abdo pain tutorial

Question 1

if a patient with intra abdominal disease presents with only 1 symptom what is that most likely to be?

Answer 1

pain alone

Question 2

two most significant properties of pain to make diagnosis

Answer 2

site and character

Question 3

abdominal pain acronym explain

Answer 3

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

Question 4

name the 9 quadrants (and what doctors consider the 10th quadrants in practise- meaning extra areas u want to check)

Answer 4

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

Question 5

what are the abdo cross section levels?

Answer 5

transpyloric plane
subcostal plane

supracristal plane
intertubercular plane

interspinous plane

Question 6

what structures are found in the transpyloric plane -L1

Answer 6

PYLORUS OF STOMACH
neck of pancreas
fundus of gallbladder
renal hilum
duodenojejenal flexure
end of spinal cord (in adult)– (not vertebral columnl… spinal CORD)

Question 7

important landmark in subcostal plane L3

Answer 7

origin of inferior mesenteric artery

Question 8

important landmark of supracristal plane -L4

Answer 8

BIFURcation of the aorta

Question 9

from where to where is the foregut, midgut and hindgut

Answer 9

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

Question 10

what are the main features that distinguish visceral from parietal pain

Answer 10

innervation, site of pain, character of pain

Question 11

what is the innervation for visceral and parietal pain

Answer 11

visceral: autonomic sympathetic: T1-T12, L1,L2

PARASYMP: CN II, VII, IX, X, S2-4
vs
somatic innervation for parietal pain

Question 12

innervation splits for visceral pain in foregut midgut hindgut and where this pain shows up

Answer 12

foregut T5-T9 -feel in: Epigastrium
midgut T10-T11- Umbilical
hindgut L1-L2- Hypogastrium

Question 13

what are the 2 types of most painful conditions in the abdomen

Answer 13

inflammation and obstruction of a muscular tube

Question 14

what are the 3 main differences of inflammation induced pain vs obstruction of a muscular tube…

Answer 14

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

Question 15

what happens after prolonged obstruction to a hollow viscus? ( mechanically and symptom wise)

Answer 15

constant stretching pain
different from ache of inflammation and if it turns into non coilcky it could indicate ischaemia

Question 16

when is pain constant and when colicky

Answer 16

colicky when hollow tbe vs constant when filled organ

Question 17

where can stomach duodenal and pancreatic pain radiate

Answer 17

straight through to back
pancreatic also to the back left

Question 18

gallblader pain radiation

Answer 18

back right (tip of scapula )

Question 19

where is kidney pain and where does it radiate

Answer 19

in loin raidates groin

Question 20

small bowel caecum retroperitonea pain radiation

Answer 20

doesnt radiate

Question 21

lower abdominal pain radiaition

Answer 21

rarely radiates- pain from structures deep in pelvis reffered to lower back/ perineum

Question 22

what does it mean when pain radiates

Answer 22

theat other structures are becoming involved

Question 23

small bowel pain doesnt radiate but it may move. how dows this work?

Answer 23

it moves when somatic as well as visceral nerves become irritated

Question 24

where is visceral colicky abdominal pain usual referred to

Answer 24

centre

Question 25

where is pain from parietal inflammation felt and what nervous system

Answer 25

over inflmamed area somatic sensation

Question 26

what is the socrates of appendicitis

Answer 26

central then shifts to right iliac region
gradual onset
constant
no radiation
nausea, ANOREXIA, fever
no previous pain
worse on movement
dull ache

Question 27

bowel obstruction socrates

Answer 27

umbilical region
gradual onset
colichy
no radiation
vommiting, bowels not open
may have had colichy pain before
passing flatus makes better (fart)
moderate

Question 28

ureteric colic pain socrates

Answer 28

loin
sudden
colichy
to groin
vomiting
previous colichy pain
cant find comfortable position
severe 10/10

Question 29

biliary colic pain socrates

Answer 29

right upper quadrant
acute
colicky
right shoulder
nausea indigestion
after eating
fatty foods
can be 10/10