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon Inferior duodenum Transverse colon Mysentery 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon Inferior duodenum Transverse colon Mysentery Small intestine 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon Inferior duodenum Transverse colon Mysentery Small intestine Rectum 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon Inferior duodenum Transverse colon Mysentery Small intestine Rectum Rectovesical pouch 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon Inferior duodenum Transverse colon Mysentery Small intestine Rectum Rectovesical pouch Bladder 9 Saturday, 24 January 2009 Oesophagus Liver Lesser omentum Lesser sac Pancreas Stomach Transverse Mesocolon Inferior
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