13: Anatomy - abdominal pain (covers first dissection) Flashcards
What hangs off the caecum at the beginning of the large intestine?
Appendix
Which organ pushes the right side of the GI tract inferiorly?
Liver
Where in the abdominal cavity is the liver found?
Right upper quadrant
Right hypochondral / epigastric zone
What are the three areas of the abdomen, named according to their organs’ embryological origin?
Foregut
Midgut
Hindgut
What are the two planes which split up the abdominal regions?
Subcostal plane
Transtubecular plane
What are the three layers of anterolateral abdominal muscle?
External obliques
Internal obliques
Transversus abdominis
What are the “six pack” muscles found in the anterior abdominal wall?
Rectus abdominis
The muscles found in the midline of the anterior abdominal wall are the (rectus abdominis / transversus abdominis).
rectus abdominis
The muscles found at the deepest layer of the anterolateral abdominal wall are the (rectus abdominis / transversus abdominis).
transversus abdominis
What is the contraction of abdominal muscle to prevent injury to internal organs?
Guarding
Which inflammatory disease triggers guarding of abdominal muscle?
Peritonitis
What causes peritonitis?
Blood, pus, faeces in the peritoneal cavity
What is parietal peritoneum?
Peritoneum which is in contact with the body wall
What is visceral peritoneum?
Peritoneum which invests organ(s)
What name is given to a double layer of visceral peritonum which suspends an organ to the posterior abdominal wall?
Mesentery
Which abdominal organs are intraperitoneal?
Liver
Gall bladder
Stomach
Spleen
Bits of the small intestine
Transverse colon
Which abdominal organs are retroperitoneal?
Kidneys
Adrenal glands
Pancreas
Bits of large intestine
What does mesentery do?
Suspends organ to posterior abdominal wall
Blood and nerve supply
Provides mobility
Which double layers of peritoneum pass from the stomach to other organs?
Greater and lesser omentum
What joins organs to one another or the body wall (apart from mesentery and omentum)?
Ligaments
Which peritoneal formation hangs over the intestines like an apron?
Greater omentum
Which aspects of the stomach and large intestine are linked by the greater omentum?
Greater curvature of the stomach
Transverse colon
Which peritoneal formation runs between the lesser curvature of the stomach and the liver?
Lesser omentum
The lesser omentum has a ___ edge.
free
The greater omentum forms the ___ sac.
The lesser omentum forms the ___ sac.
greater
lesser
Which hole joins the greater and lesser sacs?
Omental foramen / Foramen of Winslow
What blood vessels and nerves lie within the omental foramen?
Portal triad
Which ligament joins the spleen to the kidneys?
Splenorenal ligament
Which ligament joins the stomach to the spleen?
Gastrosplenic ligament
Which ligament joins the liver to the stomach?
Hepatogastric ligament
Which ligament joins the liver to the duodenum?
Hepatoduodenal ligament
Which ligament runs along the liver and connects its inferior half to the anterior body wall?
Falciform ligament
Drapes of peritoneum form ___ in the pelvic cavity.
pouches
What is ascites?
Collection of fluid in the peritoneal cavity
Which hepatic diseases can cause ascites?
Cirrhosis
Portal hypertension
Which procedure would be carried out to drain fluid from the peritoneal cavity?
Abdominocentesis
What are the characteristics of visceral pain?
Dull, achy, nauseating
What are the characteristics of somatic pain?
Sharp and stabbing
What name is given to pain which comes and goes?
What does this kind of pain indicate?
Colicky pain
Indicates that there’s something wrong with the GI tract
Which arms of the nervous system supply organs within the abdominal cavity?
Visceral afferents (sensory nervous for the organs)
Enteric nervous system (GI tract)
Sympathetic and parasympathetic nerves
What effect does parasympathetic stimulation have on the rate of peristalsis?
Increased rate of peristalsis
What effect does sympathetic stimulation have on the rate of peristalsis?
Decreased rate of peristalsis
Which arms of the nervous system supply the skin and parietal peritoneum?
Somatic sensory nerves
Somatic motor nerves
Sympathetic nerves
Do sympathetic nerve fibres for the abdominal organs synapse in the sympathetic chain like those of the heart and lungs do?
No
Where do abdominal sympathetic nerves synapse?
Prevertebral ganglia
How do abdominal sympathetic fibres reach the prevertebral ganglia from the sympathetic chain?
Splanchnic nerves
Post-synaptic sympathetic nerve fibres hitch a ride with ___ to the abdominal organs.
arteries
What is special about sympathetic fibres innervating the adrenal gland?
They don’t synapse at prevertebral ganglia
Synapse on the gland cells themselves
Which parasympathetic nerve innervates the GI tract and abdominal organs up to the end of the transverse colon?
CN X
Vagus nerve
Vagal trunks (pre-synaptic parasympathetic nerve fibres) travel on the surface of which structure before reaching the periarterial plexuses?
Oesophagus
Where are parasympathetic ganglia found?
Walls of abdominal organs
Which parasympathetic nerves supply the descending colon up to the anal canal?
Which spinal nerves are these nerves part of?
Pelvic splanhnic nerves
S2, 3, 4
Where does foregut-related abdominal pain present?
Epigastric region
Epigastric pain relates to problems in which area of the GI tract?
Foregut
Where does midgut-related abdominal pain present?
Umbilical region
Umbilical pain relates to problems in which area of the GI tract?
Midgut
Hindgut-related abdominal pain tends to present in which abdominal region?
Hypogastric / pubic region
Pubic pain may relate to problems in which area of the GI tract?
Hindgut
What are visceral afferent nerve fibres also known as?
Pain fibres
Visceral afferents run alongside ___ fibres back to the spinal cord.
sympathetic
Why is pain from abdominal organs felt at the level where nerve fibres enter the spinal cord?
Visceral afferents and sympathetics“plug in” at the same level of spinal cord - pain is REFERRED to the dermatome of the spinal nerve
Why is pain from appendicitis initially dull and aching before it becomes sharp in the right inguinal region?
Appendix is MIDGUT –> pain is felt in Umbilical region
But as condition worsens it irritates parietal peritoneum (somatic) in the right iliac fossa – pain changes
Where can stomach pain be referred?
Back
Where can liver and gall bladder pain be referred?
Right shoulder
Where can pancreatic pain be referred?
Back
commonly
What is the classical presentation of appendicitis?
Dull, achey pain in umbilical region
THEN
Sharp, stabbing pain in right iliac fossa
