20 Abdominal Pain

Question 1

For visceral pain, what is the pathways for sympathetic pain?

Answer 1

from abdominal organs, pain fibres pass through parravertebral ganglia without synapsing, with cell bodies in dorsal root ganglia. The neurone decussates on this level and travels us the lateral spinothalamic tract

Question 2

Which organs have parasympathetic innervation?

Answer 2

pelvic organs

Question 3

What is the referred pain pattern for myocardial infarction?

Answer 3

pain fibres from heart converge on spinal segments T1-4, which supplies dermatomes of the chest, neck, shoulder, and arm

Question 4

Which organs would show lateral pain?

Answer 4

testicles

kidney

Question 5

What is the foregut innervated by and what are its’ roots?

Answer 5

greater splanchnic T5-9

Question 6

What is the midgut innervated by and what are its’s roots?

Answer 6

lesser splanchnic T10-11

Question 7

What is the hindgut innervated by and what are its’ roots?

Answer 7

least splanchnic T12

Question 8

What are the pelvic organs supplied by?

Answer 8

pelvic pararsympathetics S2-4

Question 9

Which pains are felt posteriorly?

Answer 9

retropeitoneal structures
(pancreas
lower rectum
aorta
kidney
ureters)
pain fibres travelling with pararsympathetics (females sex structures)

Question 10

Which structures might have colicky pain?

Answer 10

bowel, pain due to obstruction or increased bowel activity

Question 11

What is the localisation of the peritoneum like?

Answer 11

visceral - poorly localised (autonomic innervation)

parietal - well localised (somatic innervation)

Question 12

What are the pain patterns of appendicitis?

Answer 12

umbilical diffuse colicky pain then localised constant pain

Question 13

What are the characteristics of biliary colic pain?

Answer 13

30 mins after eating a fatty meal, lasts for over an hour

Question 14

what is pyelonephritis, and what pain would it show?

Answer 14

kidney inflammation

back pain

Question 15

What are the characteristics of renal colic pain?

Answer 15

back pain and groin pain, colic lasts a few minutes

‘worse than childbirth’

Question 16

What is cholecystitis, and how would the pain present?

Answer 16

gall bladder inflammation
shoulder pain, somatic irritation and C3,4,5
constant

Question 17

How would pancreatitis pain present?

Answer 17

foregut and restorperitoneal so anterior and posterior

Question 18

How would duodenal ulcer pain present?

Answer 18

foregut/retroperitoneal, depends on what part of the duodenum

Question 19

How would an aortic aneurysm pain present?

Answer 19

back midline, may be in the groin if iliac aneurysm