Lec 9 Abdominal Pain

Question 1

Which type of abdominal pain is easy to localize?

Answer 1

somatic

Question 2

Which type of abdominal pain is hard to localize?

Answer 2

visceral

Question 3

What are characteristics of visceral afferents:

• how many
• bilateral or unilateral
• how do they localize

Answer 3

few in number, bilateral

diverge up and down several segments making it hard to localize

Question 4

What are some stimuli for visceral afferents?

Answer 4

• distension
• traction
• pressure
• smooth muscle contraction
• ischemia

Question 5

What are characteristics of somatic afferents:

• how many
• bilateral or unilateral
• how do they localize

Answer 5

high in number, unilateral and segmented traveling w/in dermatomal nerves; minimally diverge and easy to localize with pinpoint

Question 6

What structures cause epigastric [T5-T8] pain?

Answer 6

• stomach
• proximal duodenum
• pancreas
• gallbladder
• common bile duct [CBD]
• liver

Question 7

What structures cause periumbilical pain [T9-10]?

Answer 7

• distal duodenum
• small bowel
• appendix

Question 8

What structures cause hypogastric pain [T11-T12]?

Answer 8

• colon
• bladder
• rectum
• ureters
• uterus

Question 9

Diaphragmatic irritation causes referred pain to where?

Answer 9

to ipsilateral shoulder

Question 10

Where is referred pain from pancreas felt?

Answer 10

midback

Question 11

Where is referred pain from rectum felt?

Answer 11

low back

Question 12

Where is referred pain from gallbladder felt?

Answer 12

scapular area

Question 13

Where is referred pain from liver felt?

Answer 13

right shoulder

Question 14

What is the visceral pain reflex phenomena? examples?

Answer 14

viscera send signals to spinal cord and reflex back to feed skeletal muscle, skin, and sweat glands at same level

examples:

• decreased bowel motility
• reflex contraction of skeletal muscle = involuntary guarding
• changes in local blood flow and sweating

Question 15

What is the pathophysiology of appendicitis?

Answer 15

• luminal obstruction, maybe due to fecalith
• causes increased intraluminal pressure –> increases wall tension/distension and visceral pain –> venous pressure exceded –> venous collapse –> ischemia of appedix –> viscious cycle

Question 16

What is clinical presentation of appendicitis?

Answer 16

vague diffuse ab discomfort, nausea, mild fever

over 6-12 hrs evoles to localized sharp RLQ pain with more nausea and fever

Question 17

What are some examples of people that present with atypical appendicitis?

Answer 17

• pregnant women: RUQ b/c pregnancy pushes everything up
• situs inverus: LLQ
• retrocecal appendix: back pain

Question 18

What are some complications of appendicitis?

Answer 18

• risk of perforation –> peritonitis

- abscess

Question 19

What is pathophysiology of diverticular disease?

Answer 19

• see in low fiber western diet –> leads to slow colonic transit and increased intraluminal pressures

leads have muscular hypertrophy, increased intraluminal pressure in colon –> mucosa and submucosa herniates at points of weakness

Question 20

Who gets diverticulosis?

Answer 20

usually over age 60

Question 21

What are symptoms of diverticulosis?

Answer 21

crampy ab pain
usually LLQ b/c diverticula usually in sigmoid colon
constipation

Question 22

What is diverticulitis?

Answer 22

diverticula become infected

Question 23

What are signs of diverticulitis?

Answer 23

• pain
• fever
• leucocytosis

Question 24

What is pathophysiology of diverticular bleeding?

Answer 24

erosion of arteriole at mouth of diverticulum

have pianless bright red blood in stool