Abdominal Pain Flashcards
(28 cards)
what are the 9 regions of the abdomen
what are the 4 quadrants
what level is the transpyloric plane
what passes through it
L1
pylorus of stomach
neck of pancreas
fundus of gallbladder
left renal hilum (as on the right side it is pushed down by liver so is lower)
duodenojejunal flexure
end of spinal cord (in adults)
origin of superior mesenteric artery
what level is the subcostal plane
what does it pass through
L3
between the lowest points of the right and left subcostal margin
origin of inferior mesenteric artery
what level is the supracristal plane
what passes through it
L4
between the tops of the iliac crests
it is where the aorta bifurcates
what organs are associated with abdominal pain in ach of the 9 regions
right hypochondrium - gallbladder, biliary pain (can be epigastric, if unsure do endoscopy)
epigastric - stomach, duodenum, pancreas
left hypochondriac - pancreas (tail), spleen
right lumbar - right kidney
umbilical - small bowel, caecum, retroperitoneal structures
left lumbar - left kidney
right iliac fossa - appendix, caecum
suprapubic - transverse colon, bladder, uterus, ovaries
left iliac fossa - sigmoid colon
what are the divisions of the gut
what is the blood supply of this
how is it clinically relevant
foregut - distal oesophagus → 2nd part of duodenum, supplied by celiac trunk = left gastric, splenic, common hepatic artery
midgut - 2nd part of duodenum → proximal ⅔ of transverse colon supplied by superior mesenteric artery
hindgut - distal ⅓ of transverse colon → rectum, supplied by inferior mesenteric artery
any bleeding of the main arteries supplying midgut, foregut, hindgut will cause ischaemia symptoms to the GI organs supplied
contrast the innervation of the parietal vs the visceral peritoneum
what effect does this have
Parietal - somatic
phrenic nerve (C3,C4,C5) innervates diaphragm, also innervates right shoulder T5-L2 (umbilicus is supplied by T10)
visceral pain is difficult to localise
what are the sites where visceral pain is felt from the abdominal organs
foregut = esophagus, stomach, pancreas, liver, gallbladder, proximal half of 2nd part of duodenum
midgut = duodenum from the distal half onwards, jejunum, ileum, cecum, appendix, ascending colon, proximal ⅔ of transverse colon,
hindgut - distal ⅓ transverse colon, descending colon, sigmoid colon, rectum
what are the main characteristics of abdominal pain
colicky pain → begins and stops abruptly due to muscular contractions which attempt to clear obstruction
what organs/problems present with colicky pain
obstruction related, pain will come and go, patient moves to try and get comfortable:
ureter
biliary colic - stone trying to pass through cystic duct or bile duct
bowel - if prolonged pain can become constant stretching pain → sign of ischaemia
what abdominal organs/problems present with constant pain
inflammation related → worse on movement
liver - hepatitis, liver abscess
spleen - RUQ pain is rare so often spleen, abscess or rupture (can be spontaneous)
kidney - pyelonephritis, abscess
label the different causes of this pain
ureteric colic → most painful
intestinal colic → not as painful, but still true colic
both come and go
biliary - not necessarily a true colic, pain reaches high intensity and only slightly fluctuates from there
when does colicky pain become constant
when there is a prolonged obstruction of a hollow viscus → distention → sign of ischaemia
does pain get better in any postion (pancreatitis) → leaning forward → abdominal viscera are not compressing pancreas aginst the back
pancreatic cancer → present with back pain due to tumour metastasising in back
a problem with what organ is likely to cause pain the right hypochondriac
where would it radiate to
gallbladder
through to the back and to the right
a problem with what organ is likely to cause pain the epigastrium
where would it radiate to
stomach, duodenum, pancreas
radiates straight through to the back
a problem with what organ is likely to cause pain in the left hypochondriac
where would it radiate to
pancreas or spleen
through to the back and to the left
a problem with what organ is likely to cause pain in the right lumbar region
where would it radiate to
kidney
“in loin and radaites to groin”
a problem with what organ is likely to cause pain in the umbilical
where would it radiate to
small bowel, caecum, retroperitoneal structures
doesn’t radiate
a problem with what organ is likely to cause pain the left lumbar region
where would it radiate to
left kidney
“pain in loin radiates to groin”
very rare possibility of aortic aneurysm
a problem with what organ is likely to cause pain the right iliac fossa
where would it radiate to
appendix or caecum
ovaries - cysts
(appendicitis starts in umbilical region due to visceral sensation then migrates to right iliac fossa due to somatic sensation of the parietal peritoneum inflammation)
a problem with what organ is likely to cause pain the suprapubic region
where would it radiate to
transverse colon - can dip down from superior part of abdomen
bladder
uterus
ovaries
lower abdominal pain rarely radiates
pain from structures deep in the elvis is referred to the lower back/perineum
a problem with what organ is likely to cause pain the left iliac fossa
where would it radiate to
sigmoid colon - diverticulitis
lower abdominal pain rarely radiates
pain from structures deep in the elvis is referred to the lower back/perineum
what does it signify when pain radiates
adjacent structures are becoming involved i.e. inflammation is spreading
