1b Abdominal Pain Flashcards
Pain in the right hypochondriac region refers to which organs?
Gall Bladder and liver
Pain in the epigastric region refers to which organs?
Stomach, duodenum and Pancreas
Pain in the left hypochondriac region refers to which organs?
Pancreas
Pain in the right lumbar region refers to which organs?
Kidney
Pain in the umbilical region refers to which organs?
Small bowel
Pain in the left lumbar region refers to which organs?
Kidney
Pain in the right iliac region refers to which organs?
appendix and caecum
Pain in the hypogastric region refers to which organs?
Uterus, bladder and adnexae
Pain in the left iliac region refers to which organs?
Sigmoid colon
What is the blood supply to the foregut?
Coeliac trunk
What is the blood supply to the midgut?
Superior Mesenteric Artery
What is the blood supply to the Hindgut?
Inferior Mesenteric Artery
What is the site of referred pain from the diaphragm?
Phrenic nerve has sensory supply and covers diaphragm and right shoulder àsites of referred pain
What is the visceral sensory innervation in the foregut?
T5-T9
What is the visceral sensory innervation in the midgut?
T10-T11
What is the visceral sensory innervation in the hindgut?
L1-L2
What is the innervation of parietal peritoneum?
Somatic
What is the innervation of visceral?
Autonomic - so sympathetic / parasympatheti c
What is the site of pain when the visceral peritoneum is involved?
Embryological origin
What is the site of pain when the parietal peritoneum is involved?
Well-localised
What is the character of pain when the visceral peritoneum is involved?
Dull, crampy, Burning
What is the character of pain when the parietal peritoneum is involved?
Sharpe ache
What are some examples of causes of colicky pain?
Kidney stones, gallstones in ducts, bowel obstruction
What are some examples of constant abdominal pain?
Liver problem, spleen problem, pyelonephritis
What might be the cause of abdominal pain which is constant, worsened by movement and continual?
INFLAMMATION
Constant pain (‘aching’)
* Made worse by movement (always ask this)
* Persists until inflammation subsides
What might be the cause of abdominal pain which is Colicky pain (‘gripping’), Fluctuates in severity - intense then relaxes and patients may move to try and get comfortable?
Obstruction of a muscular tube:
What is a key warning sign?
A change in the type of pain the patient is experiencing
What is the differences between the types of colicky pain?
- ureteric colic - relatively frequent and very intense pain
- intestinal colic - more frequent and less
intense pain - biliary ‘colic’ - patients describe as being constant as pain lasts a long time before it relaxes
How does pain from the gall bladder radiate?
Through to the back and to the right
How does pain from the pancreas radiate?
Through to the back and to the left
How does pain from the stomach and duodenum radiate?
straight through to the back
How does pain from the kidney usually radiate?
In the loin, to the groin
Pain from which structures usually doesn’t radiate?
Small Bowel
Caecum
retroperitoneal Structures
Colicky pain becomes constant. What does this suggest?
The bowel is becoming ischaemic
Pain shifting from the center to the right iliac fossa. Worse on movement. Nausea?
Appendicitis
What is the most common cause of a small bowel obstruction?
Adhesion - scarring tissue
Central colicky pain, with vomiting and no bowel movements, passing gas relieves pain?
Small bowel obstruction
Colicky pain, sudden onsent, starting in the loin, radiating to the groin, cannot find a comfortable position, very severe pain?
Uteretic colic / kidney stones
Sudden onset colicky pain in the right shoulder after eating fatty foods?
Biliary colic -
Gallbladder
* Fits in with stone
* Fat stimulates CCK release and gallbladder contraction * More painful
What other condition can give a loin to groin presentation?
Abdominal aortic aneurysm