Abdominal pain Flashcards
how do most intra abdominal diseases present?
pain alone
what are the two most important parts of SOCRATES for abdominal pain?
site
character
what is SOCRATES?
site onset character radiation associations time course exacerbating/relieving factors severity
what are the abdominopelvic regions?
9 R hypochondriac epigastric L hypochondriac R lumbar umbilical L lumbar R iliac hypogastric L iliac
what are the abdominopelvic quadrants?
RUQ
LUQ
RLQ
LLQ
what are the important planes of the abdomen?
transpyloric
subcostal
supracristal
what vertebral level does the transpyloric plane lie at?
L1
what structures are crossed by the transpyloric plane?
stomach pylorus neck of pancreas fundus of gallbladder renal hilum duodenojejunal flexure end of spinal cord
what vertebral level does the subcostal plane lie at?
L3 aka end of subcostal margin
what structures are crossed by the subcostal plane?
origin of inferior mesenteric artery
what vertebral level does the supracristal plane lie at?
L4
what important structure lies beneath the supracristal plane?
biFOURrcation of aorta L4
what important viscera underlies the right hypochondriac region?
gallbladder
what important viscera underlies the epigastric region?
stomach
duodenum
pancreas
what important viscera underlies the left hypochondriac region?
pancreas
spleen
what important viscera underlies the right and left lumbar region?
kidneys
what important viscera underlies the umbilical region?
small bowel
caecum
retroperitoneal structures
what important viscera underlies the right iliac region?
appendix
caecum
what important viscera underlies the hypogastric region?
transverse colon
bladder
uterus and appendages
what important viscera underlies the left iliac region?
sigmoid colon
what are the boundaries of the foregut?
distal oesophagus to proximal half of 2nd part of duodenum
what are the boundaries of the midgut?
distal half of 2nd part of duodenum - proximal 2/3 of transverse colon
what are the boundaries of the hindgut?
distal 1/3 of transverse colon - rectum
what is the innervation of the parietal peritoneum?
somatic so well localised
what is the character of parietal peritoneum pain?
sharp, localised, aches
what is the innervation of the visceral peritoneum?
autonomic
sympathetic T1-L2
parasympathetic - CN III, VII, IX, X, S2-4
what is the character of visceral peritoneum pain?
dull, crampy, burning and comes from embryological origin
what is the innervation of sensation for the foregut?
T5-T9
so epigastrium
what is the innervation of sensation of the midgut?
T10-11
so umbilical
what is the innervation of sensation of the hindgut?
L1-2
so hypogastrium
what is the innervation of sensation of the hindgut?
L1-2
so hypogastrium
what is the innervation of sensation of the hindgut?
L1-2
so hypogastrium
what is the innervation of sensation of the hindgut?
L1-2
so hypogastrium
where is the site of foregut pain?
epigastrium
where is the site for midgut pain?
umbilical
where is the site for hindgut pain?
hypogastrium
how does inflammatory abdominal pain present?
constant pain
made worse by movement
persists until inflammation subsides
how does obstruction of a muscular tube present in pain?
colicky, gripping pain
fluctuates in severity
people move to try to get comfortable
how does prolonged obstruction of a hollow viscus, causing distention, present in pain?
constant, stretching pain
different ache from inflammatory ache
(should suspect ischaemia)
how do biliary, uteric and intestinal colic differ?
biliary - fairly fast and small fluctuations in intense pain
uteric - slightly slower, large fluctuations between intense and manageable pain
intestinal - medium sized fluctuations, not too intense
where does gallbladder pain radiate to?
through the back and right
shoulder/scapular pain possible
where does stomach and duodenal pain radiate to?
straight through to the back of epigastric region
where does pancreatic pain radiate to?
through the back epigastric or left side
how is pancreatitis pain often relieved?
through leaning forward
where does kidney pain often radiate?
in loin and radiates to groin
where does small bowel, caecum and retroperitoneal structures pain radiate to?
doesnt normally radiate at all
what regions of the abdomen (upper, central, lower) normally don’t radiate?
lower - appendix, caecum, transverse colon, sigmoid colon, bladder, uterus
where is pain from deep pelvic structures often felt/radiate to?
lower back/perineum
what conditions present with pain in the RUQ?
gallstones
cholangitis
hepatitis
liver abscess
what conditions present with pain in the epigastric region?
oesophagitis
peptic ulcers/perforated ulcers
pancreatitis
biliary tract disease
what conditions present with pain in the LUQ?
splenic abscess
acute splenomegaly
splenic rupture
what conditions present with pain in the right lumbar region?
renal colic
pyelonephritis
ovarian cyst/mass/torsion
what conditions present with pain in the umbilical region?
early appendicitis
mesenteric adenitis
meckels diverticulitis
what conditions present with pain in the left lumbar region?
renal colic
pyelonephritis
ovarian cyst/mass/torsion
what conditions present with pain in the RLQ?
late appendicitis crohns disease ovarian cyst/torsion ectopic pregnancy hernias renal colic
what conditions present with pain in the hypogastric/suprapubic region?
urinary retention
cystitis
uterine fibroid
endometriosis
what conditions present with pain in the LLQ?
diverticulitis ulcerative colitis constipation pelvic inflammatory disease ectopic pregnancy hernias renal colic
what is biliary colic?
stones in neck of gallbladder/cystic duct
gallbladder contracts against them to try to force bile out
what is acute cholecystitis?
inflammation of the gallbladder wall
can be result of gallstones in ducts
what is ascending cholangitis?
inflammation of bile ducts
