Abdominal and pelvic autonomics and Pain

Question 1

Sympathetic and parasympathetic affect on the Gastrointestinal tract, via the longitudinal and circular muscle fibers, sphincter muscles, and glands

Answer 1

Longitudinal and circular muscle fibers:

• parasympathetics increase motility
• sympathetics decrease motility

sphincter muscles:

• PNS: relaxation
• SNS: contraction

glands:

• PNS: increase secretions
• SNS: decrease secretions

Question 2

Sympathetic and parasympathetic affect on splenic capsule

Answer 2

Splenic capsule:

• PNS: no effect
• SNS: contraction

Question 3

Sympathetic and parasympathetic affect on pancreas via endocrine and exocrine

Answer 3

Endocrine pancreas:

• SNS: insulin secretion
• PNS: no effect

Exocrine pancreas:

• SNS: no secretion
• PNS: increase secretion

Question 4

Sympathetic and parasympathetic affect on liver

Answer 4

Glycogenolysis/gluconeogenesis:

• SNS: increase
• PNS: no effect

Question 5

Sympathetic and parasympathetic affect on Urinary bladder via detrusor vesicae, and functional bladder sphincter

Answer 5

Detrusor vesicae:

• SNS: relaxation
• PNS: contraction

Functional bladder sphincter:

• SNS: contraction
• PNS: inhibit contraction

Question 6

Sympathetic and parasympathetic affect on seminal vesicle and ductus deferens

Answer 6

Seminal vesicle and ductus deferens:

• SNS: contraction (ejection)
• PNS: no effect

Question 7

Sympathetic and parasympathetic affect on Uterus

Answer 7

Uterus

• SNS: contraction or relaxation depending on hormone state
• PNS: no effect

Question 8

Sympathetic and parasympathetic affect on Arteries

Answer 8

Arteries

• SNS: Vasoconstriction
• PNS: Vasodilation of the arteries of the penis and clitoris (erection)

Question 9

Sympathetic and parasympathetic affect on suprarenal glands

Answer 9

Suprarenal glands:

• SNS: release adrenalin
• PNS: no effect

Question 10

Sympathetic and parasympathetic affect on Urinary tract

Answer 10

Kidney:

• SNS: Vasoconstriction inhibiting urine formation
• PNS: Vasodilation

Question 11

Pathology based on pain in the: Right Hypochondriac area

Answer 11

• Gallstones
• cholangitis
• hepatitis
• liver abscess

Question 12

Pathology based on pain in the: epigastric area

Answer 12

• Esophagitis
• peptic ulcer
• perforated ulcer
• pancreatitis

Question 13

Pathology based on pain in the: left hypochondriac area

Answer 13

• Spleen abscess
• acute splenomegaly
• spleen rupture

Question 14

Pathology based on pain in the: umbilical region

Answer 14

• early apendicicits
• mesenteric adentitis
• meckels diverticulitis
• lymphomas

Question 15

Pathology based on pain in the: right/left flank or lumbar area

Answer 15

• ureteric colic

- pyelonephritis

Question 16

Pathology based on pain in the: right inguinal area

Answer 16

• Apendicitis late
• crohns disease
• cecum obstruction
• ovarian cyst
• ectopic pregnancy
• hernias

Question 17

Pathology based on pain in the: hypogastric or pubic area

Answer 17

• Testicular torsion
• urinary retention
• cystitis
• placenta abruption

Question 18

Pathology based on pain in the: left inguinal area

Answer 18

• Diverticulitis
• ulcerative colitis
• constipation
• ovarian cyst
• hernias

Question 19

what does retroperitoneal pain mean?

Answer 19

Retroperitoneal structures are the kidneys, pancreas, and aorta

pathology involving these structures frequently involve surrounding tissues and patient gets pain in the back

Question 20

what does it mean if their is Colicky pain?

Answer 20

Intermittent cramp like pain

caused by obstruction of hollow muscular organs

• bowel obstruction
• stone in ureter
• stone in neck of gall bladder

GItract: foregut, midgut, or hindgut

urinary tract: loin to groin

Question 21

Signs of gastric ulcer

Answer 21

Foregut visceral pain

worse on eating and patient tends to avoid meals

Question 22

signs of perforated gastric ulcer

Answer 22

Foregut chronic visceral pain

sudden severe pain spreading all over abdomen

signs of generalized peritonitis

Question 23

signs of acute cholecystitis

Answer 23

Foregut visceral pain

somatic pain in right upper quadrant

• referred pain to right shoulder
• nausea and vomiting
• fever
• tender right upper quadrant
• positive murphys sign

Question 24

signs of acute appendicitis

Answer 24

Midgut visceral pain

somatic pain in right lower quadrant

nausea and vomiting

fever

tender right lower quadrant

if appendix has ruptured, patient will have signs of localized peritonitis in right ower quadrant

Question 25

signs of an adhesive small bowel obstruction

Answer 25

• History of previous abdominal surgery
• midgut visceral colicky pain
• vomiting
• no flatus or bowel action
• possible dehydration
• distended soft abdomen; non-tender
• increased bowel sounds

Question 26

signs of passage of a kidney stone

Answer 26

• Sudden onset of very severe colicky pain from loin to groin
• severe back pain
• patient writhing with pain and pacing about it
• possible hematuria
• afebrile
• soft abdomen
• tender renal angle

Question 27

signs of obstructing cancer of descending colon

Answer 27

• older age patient
• weight loss
• hindgut visceral colicky pain
• no flatus or feces
• distended abdomen
• possible mass to feel in left quadrant
• increased bowel sounds

Question 28

signs of a ruptured ectopic pregnancy

Answer 28

• woman of childbearing age
• missed her last menstrual period
• sudden onset of severe pain in hypogastrium radiating to sacral area
• afebrile
• localized peritonitis in suprapubic (hypogastric area)
• tenderness in rectouterine pouch on DRE or vaginal examination

Question 29

signs of a leaking aortic aneurysm

Answer 29

• elderly male with history of atherosclerotic disease such as hypertension or cardiac disease
• sudden onset of severe back pain
• pale and shocked; hypotensive
• tender epigastrium
• palpable impulse from aneurysm in epigastrium