abdo pain tutorial Flashcards
if a patient with intra abdominal disease presents with only 1 symptom what is that most likely to be?
pain alone
two most significant properties of pain to make diagnosis
site and character
abdominal pain acronym explain
socrates
site
onset (Means did it come acutely, did it come over days- does NOT mean how long has it been going on)
character
radiation
associations
time course
exacerbating/ aleviating factors
severity
name the 9 quadrants (and what doctors consider the 10th quadrants in practise- meaning extra areas u want to check)
right hypochondriac
left hypochondriac
hypergastric
umbilical
right lumbar region
left lumbar region
right iliac region
left iliac region
hypogastric region
extra : flanks (wghere u ckeck for kidney on back as well as neck: you get metastasis of gastric cancer in left gland smth there
what are the abdo cross section levels?
transpyloric plane
subcostal plane
supracristal plane
intertubercular plane
interspinous plane
what structures are found in the transpyloric plane -L1
PYLORUS OF STOMACH
neck of pancreas
fundus of gallbladder
renal hilum
duodenojejenal flexure
end of spinal cord (in adult)– (not vertebral columnl… spinal CORD)
important landmark in subcostal plane L3
origin of inferior mesenteric artery
important landmark of supracristal plane -L4
BIFURcation of the aorta
from where to where is the foregut, midgut and hindgut
foregut from DISTAL oesophagus to proximal half of second part of duodenum
midgut: distal part of second half of duodenum to proximal 2/3 of transverse colon
hindgut: distal 1/3 of transverse colon to rectum
what are the main features that distinguish visceral from parietal pain
innervation, site of pain, character of pain
what is the innervation for visceral and parietal pain
visceral: autonomic sympathetic: T1-T12, L1,L2
PARASYMP: CN II, VII, IX, X, S2-4
vs
somatic innervation for parietal pain
innervation splits for visceral pain in foregut midgut hindgut and where this pain shows up
foregut T5-T9 -feel in: Epigastrium
midgut T10-T11- Umbilical
hindgut L1-L2- Hypogastrium
what are the 2 types of most painful conditions in the abdomen
inflammation and obstruction of a muscular tube
what are the 3 main differences of inflammation induced pain vs obstruction of a muscular tube…
character: colichy (obstruction) vs constant pain
progression: fluctuates severity (Obstruction) vs persists until inflammation subsides
movement: move to try get comfortable vs made worse by movement ( inflammation) w
what happens after prolonged obstruction to a hollow viscus? ( mechanically and symptom wise)
constant stretching pain
different from ache of inflammation and if it turns into non coilcky it could indicate ischaemia
when is pain constant and when colicky
colicky when hollow tbe vs constant when filled organ
where can stomach duodenal and pancreatic pain radiate
straight through to back
pancreatic also to the back left
gallblader pain radiation
back right (tip of scapula )
where is kidney pain and where does it radiate
in loin raidates groin
small bowel caecum retroperitonea pain radiation
doesnt radiate
lower abdominal pain radiaition
rarely radiates- pain from structures deep in pelvis reffered to lower back/ perineum
what does it mean when pain radiates
theat other structures are becoming involved
small bowel pain doesnt radiate but it may move. how dows this work?
it moves when somatic as well as visceral nerves become irritated
where is visceral colicky abdominal pain usual referred to
centre
