Ab pain Flashcards
Most organs in ab
do not have pain fibers in parenchyma
Visceral peritoneum
pain mediated by
Predominantly
Feeling
visceral afferents of ANS
unmyelinated C fibers- slow conduction/density
Dull, crampy, achy, poorly localized
Visceral pain receptors
activated via
Visceral pain is perceived along
Stomach vs kidney/ureter/liver/GB pain
all serosal surfaces of ab, mesentery, hollow organs
chemical/mechanical stimuli
Spinal segments where VAN enter- usually midline (bilateral)
Stomach- anterior low chest/ab on midline
Organs- lateralized, unilateral innervation
Pain perceived in distal location
transmitted via
Reffered- VAN and somatic cutaneous afferens synapse on same dorsal horn nuclei
Spinothalamic pathway to brain
C3-C5 reffered to R
Referred to L
T5-T8
T6-T9
T7-T9
T6-T10
Visceral origin and referred location
Diaphragmatic irritation- R shoulder
Diaphragmatic irritation- L shoulder
Stomach/duodenum- Left lower chest/mid back
GB/Biliary tree- right scapula
Pancreas- mid/left midback
SI- periumbilical pain
T10-T12
T10- L2
L1
L1-L2
S2-S4
Visceral origin and referred location
Kidney/ureter- flank/groin
Colon- hypogastric/low back
Ovaries/tests- uni hypogastric
Uterus- mid hypogastric
Rectum- parasacral
Parietal peritoneum innvervated by
Pain signals carried by
More irritating
Somatic nerves also innervate
somatic nerves- well localized
A fibers- constant/sharp
More intense
ab wall- pain to palpation reflex spasm (guarding)
Peritoneal pain accentuated by
Indicative signs
Change in tension- moving/coughing
Rebound tenderness
lie motionless
Ab wall pain
Obstructed hollow viscera
Mechanism and feel
Muscle spasm/pressure
Constant, achy, worse with movement/standing
Visceral mediated
SBO- IM, poorly localized
RUQ pain
Vasc disturbances
Parietal peritoneal inflamm
Mech
Feeling
Ischemia releases chemical mediators of visceral pain
Mild to severe, out of proprotion to exam
Mesenteric thrombosis- constant, IM, general ab pain
Steady/achy localized
Worse with pressure changes
Associated with spasm
Surgical abdomen dz consider:
Intestinal obstruction
Peritonitis
IO- pain/anorexia/bloating/NV
High pitched/absent bowel sounds
Dx with radiographs lying/upright (CT better)
severe pain, signs of sepsis
movement exacerbates, guarding, TTP, rebound tenderness
absent bowel sounds
Gastroenteritis
Acute mesenteric ischemia
chronic
SBO
Intussception
Generalized ab pain
Acute/subacute, mild/mod
NV/diarrhea
Acute/severe/persistent
Hx of a fib
Intestinal angina (pain after eating) Wl, eating smaller meals
Acute/severe/persistent
severe N/V
Acute/IM/Severe- 15/30 min intervals
Anorexia,NV
SBP
DKA
Ruptured aortic aneurysm
IBS
Constipation
Generalized ab pain
Acute/sub, mod/severe
hx/rf cirrhosis
Pain/TTP that shifts
DM or hypergly
Ab/back pain
HypoTN, pusling ab mass
Chronic, mild/mod, worse w eating/stress
Diarrhea/constipation
Chronic/ IM mild to mod
Dec stool freq
PUD
GERD
Gastritis
Gastroparesis
Epigastric pain
Subacute/chronic, mild/mod
perf with severe pain/guarding
chronic/ mild to mod, worse with eating/lying down
Regurg/HB
Acute/chronic, mild mod
NSAIDS/aspirin/alcohol
Chronic/fullness
Vomiting/wl
Acute pancreatitis
MI
Epigastric pain
Acute, severe pain radiating to back
NV, anorexia
Mod/severe pain w exertion
Dyspnea
Dx testing fo epigastric ab pain
Targeted at
Measure
PUD/gastritis
Acute pancreatitis, PUD
serum lipase
endoscopy
Biliary colic
Cholecystitis
Cholangitis
Acute hep
Urolithiasis
Pyeloneph
RUQ pain
IM, acute pain, worse with eating
Acute, severe pain, worse with eating
fever, NV, anorexia
Same as cholecystits w jaundice
mild/mod, subacute
Rf
Acute, severe spastic pain
Felt in groin/testes
Anorexia, NV
CVAT, dysuria, inc freq
RUQ pain eval
LFT and US
LUQ
____ more common
Spleen, stomach, kidney, colion
nongastric
Acute appendicitis
Chron’s
Urolithiasis
PID
Ovarian torsion
RLQ pain
Acute, fever, NV
subacute/chronic, IM
Wl, diarrhea
Acute/severe, groin tests
Anorexia, NV
acute/subacute
Fever, cervical discharge
Mod to severe, acute
nausea, adnexal mass
Rupture ovarian cyst
Ruptured ectopic preg
RLQ pain
acute, sharp, focal, mod to severe
Women in repro age
Acute, sudden, severe
Missed menstruation/vaginal bleeding
Diverticulitis
Chron’s
Ulcerative colitis
Constipation
Urolithiasis
LLQ
acute/subacute
Fever, anorexia, diarrhea/cons
subacute/chronic, IM
wl, diarrhea
sub/chronic, IM
bloody bowel movements
Chronic, IM, mild to mod
dec freq, hard stools
acute, severe, groin test
PID
ROC
REP
LLQ
acute/sub
fever, cervical discharge
acute, sharp
women of repro age
acute, sudden, severe
missed menstruation
