Abdominal Pain Flashcards
(95 cards)
1
Q
What are the 2 most significant properties of pain?
A
- site
- character
2
Q
What does SOCRATES stand for?
A
Site Onset Character Radiation Associations Time Exacerbating factors Severity
3
Q
What are the 4 abdominopelvic quadrants?
A
Right Upper
Right Lower
Left Upper
Left Lower
4
Q
What are the 9 adbominopelvic regions?
A
- right hypochondriac
- epigastric
- left hypochondriac
- right lumbar
- umbilical
- left lumbar
- right iliac
- hypogastric
- left iliac
5
Q
What is in the transpyloric plane?
A
- pylorus of the stomach
- neck of the pancreas
- fundus of the gall bladder
- renal hilum
- duodenojejunal flexure
- end of the spinal cord (adult)
6
Q
What do most intra-abdominal diseases present with?
A
pain alone
7
Q
Where is the intertubercular plane?
A
passes through the iliac fossa, around L5
8
Q
Where is the transpyloric plane?
A
L1
9
Q
Where is the subcostal plane?
A
L3
10
Q
What happens at the subcostal plane?
A
the origin of the inferior mesenteric artery
11
Q
Where is the supracristal plane?
A
L4
12
Q
What happens at the supracristal plane?
A
Bifurcation of the aorta
13
Q
What happens at the transpyloric plane?
A
origin of the superior mesenteric acid
14
Q
What tends to cause pain in the right hypochondriac region?
A
gallbladder
15
Q
What tends to cause pain in the epigastric region?
A
stomach, duodenum and pancreas
16
Q
What tends to cause pain in the left hypochondriac region?
A
pancreas/spleen
17
Q
What tends to cause pain in the right lumbar region?
A
kidney (right)
18
Q
What tends to cause pain in the umbilical region?
A
- small bowel
- caecum
- retroperitoneal structures
19
Q
What tends to cause pain in the left lumbar region?
A
kidney
20
Q
What tends to cause pain in the right iliac region?
A
- appendix
- caecum
21
Q
What tends to cause pain in the hypogastric region?
A
- transverse colon
- bladder
- uterus
- ovaries
22
Q
What tends to cause pain in the left iliac region?
A
sigmoid colon
23
Q
What is in the foregut?
A
distal oseophagus to the proximal half of the 2nd part of the duodenum
24
Q
What is in the midgut?
A
distal half of the 2nd part of the duodenum to the proximal 2/3 of the transverse colon
- small bowel
- appendix
- caecum
- ascending colon
25
What is in the hindgut?
distal 1/3 of the transverse colon to the rectum
26
What supplies the foregut?
the celiac trunk
27
What is the celiac trunk comprised of?
- hepatic artery
- splenic artery
- left gastric artery
28
What supplies the midgut?
superior mesenteric artery
29
What supplies the hindgut?
inferior mesenteric artery
30
What does the parietal peritoneum cover?
- anterior abdominal wall
| - posterior abdominal cavity
31
What does the visceral peritoneum cover?
covers the organs themselves
32
What 2 structures are extra/retroperitoneal?
- pancreas
| - duodenum
33
What supplies the parietal peritoneum cover?
- phrenic nerves
| - sensation to the central tendon of the diaphragm (C3, C4 and C5)
34
Why do diaphragmatic problems cause right shoulder pain?
cause sensation in both the diaphragm and the right should is done by the phrenic nerves (C3,4,5)
35
Where does the phrenic segmental innervation of the parietal peritoneum originate?
T6-L2
36
What supplies the umbilicus?
T10
37
What provides parasympathetic innervation of the visceral peritoneum?
- the vagus nerve (CNX)
| - parasympathetic sensation from S2-S4
38
Where does the sympathetic innervation of the visceral peritoneum originate?
T1-L2
39
What are the different plexuses involved in the sympathetic innervation of the visceral peritoneum?
- celiac plexus
- superior mesenteric plexus
- inferior mesenteric plexus
40
Where is the site of pain with the visceral plexus?
embryological origin
41
Where is the site of pain with the parietal plexus?
well-localised
42
What is the character of pain from the visceral plexus?
- dull
- crampy
- burning
43
What is the character of pain from the parietal plexus?
- sharp
| - ache
44
What innervates the foregut?
T5-T9
45
What innervates the midgut?
T10-T11
46
What innervates the hindgut?
L1-L2
47
Where is the site of pain from the foregut?
epigastrium
48
Where is the site of pain from the midgut?
umbilical
49
Where is the site of pain from the hindgut?
hypogastrium
50
What is the type of innervation of the parietal peritoneum?
somatic
51
What is the type of innervation of the visceral peritoneum?
- autonomic sympathetic
| - parasympathetic
52
How does pain caused by inflammation tend to present?
- constant pain 'aching'
- made worse by movement
- persists until inflammation subsides
53
How does pain caused by obstruction of a muscular tube tend to present?
- colicky pain 'griping'
- severity fluctuates
- movement to try and get comfortable
54
How does pain caused by prolonged obstruction of a hollow viscus (causing distension) tend to present?
- constant stretching pain
| - different from the ache of inflammation and not colicky, sign of future ischaemia.
55
What type of pain would ureter problems present with?
colicky pain
56
What type of pain would liver problems present with?
constant pain
57
What type of pain would biliary colic present with?
colicky
58
What type of pain would spleen problems present with?
constant
| abscess or rupture
59
What type of pain would kidney problems present with?
constant
| abscess, pylonephritis
60
What type of pain would bowel obstruction present with?
colicky
61
Why is biliary colic not actually colic?
intensity and minor fluctuate rather than actual fluctuations
62
When does colicky pain become constant?
ischaemia
63
Where does biliary colic pain tend to radiate?
through to the back, on the right
64
Where does epigastric pain tend to radiate?
straight through the back (retroperitoneal structures)
65
In what disease does sitting up and leaning forward relieve the pain?
pancreatitis
66
Where does left hypochondriac pain (tail of pancreas) tend to radiate?
through to the back, on the left
67
Where does right lumbar (kidney) pain tend to radiate?
in the loin and radiates to the groin (from the kidney, through the ureter towards the bladder)
68
Where does umbilical pain tend to radiate?
doesn't normally radiate (due to being mostly visceral innervation)
69
Where does left lumbar (kidney) pain tend to radiate?
in the loin and radiates to the groin (from the kidney, through the ureter towards the bladder)
70
What condition can present with ureteric colic (only on the left)?
abdominal aortic aneurysm
71
Where does lower abdominal pain tend to radiate?
- rarely radiates
| - pain from deep in the pelvis structures refers to lower back/perineum
72
Generally, where does colicky abdominal pain radiate to?
the centre of the abdomen due to visceral sensation
73
Generally, where does pain from parietal inflammation radiate to?
doesn't tend to radiate, only felt over the inflamed area
74
What does radiating pain indicate?
other structures are becoming involved
75
What may happen with small bowel pain?
- no radiation, but pain may move
| - as somatic and visceral nerves become irritated
76
How does pain from appendicitis tend to preset?
- initially central
| - shifts to the right iliac region
77
What can happen with the appendix that makes examination difficult?
can be retro-caecal, pain with pressure is not seen
78
In which disease does passing flatus relieve pain?
bowel obstruction
79
What is the most common cause of small bowel obstructions?
adhesions/fibrous bands (post-op?)
80
What tends to be the most painful form of colic?
ureteric (stone in ureter)
81
What causes pain to worsen after consumption of fatty food?
biliary colic
82
What is biliary colic?
pain trying to pass
83
What is cholecystitis?
- stone stuck in the cystic duct
- bile is unable to pass
- wall continues to produce mucus
- causing infection
84
How does cholecystitis present?
- murphy's sign
| - localised pain (referal unlikely)
85
What diseases cause right hypochondriac pain?
- gallstones
- cholangitis
- hepatitis
- liver abscess
86
What diseases cause epigastric pain?
- perforated ulcer
- peptic ulcer
- oesophagitis
- pancreatitis
- biliary tract disease
87
What diseases cause left hypochondriac pain?
- splenic abscess
- acute splenomegaly
- splenic rupture
88
What diseases cause umbilical pain?
- appendicitis (early)
- mesenteric adenitis
- Meckel's diverticulitis
89
What is mesenteric adenitis?
- inflammatory bowel
- reactive lymphnodes cause the pain
- often mistaken for appendicitis
90
What is Meckel's diverticulitis?
- out pouching of small bowel
- contains ectopic pancreatic or gastric tissue
- can lead to diverticulitis
91
What diseases cause left lumbar pain?
- renal colic
- pyelonephritis
- ovarian cyst
- ovarian mass
- ovarian torsion
92
What diseases cause left iliac region pain?
- diverticulitis
- ulcerative colitis
- constipation
- ovarian cyst/torsion
- PID
- ectopic pregnancy
- obstructive hernias
- renal colic
93
What diseases cause hypogastric pain?
- urinary retention
- cystitis
- uterine fibroid
- endometriosis
94
What diseases cause right iliac region pain?
- appendicitis (late)
- Crohn's disease
- ovarian cyst/torsion
- ectopic pregnancy
- hernias
- renal colic
95
What diseases cause right lumbar region pain?
- renal colic
- pyelonephritis
- ovarian cyst
- ovarian torsion
- ovarian mass
