13: Anatomy - abdominal pain (covers first dissection)

Question 1

What hangs off the caecum at the beginning of the large intestine?

Answer 1

Appendix

Question 2

Which organ pushes the right side of the GI tract inferiorly?

Answer 2

Liver

Question 3

Where in the abdominal cavity is the liver found?

Answer 3

Right upper quadrant

Right hypochondral / epigastric zone

Question 4

What are the three areas of the abdomen, named according to their organs’ embryological origin?

Answer 4

Foregut

Midgut

Hindgut

Question 5

What are the two planes which split up the abdominal regions?

Answer 5

Subcostal plane

Transtubecular plane

Question 6

What are the three layers of anterolateral abdominal muscle?

Answer 6

External obliques

Internal obliques

Transversus abdominis

Question 7

What are the “six pack” muscles found in the anterior abdominal wall?

Answer 7

Rectus abdominis

Question 8

The muscles found in the midline of the anterior abdominal wall are the (rectus abdominis / transversus abdominis).

Answer 8

rectus abdominis

Question 9

The muscles found at the deepest layer of the anterolateral abdominal wall are the (rectus abdominis / transversus abdominis).

Answer 9

transversus abdominis

Question 10

What is the contraction of abdominal muscle to prevent injury to internal organs?

Answer 10

Guarding

Question 11

Which inflammatory disease triggers guarding of abdominal muscle?

Answer 11

Peritonitis

Question 12

What causes peritonitis?

Answer 12

Blood, pus, faeces in the peritoneal cavity

Question 13

What is parietal peritoneum?

Answer 13

Peritoneum which is in contact with the body wall

Question 14

What is visceral peritoneum?

Answer 14

Peritoneum which invests organ(s)

Question 15

What name is given to a double layer of visceral peritonum which suspends an organ to the posterior abdominal wall?

Answer 15

Mesentery

Question 16

Which abdominal organs are intraperitoneal?

Answer 16

Liver

Gall bladder

Stomach

Spleen

Bits of the small intestine

Transverse colon

Question 17

Which abdominal organs are retroperitoneal?

Answer 17

Kidneys

Adrenal glands

Pancreas

Bits of large intestine

Question 18

What does mesentery do?

Answer 18

Suspends organ to posterior abdominal wall

Blood and nerve supply

Provides mobility

Question 19

Which double layers of peritoneum pass from the stomach to other organs?

Answer 19

Greater and lesser omentum

Question 20

What joins organs to one another or the body wall (apart from mesentery and omentum)?

Answer 20

Ligaments

Question 21

Which peritoneal formation hangs over the intestines like an apron?

Answer 21

Greater omentum

Question 22

Which aspects of the stomach and large intestine are linked by the greater omentum?

Answer 22

Greater curvature of the stomach

Transverse colon

Question 23

Which peritoneal formation runs between the lesser curvature of the stomach and the liver?

Answer 23

Lesser omentum

Question 24

The lesser omentum has a ___ edge.

Answer 24

free

Question 25

The **greater omentum** forms the ___ sac. The **lesser omentum** forms the ___ sac.

Answer 25

**greater** **lesser**

Question 26

Which hole joins the **greater** and **lesser sacs**?

Answer 26

**Omental foramen /** Foramen of Winslow

Question 27

What blood vessels and nerves lie within the **omental foramen**?

Answer 27

**Portal triad**

Question 28

Which **ligament** joins the **spleen** to the **kidneys**?

Answer 28

**Splenorenal ligament**

Question 29

Which **ligament** joins the **stomach** to the **spleen**?

Answer 29

**Gastrosplenic ligament**

Question 30

Which **ligament** joins the **liver** to the **stomach**?

Answer 30

**Hepatogastric ligament**

Question 31

Which **ligament** joins the **liver** to the **duodenum**?

Answer 31

**Hepatoduodenal ligament**

Question 32

Which **ligament** runs along the liver and connects its inferior half to the anterior body wall?

Answer 32

**Falciform ligament**

Question 33

Drapes of peritoneum form ___ in the pelvic cavity.

Answer 33

**pouches**

Question 34

What is **ascites**?

Answer 34

Collection of **fluid in the peritoneal cavity**

Question 35

Which **hepatic diseases** can cause **ascites**?

Answer 35

**Cirrhosis** **Portal hypertension**

Question 36

Which procedure would be carried out to drain fluid from the peritoneal cavity?

Answer 36

**Abdominocentesis**

Question 37

What are the characteristics of **visceral pain**?

Answer 37

**Dull, achy, nauseating**

Question 38

What are the characteristics of **somatic pain**?

Answer 38

**Sharp** and **stabbing**

Question 39

What name is given to pain which **comes and goes**? What does this kind of pain indicate?

Answer 39

**Colicky pain** Indicates that there's something wrong with the GI tract

Question 40

Which arms of the nervous system supply organs **within** the abdominal cavity?

Answer 40

**Visceral afferents** (sensory nervous for the organs) **Enteric nervous system** (GI tract) **Sympathetic and parasympathetic nerves**

Question 41

What effect does **parasympathetic stimulation** have on the rate of peristalsis?

Answer 41

**Increased rate of peristalsis**

Question 42

What effect does **sympathetic stimulation** have on the rate of peristalsis?

Answer 42

**Decreased rate of peristalsis**

Question 43

Which arms of the nervous system supply the skin and parietal peritoneum?

Answer 43

**Somatic sensory nerves** **Somatic motor nerves** **Sympathetic nerves**

Question 44

Do **sympathetic nerve fibres** for the abdominal organs **synapse** in the sympathetic chain like those of the heart and lungs do?

Answer 44

No

Question 45

Where do **abdominal sympathetic nerves** synapse?

Answer 45

**Prevertebral ganglia**

Question 46

How do abdominal sympathetic fibres reach the prevertebral ganglia from the sympathetic chain?

Answer 46

**Splanchnic nerves**

Question 47

Post-synaptic sympathetic nerve fibres hitch a ride with ___ to the abdominal organs.

Answer 47

**arteries**

Question 48

What is special about sympathetic fibres innervating the **adrenal gland**?

Answer 48

They **don't** synapse at prevertebral ganglia Synapse on the gland cells themselves

Question 49

Which **parasympathetic nerve** innervates the **GI tract** and **abdominal** organs up to the **end of the transverse colon?**

Answer 49

**CN X** Vagus nerve

Question 50

**Vagal trunks** (pre-synaptic parasympathetic nerve fibres) travel on the surface of which structure before reaching the periarterial plexuses?

Answer 50

**Oesophagus**

Question 51

Where are parasympathetic ganglia found?

Answer 51

**Walls of abdominal organs**

Question 52

Which **parasympathetic nerves** supply the **descending colon** up to the **anal canal**? Which spinal nerves are these nerves part of?

Answer 52

**Pelvic splanhnic nerves** **S2, 3, 4**

Question 53

Where does **foregut-related** abdominal pain present?

Answer 53

**Epigastric region**

Question 54

**Epigastric pain** relates to problems in which area of the GI tract?

Answer 54

**Foregut**

Question 55

Where does **midgut-related** abdominal pain present?

Answer 55

**Umbilical region**

Question 56

**Umbilical pain** relates to problems in which area of the GI tract?

Answer 56

**Midgut**

Question 57

**Hindgut-related** abdominal pain tends to present in which abdominal region?

Answer 57

**Hypogastric / pubic region**

Question 58

**Pubic** pain may relate to problems in which area of the GI tract?

Answer 58

**Hindgut**

Question 59

What are **visceral afferent** nerve fibres also known as?

Answer 59

**Pain fibres**

Question 60

**Visceral afferents** run alongside ___ fibres back to the spinal cord.

Answer 60

**sympathetic**

Question 61

Why is **pain** from abdominal organs **felt** at the level where nerve fibres enter the spinal cord?

Answer 61

**Visceral afferents** and **sympathetics**"plug in" at the same level of spinal cord - pain is **REFERRED** to the **dermatome** of the spinal nerve

Question 62

Why is pain from appendicitis initially **dull** and **aching** before it becomes **sharp** in the **right inguinal region**?

Answer 62

**Appendix is MIDGUT** --\> pain is felt in **Umbilical** region But as condition worsens it **irritates** **parietal peritoneum** (somatic) in the **right iliac fossa** -- pain changes

Question 63

Where can **stomach pain** be referred?

Answer 63

**Back**

Question 64

Where can **liver** and **gall bladder** pain be referred?

Answer 64

**Right shoulder**

Question 65

Where can **pancreatic** pain be referred?

Answer 65

**Back** commonly

Question 66

What is the classical presentation of **appendicitis**?

Answer 66

**Dull, achey pain in umbilical region** THEN **Sharp, stabbing pain in right iliac fossa**