Abdominal Pain Flashcards
Define SOCRATES
Site, Onset, Character, Radiation, Associations, Time Course, Exacerbating/Relieving Factors, Severity
Define the abdominopelvic regions
Right hypochondriac region, Epigastric region, Left hypochondriac region, Right lumbar region, Umbilical region, Left lumbar region, Right iliac region, Hypogastric region, Left iliac region
From superior to inferior, name the planes of the abdomen
Transpyloric, Subcostal, Supracristal, Intertubercular, Interspinous
What is found at the transpyloric plane?
Occurs at L1 level. Pylorus of Stomach Neck of Pancreas Fundus of Gallbladder Renal Hilum Duodenojejunal Flexure End of Spinal Cord (adult)
What is found at the subcostal and supracristal planes?
Subcostal Plane – L3
Origin of Inferior Mesenteric Artery
Supracristal Plane – L4
Bifurcation of the aorta
What organs are found in each of the abdominopelvic regions?
Right hypo: Gallbladder Epigastric: Stomach, Duodenum, Pancreas Left hypo: Pancreas Right lumbar: Kidney Umbilicus: Small bowel, caecum, retroperitoneal structures Left lumbar: Kidney Right iliac: Appendix + Caecum Hypogastric: Transverse colon, bladder, uterus and adnexae Left iliac: sigmoid colon
What constitues foregut, midgut and hindgut?
Foregut: Distal oesophagus to proximal half of 2nd part of duodenum
Midgut: Distal half of 2nd part of duodenum to proximal 2/3 of transverse colon
Hindgut: Distal 1/3 of transverse colon to rectum
Describe visceral vs parietal innervation
Visceral: Autonomic
Sympathetic – T1 – T12, L1,L2
Parasympathetic – CN III, VII, IX, X, S2 - 4
Parietal: Somatic
Describe site of pain and character in visceral vs parietal peritoneum
Visceral: Site of pain: Embryological origin Character: Dull, crampy, burning Parietal: Site of pain: Well-localised Character: Sharp ache
Describe innervation and site of pain for different parts of gut
Foregut Innervation: T5-T9 Site: Epigastrium Midgut Innervation: T10-T11 Site: Umbilical Hindgut Innervation: L1-L2 Site: Hypogastrium
What 2 categories do most painful conditions of the abdomen fall into?
1. Inflammation Constant pain (‘aching’) Made worse by movement Persists until inflammation subsides 2. Obstruction of a muscular tube: Colicky pain (‘gripping’) Fluctuates in severity Move to try and get comfortable
What is a third type of abdominal pain?
Prolonged obstruction of a hollow viscus causes distension. Constant stretching pain. Different from ache of inflammation & not colicky - may be due to ischaemia.
What type of pain is associated with the different organs?
Kidneys - colicky Liver - Constant Gallbladder - Colicky Spleen - Constant Intestinal - Colicky
Compare character of pain caused by ureteric colic, biliary colic and intestinal colic
Ureteric colic most intensely painful with greatest fluctuations in pain level. Waves of 3-10 minutes. Biliary colic remains at an almost constant intensity with shorter cycles. Intestinal colic least painful with lowest amplitude.
Where does upper zone pain radiate?
Gallbladder pain in right hypochondriac pain radiates through to the back and right. Stomach, duodenum and pancreas pain in epigastrium radiates straight through to the back. Pancreatic pain in the left hypochondriac region radiates through to the back and left.
Where does central zone pain radiate?
Kidney pain in right lumbar region radiates to loin and groin - same fro left. Small bowel, caecum and retroperitoneal structure pain in umbilicus doesn’t normally radiate.
Where does lower zone pain radiate?
Lower abdominal pain rarely radiates. Pain from structures deep in pelvis referred to lower back/perineum.
What are 4 points about radiation of pain?
- Colicky abdominal pain is referred to the centre (Visceral sensation)
- Pain from parietal inflammation felt over inflamed area (Somatic sensation)
- When pain radiates it signifies other structures are becoming involved
- Small bowel pain doesn’t radiate but may move when somatic as well as visceral nerves become irritated
Describe classic presentation of appendicitis
Central then shifts to right iliac region Gradual onset Constant No radiation Nausea, anorexia, fever No previous pain Worse on movement Dull ache
Describe classic presentation of bowel obstruction
Central Gradual onset Colicky none Vomiting, bowels not open Previous colicky pain Passing flatus relieves pain Moderate
Describe classic presentation of ureteric colic
Loin Sudden onset Colicky To groin Vomiting Previous colicky pain Cannot find a comfortable position Severe – 10/10
Describe classic presentation of biliary colic
Right upper quadrant Sudden onset Colicky Right shoulder Nausea, indigestion After eating Fatty foods Can be 10/10
List conditions causing pain in right hypochondriac region
Gallstones
Cholangitis
Hepatitis
Liver abscess
List conditions causing pain in epigastrium
Oesophagitis Peptic ulcer Perforated ulcer Pancreatitis Biliary tract disease
List conditions causing pain in left hypochondriac region
Splenic abscess
Acute splenomegaly
Splenic rupture
List conditions causing pain in right and left lumbar regions
Renal colic Pyelonephritis Ovarian cyst Ovarian mass Ovarian torsion
List conditions causing pain in umbilicus
Appendicitis (early)
Mesenteric adenitis
Meckel’s diverticulitis
List conditions causing pain in right iliac region
Appendicitis (late) Crohn’s Disease Ovarian cyst/torsion Ectopic pregnancy Hernias Renal colic
List conditions causing pain in the hypogastrium
Urinary retention
Cystitis
Uterine fibroid
Endometriosis
List conditions causing pain in left iliac region
Diverticulitis Ulcerative colitis Constipation Ovarian cyst/torsion PID Ectopic pregnancy Hernias Renal colic
