Understanding Abdominal Pain

Question 1

What are the organs of the foregut?

Answer 1

Oesophagus, stomach, liver, gallbladder, pancreas to proximal duodenum.

Question 2

What are the organs of the midgut?

Answer 2

Distal duodenum to the proximal 2/3 of transverse colon.

Question 3

What are the organs of the hind gut?

Answer 3

Distal 1/3 of transverse colon to the rectum.

Question 4

What is visceral pain?

Answer 4

Deep organ pain which is non-specific and poorly localised, and unaffected by movement. Pain follows embryological distribution and usually in the midline.

Question 5

What is parietal pain?

Answer 5

Sensor nerve fibres transmit signals from the parietal peritoneum that follows the dermatomal level, and worse on movement, because it is localised to the structure. Typically sharp pain.

Question 6

What does epigastric pain indicate?

Answer 6

Foregut issue.

Question 7

What does periumbilical pain indicate?

Answer 7

Midgut issue.

Question 8

What does lower pain indicate?

Answer 8

Hindgut issue.

Question 9

Epigastric pain radiating to the right upper quadrant?

Answer 9

Cholecystitis: inflammation of the gall bladder.

Question 10

Epigastric pain radiating to the back?

Answer 10

Pancreatitis.

Question 11

Periumbilical pain radiating to the lower right quadrant?

Answer 11

Appendicitis.

Question 12

Periumbilical pain radiating to the lower region?

Answer 12

Meckel’s diverticulitis, a congenital abnormality where a remnant of the vitelline duct is not obliterated. The vitelline duct is important for connection between yolk sac and midgut.

Question 13

Hypogastric pain radiating to the left iliac fossa?

Answer 13

Diverticulitis.

Question 14

Epigastric pain radiating to the lower right iliac fossa?

Answer 14

Duodenal ulcer.

Question 15

What are causes of acute abdominal pain?

Answer 15

Obstruction
Ischaemia/Infarct
Torsion of organs
Rupturing
-> These are emergencies that require urgent surgical intervention.

Question 16

What does subacute/ chronic abdominal pain indicate?

Answer 16

Crohn’s disease
Chronic pancreatitis

Question 17

What is colicky pain?

Answer 17

Gripping pain that comes and goes in waves, which can be exacerbated during defaecation.

Question 18

What is non-colicky pain?

Answer 18

Persistent pain that is only relieved by analgesics, usually due to inflammation.

Question 19

What is abdominal pain associated with in the GI tract?

Answer 19

Vomiting, weight changes, fever, bowel changes

Question 20

What is abdominal pain in the gynaecological system?

Answer 20

Vaginal bleeding or dysmenorrhoea(painfu menstruation)

Question 21

What is abdominal pai associated with in urological system?

Answer 21

Fever, UTI, bleeding and frequency of urination.

Question 22

What is abdominal pain associated with in vascular system?

Answer 22

Dizziness, sweating and palpitations.

Question 23

What are extraperitoneal causes of abdominal pain?

Answer 23

Abdominal wall bruising or haematoma.
Referred pain from Testicular torsion or herpes dermatome

Question 24

What are the medical conditions that cause abdominal pain?

Answer 24

Electrolyte disturbances
Sickle cell crisis
Leukaemia
Hyperparathyoridism

Question 25

What is bowel obstruction?

Answer 25

Divided into open-ended or close-ended bowel obstruction. It is commonly caused by adhesions due to surgery, hernia or tumour. Hypovolaemic shock is common because of loss of fluid from intravascular space into colon.

It causes colicky abdominal pain, constipation, vomiting and distention.

Question 26

Causes of bowel obstruction in the foregut?

Answer 26

Pyloric stenosis
Strictures that are malignant or bending
Foreign body
Food bolus

Question 27

Causes of bowel obstruction in the midgut?

Answer 27

IBS

Question 28

Causes of bowel obstruction in the hindgut?

Answer 28

Strictures
Volvulus: loop of intestine twists around itself