Abdominal Pain Tutorial Flashcards
(75 cards)
1
Q
How does most intrabdominal disease present?
A
- pain alone
- careful history important
2
Q
What are the two most significant properties of pain?
A
- site
- character
- if you know these you have good chance of making correct diagnosis
3
Q
How do you take an abdominal pain history?
A
socrates
4
Q
What could the nature of the abdominal pain be?
A
- Burning
- Throbbing
- Stabbing
- Constricting
- Colicky
- aching
5
Q
What are the abdominopelvic regions?
A
- Right hypochrondriac region
- Left hypochondriac region
- Epigastric region
- Umbilical region
- hypogastric region
- right lumbar region
- left lumbar region
- right iliac region
- left iliac region
6
Q
What are the abdominopelvic quadrants?
A
- Right upper quadrant (RUQ)
- Left upper quadrant (LUQ)
- Right lower quadrant (RLQ)
- Left lower quadrant (LLQ)
7
Q
What are the different planes?
A
- Transpyloric plane
- Subcostal plane
- Supracristal plane
- Intertubercular plane
- Interspinous plane
8
Q
What level is the transpyloric plane?
A
L1
9
Q
Where is the interspinous plane?
A
line through anterior superior iliac spines
10
Q
Where is the intertubercular plane?
A
line through iliac tuberclew (L5)
11
Q
What is at the transpyloric plane?
A
- Pylorus of Stomach
- Neck of Pancreas
- Fundus of Gallbladder
- Renal Hilum
- Duodenojejunal Flexure
- End of Spinal Cord (adult)
12
Q
What level is the subcostal plane at?
A
L3
13
Q
What is at the subcostal plane?
A
Origin of Inferior Mesenteric Artery
14
Q
What level is the supracristal plane?
A
L4
15
Q
What is at the supracristal plane?
A
Bifurcation of the aorta
16
Q
What is in the left hypogastric region?
A
pancreas
17
Q
What is in the right hypogastric region?
A
gallbladder
18
Q
What is in the epigastric region?
A
- stomach
- duodenum
- pancreas
19
Q
What is in the right lumbar region?
A
kidney
20
Q
What is in the left lumbar region?
A
kidney
21
Q
What is in the right iliac region?
A
- appendix
2. caecum
22
Q
What is in the left iliac region?
A
sigmoid colon
23
Q
What is in the umbilical region?
A
- small bowel
- caecum
- retroperitoneal structures
24
Q
What is in the hypogastric region?
A
- transverse colon
- bladder
- uterus
- adnexae
25
Where is the foregut?
Distal oesophagus → proximal half of 2nd part of duodenum
26
Where is the midgut?
Distal half of 2nd part of duodenum → proximal 2/3 of transverse colon
27
Where is the hindgut?
Distal 1/3 of transverse colon → rectum
28
What is small bowel pain like?
does not usually radiate but it does MOVE when somatic as well as visceral nerves are irritated
29
What are the different nerve plexus?
CP – coeliac plexus
SMP – superior mesenteric plexus
IMP – Inferior mesenteric plexus
30
What is the visceral innervation?
1. Autonomic
2. Sympathetic:
- T1-T12
- L1,L2
2. Parasympathetic:
- CN III
- CN VII
- CN IX
- CN X
- S2, S3, S4
31
What is the site of pain for the visceral?
embryological origin
32
What is the character of pain for the visceral?
- dull
- crampy
- burning
33
What is the parietal innervation?
somatic
34
What is the site of pain for parietal?
well-localised
35
What is the character if pain for parietal?
- sharp
| - ache
36
What is the innervation for sensation for the foregut?
T5-T9
37
What is the innervation for sensation for the midgut?
T10-T11
38
What is the innervation for sensation for the hindgut?
L1-L2
39
What is the site of pain for the foregut?
epigastrum
40
What is the site of pain for the midgut?
umbilical
41
What is the site of pain for the hindgut?
hypogastrum
42
What are the 2 categories that most painful conditions in the abdomen fall into?
- Inflammation
| - Obstruction of a muscular tube
43
What is inflammation pain like?
* Constant pain (‘aching’)
* Made worse by movement
* Persists until inflammation subsides
44
What is obstruction of muscular tube pain like?
* Colicky pain (‘gripping’)
* Fluctuates in severity
* Move to try and get comfortable
45
What does prolonged obstruction of a hollow viscus cause? What is the pain like?
-distension
•Constant stretching pain
•Different from ache of inflammation & not colicky - ?ischaemia
46
If there is pain in the kidney stone what is the pain like?
colicky
47
If there is pain in the liver what is the pain like?
constant
48
If there is pain in the billiary what is the pain like?
colicky
49
If there is pain in the spleen what is the pain like?
constant
50
If there is pain in the kidneys what is the pain like?
constant
51
If there is pain in the bowel what is the pain like?
colicky
52
What is the radiation of the pain of the right hypochondriac region (gallbladder)?
through to the back and the right
53
What is the radiation of the pain of the left hypochondriac region (pancreas)?
through to the back and the left
54
What is the radiation of the pain of the epigastrum (stomach, duodenum, pancreas)?
straight through to the back
55
What is the radiation of the pain of the right lumbar region (kidney)?
In loin and radiates to groin
56
What is the radiation of the pain of the left lumbar region (kidney)?
In loin and radiates to groin
57
What is the radiation of the pain of the umbilical region (small bowel, caecum, retroperitoneal structures)?
Doesn't normally radiate
58
How does lower abdominal pain radiate?
* Lower abdominal pain rarely radiates
| * Pain from structures deep in the pelvis referred to lower back/perineum
59
In general where is colicky abdominal pain referred to?
the centre (Visceral sensation)
60
In general where is pain from parietal inflammation felt?
over inflamed area (Somatic sensation)
61
What does it signify when pain radiates?
other structures are becoming involved
62
When does small bowel pain radiate?
doesn’t radiate but may move when somatic as well as visceral nerves become irritated
63
What does right hypochondriac region pain indicate?
1. Gallstones
2. Cholangitis
3. Hepatitis
4. Liver abscess
64
What does left hypochondriac region pain indicate?
1. Splenic abscess
2. Acute splenomegaly
3. Splenic rupture
65
What does epigastric region pain indicate?
1. Oesophagitis
2. Peptic ulcer
3. Perforated ulcer
4. Pancreatitis
5. Biliary tract disease
66
What does umbilical region pain indicate?
1. Appendicitis (early)
2. Mesenteric adenitis
3. Meckel’s diverticulitis
67
What does hypogastric region pain indicate?
1. Urinary retention
2. Cystitis
3. Uterine fibroid
4. Endometriosis
68
What does right lumbar region pain indicate?
1. Renal colic
2. Pyelonephritis
3. Ovarian cyst
4. Ovarian mass
5. Ovarian torsion
69
What does left lumbar region pain indicate?
1. Renal colic
2. Pyelonephritis
3. Ovarian cyst
4. Ovarian mass
5. Ovarian torsion
70
What does right iliac region pain indicate?
1. Appendicitis
2. Crohn’s Disease
3. Ovarian cyst/torsion
4. Ectopic pregnancy
5. Hernias
6. Renal colic
71
What does left iliac region pain indicate?
1. Diverticulitis
2. Ulcerative colitis
3. Constipation
4. Ovarian cyst/torsion
5. PID
6. Ectopic pregnancy
7. Hernias
8. Renal colic
72
What is ureteric colic pain?
Intense
73
What is biliary colic pain?
constantly prolonged high intensity
74
What is intestinal colic pain?
sinsuodal
75
When does colicky pain become constant?
bowel / ischemia (act very quick)
