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Abdominal Pain Flashcards

(67 cards)

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1
Q

What do most intra abdominal disease present with?

A

Pain only

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2
Q

What are the 2 most significant characteristics of pain?

A

Site and character

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3
Q

How do we take history of pain?

A 
SOCRATES:
site
onset
character
radiation
associated symptoms
time
exacerbations
severity
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4
Q

What does the transpyloric plane divide?

A

Upper zone and middle/lower zone

Everything above it is the upper zone

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5
Q

What vertebral level is the transpyloric plane at?

A

L1

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6
Q

What is seen at the transpyloric plane?

A 
Pylorus of Stomach
Neck of Pancreas
Fundus of Gallbladder
Renal Hilum
Duodenojejunal Flexure
End of Spinal Cord (adult)
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7
Q

What vertebral level is the subcostal plane at?

A

L3

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8
Q

What can be found at the subcostal plane?

A

Origin of the inferior mesenteric artery

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9
Q

What vertebral level is the supracristal plane at?

A

L4

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10
Q

What can be found at the supracristal plane?

A

Bifurcation of aorta

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11
Q

What is everything below the supracristal plane known as?

A

The lower zone

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12
Q

What organs is pain in the right hypochondriac region associated with?

A

Gallbladder

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13
Q

What organs is pain in the right lumbar region associated with?

A

Kidney

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14
Q

What organs is pain in the right iliac region associated with?

A

Appendix and caecum

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15
Q

What organs is pain in the epigastric region associated with?

A

Stomach, duodenum and pancreas

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16
Q

What organs is pain in the umbilical region associated with?

A

Small bowel
Caecum
Retroperitoneal structures

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17
Q

What organs is pain in the right hypogastric region associated with?

A

Transverse colon
Bladder
Uterus
Adnexae

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18
Q

What organs is pain in the left hypochondriac region associated with?

A

Pancreas

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19
Q

What organs is pain in the left lumbar region associated with?

A

Kidney

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20
Q

What organs is pain in the left iliac region associated with?

A

Sigmoid colon

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21
Q

What does the foregut encompass?

A

Distal oesophagus to proximal half of 2nd part of duodenum

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22
Q

What does the midgut encompass?

A

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

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23
Q

What does the hindgut encompass? What artery supplies it?

A

Distal 1/3 of transverse colon to rectum, supplied by inferior mesenteric artery

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24
Q

What is the blood supply to the foregut?

A

Coeliac trunk

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25
What is the blood supply to the midgut?
Superior mesenteric artery
26
What is the blood supply to the hindgut?
Inferior mesenteric artery
27
What is the innervation of the visceral peritoneum?
Foregut by the coeliac plexus Midgut by the superior mesenteric plexus Hindgut by the inferior mesenteric plexus
28
What is the innervation of the parietal peritoneum?
It is sectionally innervated
29
What does the sensory supply of the phrenic nerve cover? Why is this significant?
Right diaphragm ASWELL AS right shoulder, even is the pain originates in the abdomen the patient may complain of right shoulder pain too
30
What spinal nerves are involved in the sympathetic innervation of the visceral pleura?
T1-T12, L1, L2
31
What nerves are involved in the parasympathetic innervation of the visceral pleura?
CNIII, VII, IX, X, S2-4
32
What nerves are involved in the innervation of the parietal pleura?
Somatic nerves
33
What is the character of pain originating from the visceral pleura?
Dull, crampy, burning
34
What is the character of pain originating from the parietal pleura?
Sharp, achy
35
What is the innervation for sensation for the foregut?
T5-T9
36
What is the innervation for sensation for the midgut?
T10-T11
37
What is the innervation for sensation for the hindgut?
L1-L2
38
What is the site of pain for the foregut?
Epigastrium
39
What is the site of pain for the midgut?
Umbilical
40
What is the site of pain for the hindgut?
Hypogastrium
41
What are the 2 main categories for character of abdominal pain?
Inflammation | Obstruction of a muscular tube
42
How will patients complain of pain caused by inflammation in the abdomen?
Constant pain (‘aching’) Made worse by movement Persists until inflammation subsides
43
How will patients complain of pain caused by obstruction of a muscular tube in the abdomen?
``` Colicky pain (‘gripping’)- gets very intense and then relaxes Fluctuates in severity Move to try and get comfortable (very specific) ```
44
What does prolonged obstruction of a hollow viscus cause? Why is this important
Distention | Its important as it indicates a change in blood supply that causes ischaemia
45
What will patients complain of when a prolonged obstruction of a hollow viscus causes distention?
Constant stretching pain | Different from ache of inflammation & not colicky
46
When should you be worries about ischaemia in abdominal pain?
When colicky pain becomes constant
47
Is kidney pain colicky or constant?
Constant
48
Is liver pain colicky or constant?
Constant
49
Is biliary pain colicky or constant?
Colicky
50
Is spleen pain colicky or constant?
Constant
51
Is pain from trauma colicky or constant?
Constant
52
Is bowel pain colicky or constant?
Colicky
53
Where will gallbladder pain radiate?
Through to the back and right
54
Where will stomach/duodenum pain radiate?
Straight through to the back
55
Where will pancreas pain radiate?
Through to the back and the left
56
Where will kidney pain radiate?
Starts in loin and goes to groin
57
Where will small bowel/caecum/retroperitoneal structures pain radiate?
Doesn't normally radiate
58
Where will lower abdominal pain radiate?
It usually doesn't
59
What does radiating pain mean?
Other structures are becoming involved
60
What other than abdominal problems can cause abdominal pain?
Cardiac causes | Lung causes
61
Go through SOCRATES for appendicitis
``` Visceral Umbilical central abdominal pain Then later localises to the right as it affects parietal peritoneum Constant pain Doesn’t tend to radiate May have nausea, anorexia and fever No previous pain Worse on movement Dull ache ```
62
What is important to remember with appendicitis pain?
It may not be central or right if their appendix is anatomically somewhere else
63
Go through SOCRATES for bowel obstruction
``` Central pain Gradual onset Colicky pain No radiation Vomiting, bowels not open Previous colicky pain Passing flatus relieves pain Moderately severe pain ```
64
What is the most common cause of bowel obstruction?
Adhesions, these are areas of scarring tissue (that can arise after surgery)
65
Go through SOCRATES for ureteric colic
``` Loin pain Sudden onset Colicky Radiates to the groin Vomiting Previous colicky pain Cannot find a comfortable position 10/10 very severe pain ```
66
Go through SOCRATES for biliary colic
``` Right upper quadrant Sudden onset Colicky Radiates to right shoulder Nausea, indigestion Worse after eating Associated with fatty foods Can be 10/10 pain ```
67
What other than kidney problems can present with loin to groin pain?
Rupture of an aortic aneurysm

BRS Y2 (85 decks)

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