Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 - BRS > 6.4 - Abdominal pain tutorial > Flashcards

6.4 - Abdominal pain tutorial Flashcards

1
Q

What symptom do most intra-abdominal diseases present with alone?

A

Pain - so a careful history is never wasted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 most significant properties of the abdominal pain?

A
  • site
  • character
  • if you know these two, you have a good chance of making the correct diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What framework do we use to ask patients about (abdominal) pain?

A
  • Site - where is it?
  • Onset - has it come on suddenly or gradually?
  • Character - what is the pain like? Is it burning? Colicky (sharp, localised)? Aching?
  • Radiation - where does it go to?
  • Associated symptoms - is it associated with vomiting? Fever?
  • Time course - have they had that pain before?
  • Exacerbating or relieving factors - what makes it better? What makes it worse?
  • Severity - how bad is it e.g. /10?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 2 main ways of marking surface anatomy for site of pain?

A
  • abdominopelvic regions (9)
  • abdominopelvic quadrants (4)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the nine abdominopelvic regions? (left to right, top to bottom)

A
  • right hypochondriac
  • epigastric
  • left hypochondriac
  • right lumbar
  • umbilical
  • left lumbar
  • right iliac
  • hypogastric/suprapubic
  • left iliac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Abdominopelvic regions - What are the right and left vertical lines?

A

Mid-clavicular lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Abdominopelvic regions - What is the top horizontal line?

A

Transpyloric line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Abdominopelvic regions - What is the bottom horizontal line?

A

Interspinous line through the 2 ASIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What organs are the right hypochondriac region responsible for?

A

Gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What organs are the epigastric region responsible for?

A

Stomach, duodenum, pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What organs are the left hypochondriac region responsible for?

A

Pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What organs are the right lumbar region responsible for?

A

Kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What organs are the umbilical region responsible for?

A

Small bowel, caecum, retroperitoneal structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What organs are the left lumbar region responsible for?

A

Kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What organs are the right iliac region responsible for?

A

Appendix and caecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What organs are the hypogastric region responsible for?

A

Transverse colon, bladder, uterus and adnexae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What organs are the left iliac region responsible for?

A

Sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the four abdominopelvic quadrants?

A
  • right upper quadrant
  • left upper quadrant
  • right lower quadrant
  • left lower quadrant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the vertical and horizontal lines passing through in the four abdominopelvic quadrants?

A

Umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some different abdominal planes? (5)

A
  • transpyloric plane
  • subcostal plane
  • supracristal plane
  • intertubercular plane
  • interspinous plane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What vertebral levels are the transpyloric, subcostal and supracristal planes?

A
  • transpyloric plane - L1
  • subcostal plane - L3
  • supracristal plane - L4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What organ structures are found at the transpyloric plane?

A
  • pylorus of stomach
  • neck of pancreas
  • fundus of gallbladder
  • renal hilum of left kidney (right kidney pushed down a bit by liver)
  • duodenojejunal flexure
  • end of spinal cord in adult
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What organ structures are found at the subcostal plane?

A

Origin of inferior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What organ structures are found at the supracristal plane?

A

Bifurcation of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the foregut made of?

A

Distal oesophagus → proximal half of 2nd part of duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What innervates the pain in the foregut?

A

T5-T9 (greater splanchnic nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What pain is the foregut the site of?

A

Epigastrium

28
Q

What is the midgut made of?

A

Distal half of 2nd part of duodenum → proximal 2/3 of transverse colon

29
Q

What innervates the pain in the midgut?

A

T10 and T11 (lesser splanchnic nerve)

30
Q

What pain is the midgut the site of?

A

Umbilical

31
Q

What is the hindgut made of?

A

Distal 1/3 of transverse colon → superior rectum

32
Q

What innervates the pain in the hindgut?

A

L1 and L2 (lumbar and sacral splanchnic nerves)

33
Q

What pain is the hindgut the site of?

A

Hypogastrium

34
Q

What main arteries supply the foregut, midgut and hindgut respectively?

A
  • foregut - coeliac trunk (–> left gastric, splenic, hepatic)
  • midgut - superior mesenteric artery
  • hindgut - inferior mesenteric artery
35
Q

What is the parietal peritoneum?

A

Covering of abdominal wall anteriorly + covering of abdominal cavity posteriorly

36
Q

What is visceral peritoneum?

A
  • peritoneum covering organs
  • liver peritoneum, colon peritoneum
37
Q

What is special about the pancreas and duodenum?

A

They’re both retroperitoneal structures (not actually inside abdomen)

38
Q

What nerves supply the parietal peritoneum?

A
  • somatic
  • phrenic nerves that supply sensation from central tendon to diaphragm → C3, C4, C5
    • C3 and C5 also innervate right shoulder - patients can present with right shoulder pain when something is going on under diaphragm
  • segmental innervation from T5-L2 (umbilicus supplied by T10)
39
Q

What nerves supply the visceral peritoneum?

A
  • autonomic
  • parasympathetic supply from vagus nerve (CN III, VII, IX, X)
  • parasympathetic supply from S2-4
  • sympathetic chain goes T1-12 and L1-2 (T5 to L2 innervation)
40
Q

What nerve plexuses are there of the visceral peritoneum? (3)

A
  • coeliac plexus
  • superior mesenteric plexus
  • inferior mesenteric plexus
41
Q

What is the site and character of the pain from visceral vs parietal peritoneum?

A
  • embryological origin vs well-localised
  • dull, crampy, burning vs sharp, ache
42
Q

What kind of pain does abdominal organ inflammation cause?

A
  • constant ‘aching’ pain
  • worse on movement
  • persists until inflammation subsides
43
Q

What kind of pain does obstruction of a muscular tube cause?

A
  • colicky ‘gripping’ pain
  • fluctuates in severity
  • patient moves to try and get comfortable
44
Q

What happens if colicky pain has changed and has become a constant stretching pain?

A
  • there has been prolonged obstruction of a hollow vicus that has caused distension
  • this is different from ache of inflammation and is not colicky
  • there may be impending ischaemia
45
Q

What character of pain do you find in ureter?

A

Colicky

46
Q

What character of pain do you find in liver?

A

Constant e.g. could be hepatitis or liver abscess

47
Q

What character of pain do you find in biliary-colic?

A

Colicky e.g. stone trying to get through duct like bile duct

48
Q

What character of pain do you find in spleen?

A

Constant e.g. splenic abscess or rupture

49
Q

What character of pain do you find in kidney?

A

Constant e.g. pyelonephritis or abscess

50
Q

What character of pain do you find in small/large bowel?

A

Colicky

51
Q

Where does gallbladder (right hypochondriac region) pain radiate?

A

Through to the back and right - happens in 50% of cases

52
Q

Where does stomach, duodenum, pancreas (epigastrium) pain radiate?

A
  • straight through to back - especially since pancreas and duodenum are retroperitoneal structures
  • people with pancreatic cancer present with back pain as tumour infiltrates posteriorly
  • pancreatic cancer patients - sitting up and leaning forward helps as abdominal viscera are not pushing against pancreas
53
Q

Where does tail of pancreas (left hypochondriac region) pain radiate?

A

Through to the back and the left

54
Q

Where does right kidney (right lumbar region) pain radiate?

A

In loin and radiates to groin (following ureter) - loin to groin

55
Q

Where does small bowel, caecum, retroperitoneal structures (umbilical region) pain radiate?

A

Does not normally radiate as it is visceral

56
Q

Where does left kidney (left lumbar region) pain radiate?

A

In loin and radiates to groin (following ureter) - loin to groin

57
Q

What can people with AAA present with regarding left kidney pain?

A

They can describe left ureteric colicky pain

58
Q

Where do the lower zone organs (appendix and caecum, bladder, transverse colon, uterus, adnexae, sigmoid colon) pain radiate?

A
  • lower abdominal pain rarely radiates
  • pain from structures deep in pelvis referred to lower back/perineum
59
Q

What are the key learning points regarding referral of abdominal pain?

A
  • colicky abdominal pain is referred to the centre (visceral sensation)
  • pain from parietal inflammation is felt over the inflamed area (somatic sensation)
  • when pain radiates it signifies other structures are becoming involved
  • small bowel pain does not radiate but may move when somatic as well as visceral nerves become irritated
60
Q

S → Central then shifts to right iliac region

O → Gradual

C → Constant

R → No radiation

A → Nausea, anorexia, fever

T → No previous pain

E → Worse on movement

S → Dull ache

WHAT IS THE DIAGNOSIS?

A

Appendicitis

61
Q

What is important to know about the location of the appendix?

A

It can be retrocaecal (64% of the time) and pelvic (32%) which means if we examine their abdomen and press it you won’t feel the appendix- when it’s pelvic they won’t even have abdominal pain

62
Q

S → Central

O → Gradual

C → Colicky

R → No radiation

A → Vomiting, bowels not open

T → Previous colicky pain

E → Passing flatus relieves pain

S → Moderate

WHAT IS THE DIAGNOSIS?

A

Bowel obstruction (causing intestinal colic)

63
Q

What is the commonest cause of small bowel obstructions?

A
  • adhesions - if you have an operation you get a scar on anterior abdominal wall but some patients get scarring on inside too (adhesions) = fibrous bands
  • can wrap around and cause a closed loop obstruction (nothing in or out)
  • that part of bowel becomes ischaemic quickly and explode
64
Q

How can we treat adhesions?

A
  • these band adhesions can twist around bowel and obstruct
  • put NG tube down and decompress = it will untwist
  • can do surgery and cut band with pair of scissors
65
Q

S → Loin

O → Sudden onset

C → Colicky

R → To groin

A → Vomiting

T → Previous colicky pain

E → Cannot find a comfortable position

S → Severe 10/10

WHAT IS THE DIAGNOSIS?

A

Right ureteric colic

66
Q

S → Right upper quadrant

O → Sudden onset

C → Colicky

R → To right shoulder

A → Nausea, indigestion

T → After eating

E → Fatty foods

S → Can be severe 10/10

WHAT IS THE DIAGNOSIS?

A

Biliary colic (stone trying to get through tube = colicky)

67
Q

How is cholelithiasis different to biliary colic?

A
  • stone stuck in cystic duct
  • bile cannot get in and out
  • lining of gallbladder keeps producing mucus which has nowhere to go and become infected
  • sometimes it can get out as pus
  • causes localised pain, not radiating - Murphy’s sign

Cholelithiasis: stone in GB
Biliary colic: stone in bile duct

Year 2 - BRS (84 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions