Pathology of the Acute Abdomen

Question 1

What is meant by acute abdominal pain?

Answer 1

<10 days duration, new abdominal pain

Question 2

Describe the somatic innervation of the abdomen(abdominal wall and peritoneum).

Answer 2

Somatic = sensitive to tactile, thermal and chemical stimuli

Segmental nerves T5-L2 (upper abdomen starts at T5 and lower abdomen is innervated by L2)

Question 3

Describe the innervation of the diaphragm. Where is pain referred to?

Answer 3

Diaphragm = phrenic nerve C3-C5

Irritation of the undersurface –> shoulder tip pain (e.g. due to blood/gas in the peritoneal cavity)

Question 4

Describe the autonomic innervation of the abdominal hollow and solid viscera.

Answer 4

Organs do not get somatic innervation.

• Autonomic = distention(e.g. hepatitis–>dull), contraction(e.g. labour) and pressure.
• Sympathetic = via presacral and splanchnic plexuses
• L1-L2 and T6-T12
• Not well localised pain but location can give a clue.

Question 5

Name the 9 abdominal regions and the planes that divide them.

Answer 5

Question 6

Where is pain from the 3 parts of the gut referred to?

Answer 6

Question 7

Decribe the patterns of pain in appendicitis.

Answer 7

Appendix is located at McBurney’s point (one third of distance from ASIS to umbilicus)

Pain is initially felt in the umbilical region

Once inflammation involves the parietal peritoneum, pain is felt in the right inguinal region.

Question 8

When do you get colicky pain in the context of acute abdominal pain? How do you distinguish between small and large gut?

Answer 8

Colic is pain that comusually due to intestinal obstruction.

Small gut - pain is more frequent and felt in midabdomen

Large gut - the frequency of contraction is reduced and pain is felt in the lower abdomen from hindgut structures

Question 9

Name a common cause of pain in each of the abdominal quadrants.

Answer 9

Question 10

Name 3 common causes of pain the in the epigastric region.

Answer 10

(foregut structures)

• Pancreatitis
• MI
• Peptic ulcer
• Acute cholecystitis
• Perforated oesophagus

Question 11

Name 3 common causes of RUQ pain.

Answer 11

• Acute cholecystitis
• Duodenal ulcer
• Appendicitis

Question 12

Name 3 common causes of LUQ pain.

Answer 12

• Aortic aneurysm
• Gastric ulcer
• Perforated colon
• Ruptured spleen

Question 13

Name 3 common causes of umbilical pain.

Answer 13

• Intestinal obstruction
• Acute pancreatitis
• Early appendicitis
• Aortic aneurysm
• Diverticulitis

Question 14

Name 3 common causes of RLQ pain.

Answer 14

• Ruptured ectopic pregnancy
• Salpingitis (inflammation of the fallopian tubes)
• Renal/ureteric stones
• Appendicitis
• Perforated caecum

Question 15

Name 3 common causes of LLQ pain.

Answer 15

• Sigmoid diverticulitis
• Renal/ureteric stones
• Salpingitis
• Ruptured ectopic pregnancy

Question 16

Name 3 common causes of peritonitis.

Answer 16

• Duodenal ulcer
• Diverticular disease
• Intestinal obstruction

Question 17

What are the features of peritonitis?

Answer 17

• Pain is sudden and well localised
• Constant pain but not colicky
• Aggrevated by movement and breathing.