🍔Gastro🍔 - Abdominal Pain

Question 1

What are the most significant properties of (abdominal) pain?

Answer 1

Site and character

Question 2

What are the abdominopelvic regions?

Answer 2

Question 3

What are the abdominopelvic quadrants?

Answer 3

Question 4

What are the 5 main planes of the abdomen?

Answer 4

Question 5

What is the level of the transpyloric plane?

Answer 5

L1

Question 6

What lies on the transpyloric plane?

Answer 6

Pylorus of the stomach
Neck of the pancreas
Fundus of the gallbladder
Renal hilum
Duodenojejunal flexure
End of spinal cord (adult)

Question 7

What is the level of the subcostal plane?

Answer 7

L3

Question 8

What lies on the subcostal plane?

Answer 8

Origin of the inferior mesenteric artery

Question 9

What is the level of the supracristal plane?

Answer 9

L4

Question 10

What occurs on the supracristal plane?

Answer 10

Bifurcation of the aorta

Question 11

What common sites of abdominal pain are located in the right hypochondriac region?

Answer 11

Gallbladder

Question 12

What common sites of abdominal pain are located in the epigastric region?

Answer 12

Stomach
Duodenum
Pancreas

Question 13

What common sites of abdominal pain are located in the left hypochondriac region?

Answer 13

Pancreas

Question 14

What common sites of abdominal pain are located in the right lumbar region?

Answer 14

Kidney

Question 15

What common sites of abdominal pain are located in the umbilical region?

Answer 15

Small bowel
Caecum
Retroperitoneal structures

Question 16

What common sites of abdominal pain are located in the left lumbar region?

Answer 16

Kidney

Question 17

What common sites of abdominal pain are located in the right iliac region?

Answer 17

Appendix
Caecum

Question 18

What common sites of abdominal pain are located in the hypogastric region?

Answer 18

Terminal colon
Bladder
Uterus
Andexae - the ovaries, fallopian tubes and ligaments that secure the female reproductive organs

Question 19

What common sites of abdominal pain are located in the left iliac region?

Answer 19

Sigmoid colon

Question 20

What are the 3 anatomical regions of the GI tract?

Answer 20

Foregut
Midgut
Hindgut

Question 21

What section of the GI tract is labelled as the foregut?

Answer 21

Distal oesophagus to the proximal half of the 2nd part of the duodenum

Question 22

What section of the GI tract is labelled as the midgut?

Answer 22

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

Question 23

What section of the GI tract is labelled as the hindgut?

Answer 23

Distal 1/3 of the transverse colon to the rectum

Question 24

What are the visceral and parietal peritoneum?

Answer 24

Question 25

What are innervations of the visceral vs parietal peritoneum?

Answer 25

Question 26

What are the sites of pain in the visceral vs parietal peritoneum?

Answer 26

Visceral has pain of embryological origin Parietal has well-localised site of pain

Question 27

What is the difference in the character of pain experience by the visceral and parietal peritoneum?

Answer 27

Visceral has a dull, crampy, burning pain Parietal has sharp pain, or an ache

Question 28

What is the innervation for sensation in the foregut?

Answer 28

T5-T9

Question 29

What is the innervation for sensation in the midgut?

Answer 29

T10-T11

Question 30

What is the innervation for sensation in the hindgut?

Answer 30

L1-L2

Question 31

What are the sites of pain in each of the areas of the gut?

Answer 31

Foregut - epigastrium Midgut - Umbilical Hindgut - Hypogastrium

Question 32

What categories do the most painful abdominal conditions fall into?

Answer 32

Inflammation Obstruction of a muscular tube

Question 33

What is experienced with inflammation in the abdomen?

Answer 33

Constant pain ("aching") Made worse by movement Persists until inflammation subsides

Question 34

What is experienced with obstruction of a muscular tube in the abdomen?

Answer 34

Colicky pain ("gripping") Fluctuates in severity Move to try and get comfortable

Question 35

What can prolonged obstruction of a hollow viscus lead to?

Answer 35

Constant stretching pain Distention

Question 36

What should be queried if there is an abdominal pain that is different from the ache of inflammation and is not colicky?

Answer 36

Ischaemia

Question 37

What character of pain is experienced by the urinary tract?

Answer 37

Colicky

Question 38

What character of pain is experience by the liver?

Answer 38

Constant

Question 39

What character of pain is experienced by the biliary tree?

Answer 39

Colicky

Question 40

What character of pain is experienced by the spleen?

Answer 40

Constant

Question 41

What character of pain is experienced by the kidney?

Answer 41

Constant

Question 42

What character of pain is experienced by the intestinal tract?

Answer 42

Colicky

Question 43

Compare the pains of ureteric, intestinal and biliary colic

Answer 43

Question 44

What **could** a transition from colicky to constant pain indicate?

Answer 44

Ischaemia

Question 45

Where does gallbladder pain radiate to?

Answer 45

Through to the back and right

Question 46

Where does stomach, duodenal or pancreatic (in the epigastric region) pain radiate to?

Answer 46

Straight through to the back

Question 47

Where does pancreatic pain in the left hypochondriac region radiate to?

Answer 47

Through to the back and left

Question 48

Where does kidney pain radiate to?

Answer 48

The loin and radiates to the groin (on the respective side)

Question 49

Where does small bowel, caecum or retroperitoneal structure pain radiate to?

Answer 49

Doesn't normally radiate

Question 50

Where does lower abdominal pain radiate to?

Answer 50

Rarely radiates Pain from structures deep in the pelvis referred to lower back/perineum

Question 51

Where does colicky abdominal pain generally radiate to?

Answer 51

Referred to the centre (visceral sensation)

Question 52

Where does pain from parietal inflammation generally radiate to?

Answer 52

Felt over the inflamed area (somatic sensation)

Question 53

What are the causes of pain in the right upper quadrant?

Answer 53

Gallstones Cholangitis Hepatitis Liver abscess

Question 54

What are the causes of pain the the epigastric region?

Answer 54

Oesophagitis Peptic ulcer Perforated ulcer Pancreatitis Biliary tract disease

Question 55

What are the causes of pain in the left upper quadrant?

Answer 55

Splenic abscess Acute splenomegaly Splenic rupture

Question 56

What are the causes of pain in the lumbar regions?

Answer 56

Renal colic Pyelonephritis Ovarian cyst Ovarian mass Ovarian torsion

Question 57

What are the causes of pain in the right lower quadrant?

Answer 57

Appendicitis Crohn's Ovarian cyst/torsion Ectopic pregnancy Hernias Renal colic

Question 58

What are the causes of pain in the left lower quadrant?

Answer 58

Diverticulitis UC Constipation Ovarian cyst/torsion PID Ectopic pregnancy Hernias Renal colic

Question 59

What are the causes of pain in the pelvic/lower abdominal region?

Answer 59

Urinary retention Cystitis Uterine fibroid Endometriosis

Question 60

What is the typical SOCRATES of appendicitis?

Answer 60

Question 61

How will someone with appendicitis present?

Answer 61

Central pain, visceral stimulation As progresses, starts to irritate the parietal peritoneum Gradual onset Recoiling from the idea of food Non-classical presentation possible (as appendix can be in a number of places)

Question 62

What is the typical SOCRATES of bowel obstruction?

Answer 62

Question 63

How does someone with bowel obstruction present?

Answer 63

Can be small or large bowel Farting relieves pain Most common cause is adhesions (scar tissue) e.g. post op Called adhesions because they 'adhere' to the bowel

Question 64

What is a typical SOCRATES for ureteric colic?

Answer 64

Question 65

How does someone with ureteric colic present?

Answer 65

Very painful - stones through the ureter Usually a fairly easy diagnosis

Question 66

What is a typical SOCRATES for biliary colic?

Answer 66