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Flashcards in abdominal pain Deck (67):
1

what are the pain receptors for the enteric nervous system

nociceptors, free nerve endings between the smooth muscle layers, serial surface, mesentery, mucosa. cell bodies in the dorsal root ganglion

2

what do the receptors respond to?

mechanical and chemical: stretch and tissue injury products.

3

what fibers carry the pain signal?

predominantly unmyelinated c fibers, and small A delta fibers

4

what are the C fibers for?

visceral sensation

5

what are the A belt fibers for/

this is pain transmission

6

where do the afferent paths run?

with regional splanchnic through the sympathetic chain and terminate in the dorsal horn

7

what kind of localization is there for visceral

poor

8

what pathways carry the sensation?

spinorecticular, spinothalamic and dorsal column

9

how does the sensation of pain elicit arousal?

because there are synapses in the RAS

10

where does pain relay in the brain?

the thalamus

11

where do pain sensation ultimately register?

in the cortex, and pain mapping is done by the somatosensory cortex.

12

what do the efferent fibers do?

they are descending fibers that modulate pain and are predominantly inhibitory

13

where do the efferents originate?

in the cortex, limbic with projections to the medulla and the midbrain.

14

where do the efferent fibers project?

to the dorsal horn, where they modify the input form the ascending system. they also give the sympathetic and parasympathetic supply

15

what causes referred pain?

visceral afferent neurons and somatic afferents synapsing on second order neurons it he spinal cord -central convergence. all spinal neurons that receive input from the viscera also get input from the skin.

16

what is hyperalgesia of the muscle often accompanied by?

spasm

17

Kehr's sign

subdiaphragmatic irritation-iosalateral shoulder or supraclavicular pain

18

what is nociceptive abdominal pain

stimulation of peripheral nociceptors caused by mechanical: stretch, distention or injury: inflammation and ischemia

19

what is neuropathic abdominal pain

pain originating independently from nociception. structural or functional changes in the pain pathways peripheral or central causes this. examples are diabetic neuropathy and functional pain syndrome,

20

what is classic pain signals of gastroenteritis?

self-limiting, resolving in short period.

21

what is classic colicky pain?

periods of pain and resolution. this is classic muscular surges found in the blocked tublar syndrome. (renal colic, GI colic)

22

what is the classsic pain signals of appendicitis

linear, progressively worsening pain.

23

what are the classic pain signals of rupture or aortic aneurysm

catastrophic onset, sudden, very severe.

24

what are the right sided abdominal quadrant names

hypochondrium, lumbar and iliac

25

what are the center quadrant names

epigastric, umbilical, and hypogastric

26

what are the left sided abdominal names

hypochondrium, lumbar and iliac

27

characteristics of peritonitis

quiet abdomen, diminished movements, loss of abdominothroacic breathing pattern. distention and or lump, cullen/turners sign

28

cullen's sign

superficial edema and bruising in the umbilical region

29

rovsing's sign

when palpation of the left lower quadrant increases the pain felt due to appendicitis

30

carnett test

determines if the abdominal pain is arising from the abdominal wall or the intraabdominal cavity. patient raises head and the abdominal musculature is tensed. if there is greater pain on repeat palpation then the pain is in the abdominal wall

31

what does hypoactive bowel sounds indicate?

peritonitis

32

what does hyperactive bowel sounds indicate?

enteritis, colitis, early part of the obstruction

33

where does a peptic ulcer or gastroduodenal pain originate

epigastric that radiates to the back

34

what is the character of peptic ulcer pain?

gnawing, burning, lasting for 1-3 hours. aggravated by food

35

what relieves pain from gastric ulcer

fasting. food aggravates.

36

what relieves a duodenal ulcer pain

eating will relieve the pain. pain will come back at night when fasting ensues.

37

where does acute pancreatitis present?

epigastric radiating to the back.

38

character of acute pancreatitis

deep boring, severe, usually lasting 24 hours.

39

what relieves pancreatic pain?

sitting upright.

40

what other symptoms are associated with pancreatitis,

nausea and vomiting and associated ileus.

41

how does obstruction present

colicky pain, intermittent, crampy, poorly localized. it has a waxing, waning character

42

what is characteristic of proximal obstruction

vomiting, with transient relief. f

43

what characterizes distal obstruction

distention, obstipation

44

what happens if the bowel becomes ischemic?

the pain becomes sharp and localized.

45

intestinal angina

post prandial and occurs in individuals with insufficient blood flow to meet demands of the mesentery causes sitphobia

46

sitphobia

aversion to food.

47

tenesmus

frequent and painful indication to evacuate bowels with a feeling of incomplete evacuation

48

what is the cause of hepatic pain?

deep lesions are typically painless. hepatic pain is caused by stretching of glissons capsule by inflammation, vascular engorgement, rapidly expanding lesions

49

splenic pain?

LUQ occurs with stretching of the splenic capsule and infarction -look for sickle cell.

50

appendicitis presentation

PANT: pain, anorexia, nausea, tenderness. pain is initially periumbilical but when it becomes involved with the parietal peritoneum it becomes localized to the RLQ. test with mcburney's point

51

diseases of the RLQ

appendicitis, terminal ileus, crohns, tuboovarian, ectopic, ruptured ovarian cyst, reanl disorders, uretic calculus, pyogenic sacroilitis, salpingitis

52

diseases of the RUQ

acute cholecystitis, biliary colic, hepatic inflammation or distention

53

diseases of the LUQ

splenic

54

disease of the LLQ

diverticulitis, colitis, sacroilitis, tuboovarian

55

diseases off the central abdomen

gastroenteritis, peptic ulcer, small bowel colic, acute pancreatitis.

56

what to keep in mind when there is an adult female with acute abdominal pain?

ectopic

57

what to keep in mind when there is upper abdominal pain?

cardiac and respiratory differentials.

58

chronic abdominal wall pain syndrome

women, depression and obesity, superficial pain localized to small area with significant tenderness and dysethesia. +carnett sign

59

causes of CAWPS

entrapment neuropathy, hernia. rectus nerve entrapment, ilioinguinal and iliohypogastric nerve entrapment. spontaneous rectus sheath hematoma.

60

median arcuate ligament syndrome/celiac artery compression syndrome MALS

congenital displacement of the arcuate ligament hat compresses and irritates the celiac ganglion

61

presentation of MALS

women 20-40, epigastric pain after eating that causes anorexia and weight loss. there is typically a bruit in the epigastric region. USG doppler shows increased velocity in the celiac artery

62

superior mesenteric syndrome

compression of the 3rd portion of the duodenum by the abdominal aorta and the overlying SMA. the mesenteric is lost and this can occur

63

presentation of superior mesenteric syndrome

early satiety, nausea, vomiting, post prandial abdominal pain and abdominal distention. symptoms tend to improve after weight gain.

64

irritable bowel syndrome

recurrent bowel pain or discomfort >_ 3days/month in the last 3 months with improvement on defecation, changes in the frequency of stool, change in the form or appearance of stool

65

functional abdominal pain syndrome

subgroup of somatoform, more common in women, psychosocial component with a history of sexual abuse common. typical pain is almost always there, constant, relatively unchanging in character, intensity and location. nocturnal pain is considered organic, however functional pain can awaken from sleep.

66

FAPS suggestive clues on exam

absence of autonomic features on exam (tachycardia, diaphoresis) there is usually a discrepancy between the stethoscope pressure eliciting pain and the examiners hand.

67

treatment options for FAPS

opiates, NSAIDs, topical lidocaine, tricyclic AD