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POM unit 5 > abdominal pain > Flashcards

abdominal pain Flashcards

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1
Q

what are the pain receptors for the enteric nervous system

A

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

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2
Q

what do the receptors respond to?

A

mechanical and chemical: stretch and tissue injury products.

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3
Q

what fibers carry the pain signal?

A

predominantly unmyelinated c fibers, and small A delta fibers

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4
Q

what are the C fibers for?

A

visceral sensation

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5
Q

what are the A belt fibers for/

A

this is pain transmission

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6
Q

where do the afferent paths run?

A

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

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7
Q

what kind of localization is there for visceral

A

poor

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8
Q

what pathways carry the sensation?

A

spinorecticular, spinothalamic and dorsal column

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9
Q

how does the sensation of pain elicit arousal?

A

because there are synapses in the RAS

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10
Q

where does pain relay in the brain?

A

the thalamus

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11
Q

where do pain sensation ultimately register?

A

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

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12
Q

what do the efferent fibers do?

A

they are descending fibers that modulate pain and are predominantly inhibitory

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13
Q

where do the efferents originate?

A

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

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14
Q

where do the efferent fibers project?

A

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

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15
Q

what causes referred pain?

A

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.

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16
Q

what is hyperalgesia of the muscle often accompanied by?

A

spasm

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17
Q

Kehr’s sign

A

subdiaphragmatic irritation-iosalateral shoulder or supraclavicular pain

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18
Q

what is nociceptive abdominal pain

A

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

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19
Q

what is neuropathic abdominal pain

A

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,

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20
Q

what is classic pain signals of gastroenteritis?

A

self-limiting, resolving in short period.

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21
Q

what is classic colicky pain?

A

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

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22
Q

what is the classsic pain signals of appendicitis

A

linear, progressively worsening pain.

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23
Q

what are the classic pain signals of rupture or aortic aneurysm

A

catastrophic onset, sudden, very severe.

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24
Q

what are the right sided abdominal quadrant names

A

hypochondrium, lumbar and iliac

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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

POM unit 5 (12 decks)

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