Abdominal pain

Question 1

how do most intra abdominal diseases present?

Answer 1

pain alone

Question 2

what are the two most important parts of SOCRATES for abdominal pain?

Answer 2

site

character

Question 3

what is SOCRATES?

Answer 3

site
onset
character
radiation
associations
time course
exacerbating/relieving factors
severity

Question 4

what are the abdominopelvic regions?

Answer 4

9 
R hypochondriac
epigastric
L hypochondriac
R lumbar
umbilical
L lumbar
R iliac
hypogastric
L iliac

Question 5

what are the abdominopelvic quadrants?

Answer 5

RUQ
LUQ
RLQ
LLQ

Question 6

what are the important planes of the abdomen?

Answer 6

transpyloric
subcostal
supracristal

Question 7

what vertebral level does the transpyloric plane lie at?

Answer 7

L1

Question 8

what structures are crossed by the transpyloric plane?

Answer 8

stomach pylorus
neck of pancreas
fundus of gallbladder
renal hilum
duodenojejunal flexure
end of spinal cord

Question 9

what vertebral level does the subcostal plane lie at?

Answer 9

L3 aka end of subcostal margin

Question 10

what structures are crossed by the subcostal plane?

Answer 10

origin of inferior mesenteric artery

Question 11

what vertebral level does the supracristal plane lie at?

Answer 11

L4

Question 12

what important structure lies beneath the supracristal plane?

Answer 12

biFOURrcation of aorta L4

Question 13

what important viscera underlies the right hypochondriac region?

Answer 13

gallbladder

Question 14

what important viscera underlies the epigastric region?

Answer 14

stomach
duodenum
pancreas

Question 15

what important viscera underlies the left hypochondriac region?

Answer 15

pancreas

spleen

Question 16

what important viscera underlies the right and left lumbar region?

Answer 16

kidneys

Question 17

what important viscera underlies the umbilical region?

Answer 17

small bowel
caecum
retroperitoneal structures

Question 18

what important viscera underlies the right iliac region?

Answer 18

appendix

caecum

Question 19

what important viscera underlies the hypogastric region?

Answer 19

transverse colon
bladder
uterus and appendages

Question 20

what important viscera underlies the left iliac region?

Answer 20

sigmoid colon

Question 21

what are the boundaries of the foregut?

Answer 21

distal oesophagus to proximal half of 2nd part of duodenum

Question 22

what are the boundaries of the midgut?

Answer 22

distal half of 2nd part of duodenum - proximal 2/3 of transverse colon

Question 23

what are the boundaries of the hindgut?

Answer 23

distal 1/3 of transverse colon - rectum

Question 24

what is the innervation of the parietal peritoneum?

Answer 24

somatic so well localised

Question 25

what is the character of parietal peritoneum pain?

Answer 25

sharp, localised, aches

Question 26

what is the innervation of the visceral peritoneum?

Answer 26

autonomic sympathetic T1-L2 parasympathetic - CN III, VII, IX, X, S2-4

Question 27

what is the character of visceral peritoneum pain?

Answer 27

dull, crampy, burning and comes from embryological origin

Question 28

what is the innervation of sensation for the foregut?

Answer 28

T5-T9 | so epigastrium

Question 29

what is the innervation of sensation of the midgut?

Answer 29

T10-11 | so umbilical

Question 30

what is the innervation of sensation of the hindgut?

Answer 30

L1-2 | so hypogastrium

Question 31

what is the innervation of sensation of the hindgut?

Answer 31

L1-2 | so hypogastrium

Question 31

what is the innervation of sensation of the hindgut?

Answer 31

L1-2 | so hypogastrium

Question 31

what is the innervation of sensation of the hindgut?

Answer 31

L1-2 | so hypogastrium

Question 32

where is the site of foregut pain?

Answer 32

epigastrium

Question 33

where is the site for midgut pain?

Answer 33

umbilical

Question 34

where is the site for hindgut pain?

Answer 34

hypogastrium

Question 35

how does inflammatory abdominal pain present?

Answer 35

constant pain made worse by movement persists until inflammation subsides

Question 36

how does obstruction of a muscular tube present in pain?

Answer 36

colicky, gripping pain fluctuates in severity people move to try to get comfortable

Question 37

how does prolonged obstruction of a hollow viscus, causing distention, present in pain?

Answer 37

constant, stretching pain different ache from inflammatory ache (should suspect ischaemia)

Question 38

how do biliary, uteric and intestinal colic differ?

Answer 38

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

Question 39

where does gallbladder pain radiate to?

Answer 39

through the back and right | shoulder/scapular pain possible

Question 40

where does stomach and duodenal pain radiate to?

Answer 40

straight through to the back of epigastric region

Question 41

where does pancreatic pain radiate to?

Answer 41

through the back epigastric or left side

Question 42

how is pancreatitis pain often relieved?

Answer 42

through leaning forward

Question 43

where does kidney pain often radiate?

Answer 43

in loin and radiates to groin

Question 44

where does small bowel, caecum and retroperitoneal structures pain radiate to?

Answer 44

doesnt normally radiate at all

Question 45

what regions of the abdomen (upper, central, lower) normally don't radiate?

Answer 45

lower - appendix, caecum, transverse colon, sigmoid colon, bladder, uterus

Question 46

where is pain from deep pelvic structures often felt/radiate to?

Answer 46

lower back/perineum

Question 47

what conditions present with pain in the RUQ?

Answer 47

gallstones cholangitis hepatitis liver abscess

Question 48

what conditions present with pain in the epigastric region?

Answer 48

oesophagitis peptic ulcers/perforated ulcers pancreatitis biliary tract disease

Question 49

what conditions present with pain in the LUQ?

Answer 49

splenic abscess acute splenomegaly splenic rupture

Question 50

what conditions present with pain in the right lumbar region?

Answer 50

renal colic pyelonephritis ovarian cyst/mass/torsion

Question 51

what conditions present with pain in the umbilical region?

Answer 51

early appendicitis mesenteric adenitis meckels diverticulitis

Question 52

what conditions present with pain in the left lumbar region?

Answer 52

renal colic pyelonephritis ovarian cyst/mass/torsion

Question 53

what conditions present with pain in the RLQ?

Answer 53

``` late appendicitis crohns disease ovarian cyst/torsion ectopic pregnancy hernias renal colic ```

Question 54

what conditions present with pain in the hypogastric/suprapubic region?

Answer 54

urinary retention cystitis uterine fibroid endometriosis

Question 55

what conditions present with pain in the LLQ?

Answer 55

``` diverticulitis ulcerative colitis constipation pelvic inflammatory disease ectopic pregnancy hernias renal colic ```

Question 56

what is biliary colic?

Answer 56

stones in neck of gallbladder/cystic duct | gallbladder contracts against them to try to force bile out

Question 57

what is acute cholecystitis?

Answer 57

inflammation of the gallbladder wall | can be result of gallstones in ducts

Question 58

what is ascending cholangitis?

Answer 58

inflammation of bile ducts